Other cardiac Flashcards

(38 cards)

1
Q

What does this indicate
Acute, persistent febrile illness (lower grade in elderly, HF, and kidney failure), nonspecific symptoms

Embolization or metastatic infection may cause:
Cough, dyspnea, arthralgia/arthritis, diarrhea, abdominal pain, stroke or cardiac embolism
Peripheral lesions: petechiae on palate or conjunctiva or beneath fingernails, subungual “splinter” hemorrhages

Strokes + major events can occur early on

Right sided often has fever and constitutional symptoms (mostly drug users)

A

endocarditis

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2
Q

endocarditis prophylaxis

A

Prophylaxis recommended with predisposing anomalies undergoing dental procedures, operations involving the respiratory tract, or operations of skin or MSK (unrepaired cyanotic congenital disease, incompletely repaired congenital disease, or if repaired with prosthetics)

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3
Q

meds for endocarditis prophylaxis

A

Amoxicillin
PCN allergy: clindamycin or cephalexin or azithromycin
IV: ampicillin or clindamycin or cefazolin

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4
Q

What are risks for endocarditis?

A

Rheumatic valve abnormality
Bicuspid aortic valves
Calcific or sclerotic aortic valves
Hypertrophic subaortic stenosis
MVP
Congenital disorders
Tricuspid = PWID 90%
Left-sided = PWID 20%

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5
Q

What does this cause:
Bacterial or fungal infection of surface of the heart, usually in valves

Commonly from dental, upper respiratory, urologic, and lower GI diagnostic + surgical procedures
Intravascular devices
Staph aureus or viridans strep, enterococci

A

endocarditis

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6
Q

negative culture organisms for endocarditis

A

HACEK organisms - NEG organisms
Haemophilus aphrophilus
Actinobacillus actinomycetemcomitans
Cardiobacterium hominis
Eikenella corrodens
Kingella species

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7
Q

What does this indicate:
Changing new onset regurgitant murmur (uncommon)
Osler nodes = painful, violaceous raised lesions of fingers, toes, feet
Janeway lesions = painless erythematous lesions of palms or soles
Roth spots = exudative lesions in retina

Hematuria + proteinuria
Right-sided = emboli to lungs
EKG: conduction abnormalities

A

endocarditis

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8
Q

What imaging is best for endocarditis?

A

TEE

with blood cultures to diagnose!

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9
Q

Duke criteria

A

BE TIMER major minor
Blood culture +
Echo evidence
Temp>38
Immunologic phenomena (skin)
Microbio evidence
Embolic phenomenon
Risk factors

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10
Q

Definitive diagnosis - endocarditis

A

two major or one major + 3 minor or 5 minor

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11
Q

How do you treat endocarditis

A

Consult ID – treat empirically while cultures are pending
Cover: staph, strep, and entero →
IV vancomycin + ceftriaxone

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12
Q

When is surgery indicated for endocarditis

A

if medication management is unsuccessful in preventing heart failure
Almost always required if fungal is present or unresponsive to treatment 7-10 days
If sinus of Valsalva is involved or septal abscess
Recurrent infection
Continuing embolization
Large vegetation
Embolic stroke

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13
Q

T/f: use anticoagulants in endocarditis

A

false

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14
Q

What does this indicate:
Dyspnea, chest pain, arrhythmias

Suspect in:
<45y w/ new cardiac symptoms w/o cardio risk factors
New cardiac/HF symptoms + Hx of recent viral infection (several days-weeks)
Symptoms of HF w/o clear underlying cause

A

myocarditis

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15
Q

Hypersensitivity to sulfonamides, PCNs, ASA, radiation, chemo, illicit/toxic substances, phenothiazines, lithium, chloroquine, cocaine

Younger or healthier people w/o heart disease

A

myocarditis RFs

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16
Q

Inflammatory disease of cardiac muscle from infection + non-infection → acute, subclinical, or chronic
- acute viral infection or post viral response, or bacterial, spirochetes, Rickettsia, fungi, protozoa and helminths
Or autoimmune disease, medication, venom, sarcoidosis, heat stroke, hypothermia, transplant rejection, radiation injury

