IDIS

Question 1

___ are the most common cause of pericarditis

Answer 1

Viruses

• Coxsackie A/B and echo
• serous fluid NOT purulent

Question 2

Acute purulent pericarditis is caused by ___

Answer 2

Bacteria

Question 3

___ causes chronic pericarditis

Answer 3

Mycobacterium tuberculosis

Question 4

Presentation of tuberculous pericarditis

Answer 4

Fever
Pericardial friction rub
Primary seeding from lungs, sternum, spine

Question 5

+ PPD test
- fluid smear for AFB
Large volume effusions with mononuclear cells

Answer 5

Tuberculous pericarditis

Question 6

Clinical presentation of pericarditis

Answer 6

• Pain-sharp/stabbing, radiates, relieved by sitting up and leaning forward
• Pericardial effusion, clear, straw-colored
• Friction rub (pathognomonic), heard during expiration but corresponds to heart beat, scratching/grating sound

Question 7

Dx of pericarditis if it is a purulent disease

Answer 7

Pericardiocentesis

Question 8

ECG findings for pericarditis

Answer 8

Widespread ST elevations

Depressed PR segments

Question 9

Infectious causes of myocarditis in North America and Europe

Answer 9

Coxsackie B virus
Echo virus
Adeno virus
B19V and HHV6 on the rise 
*most common is B19V
*in the rest of the world it is T. cruzi (South America) and C. diphtheriae

Question 10

Coxsackie B and Adenovirus bind to ____ on myocytes

Answer 10

CAR

Question 11

Viral myocarditis causes disruption of the ____ complex

Answer 11

Dystrophin-sarcoglycans

Question 12

The acute phase of viral myocarditis lasts ____ and the subacute phase lasts ___

Answer 12

A few days

A few weeks to several months

Question 13

The chronic phase of viral myocarditis is characterized by ___

Answer 13

Myocardial remodeling and development of DCM

Question 14

Myocarditis is the most common cause of death in ___

Answer 14

Diphtheria

Question 15

You should consider ___ when a young person develops unexplained heart failure, chest pain, or arrhythmias

Answer 15

Myocarditis

Question 16

The most common symptom of myocarditis is ___

Answer 16

Chest pain

Question 17

___ is a common cause of myocarditis (and is the cause of Chagas’ disease)

Answer 17

Trypanosoma cruzi

Question 18

Sudden cardiovascular collapse and shock

Requires aggressive intervention with inotropic agents

Answer 18

Fulminant myocarditis

Question 19

Echo of patient with myocarditis shows ___

Answer 19

Chamber enlargement and diminished ventricular contractility

Question 20

Dx of myocarditis

Answer 20

Endomyocardial bx

• acute: necrosis and evidence of degenerative (not seen in chronic)
• both: >14 leukocytes/mm^2

Question 21

Criteria for Chagasic Myocarditis:

Answer 21

1. Hx of residence in endemic area
2. Serology + for T. cruzi
3. Compatible clinical syndrome
4. No evidence of another cardiac disorder

Question 22

Infective endocarditis is usually ____ and primarily affects the ____

Answer 22

Bacterial

Cardiac valves

Question 23

Most common predisposing factor for IE in developed nations

Answer 23

Mitral valve prolapse

Question 24

IE
Patients with hx of IV drug use or health care contact
Most virulent pathogen

Answer 24

S. aureus

Question 25

Imp. in prosthetic valve endocarditis

Answer 25

CONS? | S. aureus

Question 26

IE after dental work

Answer 26

1. HACEK (culture negative) 2. Viridans strep: - S. sanguis - S. mutans - S. mitis

Question 27

HACEK bacteria account for 5% of IE cases

Answer 27

``` Haemophilus Aggregatibacter Cardiobacterium Eikenella Kingella ```

Question 28

Presentations specific to myocarditis but not seen in pericarditis

Answer 28

Elevated troponin I and T

Question 29

Most common fungal pathogens associated with IE

Answer 29

1. Aspergillus (rarely found in blood cultures) | 2. Candida (blood cultures +)

Question 30

Acute vs subacute endocarditis

Answer 30

- acute: symptoms develop quickly, may be fatal in <6 weeks | - sub-acute: slow, worsens for 1 yr before fatal

Question 31

In IV drug users, the structure most likely to develop vegetations is

Answer 31

Tricuspid valve *in others it is the mitral and aortic valve -mitral>aortic>tricuspid>pulmonary

Question 32

Factors that determine complication and time course of endocarditis

Answer 32

Type of pathogen and its virulence Immune status of the patient Valve involved

Question 33

Endocarditis Rapid onset (hours to days) High fever Rigors

Answer 33

Acute

Question 34

``` Endocarditis Symptoms within 2 weeks Dx takes about 6 weeks Low back pain, fever, chills, night sweats Fatigue, anorexia, weakness ```

Answer 34

Sub-acute

Question 35

Endocarditis | What is seen with both acute and sub-acute?

Answer 35

``` Murmurs Roth spots (flame shape on retina) Petechia Splinter hemorrhages Janeway lesions Oslers nodes Splenomegaly Sudden loss of peripheral pulse ```

Question 36

Dx endocarditis | Lab values

Answer 36

Anemia Increase ESR and CRP Abnormal urinalysis