Endocarditis, Myocarditis, Pericarditis

Question 1

What are the 3 types of Endocarditis?

Answer 1

1. Infective Endocarditis
2. Non-bacterial Thrombotic Endocarditis
3. Non-bacterial Verrucous Endocarditis
   (–libmann Sachs)

Question 2

Acute Infective Endocarditis develops on ____ heart valve endothelium

Answer 2

Normal

Question 3

Subacute Infective Endocarditis develops on a ____ heart valve endothelium

Answer 3

Damaged

Question 4

Non-bacterial Thrombotic and Verrucous Endocarditis are sterile platelet vegetations on cardiac valves. The patients present with?

Answer 4

New cardiac murmur or embolic disease

Question 5

What are the main risk factors for Infective Endocarditis?

Answer 5

Older males
IV drug use
Poor dentition
Structural heart disease or implantable device

Question 6

IV drug use leads to ____ sided Endocarditis

Answer 6

Right sided Endocarditis

Question 7

What is the pathogenesis of Infective Endocarditis?

Answer 7

• Endothelial injury with platelets/fibrin adherence
• Pathogen gains access to blood
• Pathogen adheres to platelet/fibrin on valve surface
• Pathogen proliferates on endothelium

Question 8

What is the pathogenesis of Infective Endocarditis?

Answer 8

• Endothelial injury with platelets/fibrin adherence
• Pathogen gains access to the blood
• Pathogen adheres to platelets/fibrin on valve surface
• Pathogen proliferates on endothelium

Question 9

Acute Infective Endocarditis usually involves highly virulent pathogens like?

Answer 9

Staph. Aureus

Question 10

Subacute Infective Endocarditis usually involves less virulent pathogens like?

Answer 10

Strep. Viridans

Enterococci

Question 11

What are the clinical manifestations of Infective Endocarditis?

Answer 11

• Fever, malaise, night sweats, weight loss
• New cardiac murmur
• Splinter hemorrhages, janeway lesions, roth spots, osler nodes
• Vascular embolic events

Question 12

What are the clinical manifestations of Infective Endocarditis?

Answer 12

• Fever, malaise, night sweats, weight loss
• New cardiac murmur
• Splinter hemorrhages, janeway lesions, osler nodes, roth spots on eye
• Vascular embolic events

Question 13

With infective endocarditis, a new cardiac murmur can be heard. What is the usual type?

Answer 13

Regurgitation

Question 14

What is the diagnostic measures for Infective Endocarditis?

Answer 14

Echocardiography (TTE) and blood cultures before antibiotics

Question 15

Possible complications of Infective Endocarditis?

Answer 15

• Heart failure and pericarditis
• Metastatic infection/embolization
• Renal complications

Question 16

What is the treatment for Infective Endocarditis?

Answer 16

• Infective disease consult – empiric antibiotics (vancomycin)
• Remove cardiac devices/surgery

Question 17

Endocarditis prophylaxis is used for what type of patients?

Answer 17

High risk patients and relative procedures

Question 18

What patients should receive Endocarditis Prophylaxis?

Answer 18

• History of Infective Endocarditis
• Prosthetic heart valve replacement/repair/etc.
• Congenital heart disease

Question 19

What procedures should high risk patients have Endocarditis Prophylaxis for?

Answer 19

Dental procedures

Question 20

Common causes of Myocarditis?

Answer 20

• Idiopathic

- Viral = Coxsackie B virus, Parvovirus B19, HHV6

Question 21

What are 3 common viruses that cause Myocarditis?

Answer 21

• Coxsackie B virus
• Parvovirus B19
• HHV-6

Question 22

Myocarditis involves a highly variable clinical presentation. It usually occurs after a?

Answer 22

Viral infection

Question 23

Myocarditis involves a highly variable clinical presentation. What are the 3 most common patterns?

Answer 23

1. New onset/worsening heart failure
2. Conduction abnormalities
3. Acute MI-like syndrome

Question 24

Diagnostic test for Myocarditis?

Answer 24

Endomyocardial Biopsy

Question 25

Diagnostic test for Myocarditis?

Answer 25

Endomyocardial Biopsy

Question 26

Levels of WBC, ESR, CRP, Troponins and BNP for Myocarditis?

Answer 26

ELEVATED

Question 27

Treatment for Myocarditis?

Answer 27

Treat the heart failure or conduction abnormalities

Question 28

Describe the layering of the heart

Answer 28

- Endocardium - Myocardium - Visceral (serous) pericardium - Pericardial sac - Parietal (serous) pericardium - Fibrous pericardium

Question 29

What is pericarditis?

Answer 29

Inflammation of Pericardium

Question 30

Serous fluid in pericardial sac

Answer 30

Pericardial effusion

Question 31

Pericardial fluid that compresses the heart and impairs function

Answer 31

Cardiac tamponade

Question 32

Scarred, thickened and calcified pericardium that impairs function

Answer 32

Constrictive pericarditis

Question 33

What is the most common disorder involving pericardium?

Answer 33

Acute Pericarditis

Question 34

It is not usually necessary to determine the cause of Pericarditis, but what are the most common causes in developed and undeveloped nations?

Answer 34

Developed - idiopathic/viral | Undeveloped - Tuberculosis

Question 35

Symptoms of Pericarditis -- describe chest pain?

Answer 35

Chest pain - sharp and pleuritic (worse with inspiration) | -- Chest pain is worse with lying down and better when sitting up and leaning forward

Question 36

Symptoms of Pericarditis -- describe chest pain?

Answer 36

Chest pain - sharp and pleuritic (worse with inspiration) | -- Chest pain worse with lying down and better when sitting up and leaning forward

Question 37

What is heard on auscultation with Pericarditis?

Answer 37

Friction rub

Question 38

ECG changes with Pericarditis?

Answer 38

PR segment depression and/or ST elevation

Question 39

ECG changes with Pericarditis and the treatment?

Answer 39

PR segment depression and/or ST elevation | -- NSAIDs and Colchicine

Question 40

Treatment for Pericarditis?

Answer 40

NSAIDs and Colchicine