Endocarditis, Myocarditis, Pericarditis Flashcards Preview

Cardiovascular > Endocarditis, Myocarditis, Pericarditis > Flashcards

Flashcards in Endocarditis, Myocarditis, Pericarditis Deck (44):
1

what does the presence of bacteria in the bloodstream indicate?

there is a focus of infection elsewhere in the body

2

what staphylococcus species is the most likely to infect prosthetic material?

staphylococcus epidermidis

3

what is infective endocarditis?

infection of the endothelium of the heart valves

4

what are the 4 main classes of predisposing factors for infective endocarditis?

heart valve abnormality
prosthetic heart valve
IVDU
intravascular lines

5

what type of heart valve abnormalities predispose to infective endocarditis?

calcification/sclerosis of heart valves (in elderly)
congenital heart disease
post rheumatic fever

6

what is the pathogenesis of infective endocarditis?

1. heart valve damaged
2. turbulent blood flow over roughened endothelium
3. platelets/fibrin depositis forming a thrombi
4. bacteraemia (possibly transient)
5. organisms settle in fibrin/platelet thrombi becoming a microbial vegetation

7

what is the most common side of the heart to be affected?

left side
(mitral and aortic valves)

8

what are the 4 main organisms causing endocarditis of native valves?

staphylococcus aureus
viridans streptococci
enterococcus sp
staphylococcus epidermidis

9

what are the 3 classes of unusual organisms that can cause endocarditis?

atypicals (eg chlamydia psittaci, coxiella burnetii)
gram-negatives
fungi

10

what is the presentation of acute endocarditis?

overwhelming sepsis and cardiac failure

11

what is the presentation of subacute endocarditis?

fever
malasie
weight loss
tiredness
breathlessness

12

what are the sings on examination of infective endocarditis?

Fever
Roth spots
Osler nodes
Murmur (new or changing)
Janeway lesions
Anaemia
Nail (splinter) haemorrhages
Emboli
+ finger clubbing, splenomegaly

13

what can present in the urine of a patient with infective endocarditis?

(microscopic) haematuria

14

how do you diagnose infective endocarditis?

take 3 sets of blood cultures before antibiotics
echocardiogram

15

why must you take 3 sets of blood cultures for diagnosing infective endocarditis?

to ensure you haven't just identified a contaminent

16

if you suspect infective endocarditis but all 3 blood cultures are negative what should you do?

consider serology for 'atypical' organisms

17

what are the 2 types of prosthetic valve endocarditis?

early
late

18

what is early prosthetic valve endocarditis?

infected at time of valve insertion

19

what is late prosthetic valve endocarditis?

up to many years after valve insertion

20

what are the main causative organisms of early prosthetic valve endocarditis?

staph epidermidis
staph aureus

21

what are the causative organisms of late porsthetic valve endocarditis?

co-incidental bacteraemia

22

what sided infective endocarditis to IVDUs usually get?

right sided
(mainly tricuspid valve)

23

what is the usual causative organisms in a IVDU who has infective endocarditis?

staph aureus

24

what does infective endocarditis in an IVDU often present as?

as staph aureus pneumonia

25

what is the empirical treatment for native valve endocarditis infective endocarditis? (ie before microbiology results come back)

benzylpenicillin and gentamicin
IV

26

what is the empirical treatment for prosthetic valve endocarditis? (ie before microbiology results come back)

vanomycin and gentamicin
IV

27

what is the empirical treatment for drug use endocarditis? (ie before microbiology results come back)

flucloxacillin
IV

28

what is the antibiotic treatment for infective endocarditis where microbiology results show staph aureus (not MRSA) is the causative organism?

flucloxacillin IV

29

what is the antibiotic treatment for infective endocarditis where microbiology results show MRSA is the causative organism?

vancomycin and gentamicin
IV

30

what is the antibiotic treatment for infective endocarditis where microbiology results show viridans streptococci is the causative organism?

benzylpenicillin and gentamicin
IV

31

what is the antibiotic treatment for infective endocarditis where microbiology results show enterococcus sp is the causative organism?

amoxicillin/vancomycin and gentamicin
IV

32

what is the antibiotic treatment for infective endocarditis where microbiology results show staph epidermidis is the causative organism?

vancomycin and gentamicin
IV

33

in regards to treatment for infective endocarditis, how long should antibiotics be given for?

4-6 weeks

34

if antibiotic therapy for infective endocarditis is failing what should you consider?

surgery

35

what is myocarditis?

inflammation of cardiac muscle

36

what are the symptoms of myocarditis?

fever
chest pain
SOB
palptations

37

what are the signs of myocarditis?

pyrexial
arrythmia
cardiac failure

38

what are the main causes of myocardiis?

enteroviruses- coxsackie A + B, echovirus
(other eg influenza)

39

how is myocarditis diagnosed?

viral culture/PCR
throat swab + stool for enteroviruses
throat swab and serology for influenza

40

what is the treatment of myocarditis?

supportive

41

what is pericarditis?

inflammation of the pericardium

42

what is the main feature of pericarditis?

chest pain

43

what is the treatment of pericarditis?

-supportive if viral cause
-antibiotics and drainage if bacterial cause

44

what are the 2 main sequellae of infective endocarditis?

valvular heart disease
emboli