17
Q

Diagnosis based on biopsy of tissue

A

myocarditis -
HF, normal or dilated LV <2 weeks from onset
OR dilated LV 2 weeks-3m after onset of symptoms, new ventricular arrhythmias, or not responding to care

18
Q

Pericardial friction rub, gallop, depressed LV function, ST changes + positive cardiac markers, wall abnormalities on echo
Microaneurysms, dilated cardiomyopathy
Pulmonary + systemic emboli can occur

EKG: sinus tach, arrhythmia or conduction abnormalities, Q waves or LBBB (poor), ventricular ectopy
CXR: cardiomegaly, pulm HTN
WBC, ESR, CRP, troponin elevated
Echo = exclude other causes
MRI w/ gadolinium to confirm diagnosis

19
Q

How do you treat myocarditis?

A

ACEI + BBs if LVEF<40%
NSAIDS for pain
Treat arrhythmias

20
Q

How do you treat more severe myocarditis?

A

Specific antimicrobial therapy when infecting agent has been identified
Exercise limited

Severe: cardiac transplant or ventricular assistive devices

refer!

21
Q

Viral: anterior pleuritic chest pain, worse supine, better upright, w/ radiation to neck, shoulders, back, epigastric

Dyspnea, febrile, pericardial friction rub

Bacterial: more severe + toxic appearing, critically ill

22
Q

Inflammation of the pericardium – infectious or systemic disease
MCC = viral infections
Autoimmune syndromes, radiation, toxicity, surgery

Dressler syndrome - 2-5 days after MI or heart surgery

23
Q

Viral diagnosis is usually clinical
Leukocytosis
Cardiac enzymes may be slightly elevated
Echo often normal or only small amounts of fluid, pericardial effusion
Dressler syndrome = ESR elevated
Bacterial WBC count high
CMP to assess kidney function (high = uremic)
EKG: general ST + T wave changes, STE, T wave inversion
CXR: cardiomegaly, lesions + enlarged lymph nodes

24
Q

Treatment of pericarditis

A

Restriction of activity until symptoms resolve

Aspirin w/ taper
(ibuprofen can be given instead)
Colchicine to prevent recurrence + continued for 3 months, may be given for longer in refractory/recurrent cases

Dressler syndrome = aspirin + colchicine

25
Slowly progressing dyspnea, fatigue, weakness, chronic peripheral edema, hepatic congestion, ascites
constrictive pericarditis
26
Pericardial compression syndrome – restricts diastolic filling + produces chronic elevated venous pressure
constrictive pericarditis
27
Kussmaul sign → elevated JVP Cardiac cath + non-invasive tests for diagnosis (differentiate from restrictive cardiomyopathy)
constrictive pericarditis
28
How do you treat constrictive pericarditis?
Determine underlying etiology and treat accordingly Aggressive diuresis Surgical pericardiectomy if unable to control w/ meds
29
Chest pain or painless - Dyspnea, cough, pericardial friction rub, tachycardia Hepatomegaly Sitting forward helps Pain radiates to the shoulder, neck, and back
pericardial effusion
30
Fluid within the sac exceeds small amount normally present Normal = 15-50mL Small effusions that occur rapidly → tamponade Often after illness or injury, cancers
pericardial effusion
31
EKG: electrical alternans is pathognomonic Echo: primary method for demonstrating effusion Cardiac CT + MRI Pericardiocentesis or biopsy may be indicated
pericardial effusion
32
How do you treat pericardial effusion?
Small: careful observation of JVP + pulse, serial echos Large: drainage (Avoid vasodilators + diuretics to avoid HOTN)
33
Refer a pericardial effusion if
Any unexplained effusion Significant in those with HF or pericarditis HOTN or paradoxical pulse Any signs of tamponade
34
Tachycardia, tachypnea, HOTN, narrow pulse pressure, pulsus paradoxus (decreases w/ inspiration) Beck’s triad = hypotension, JVD, muffled heart sounds
pericardial tamponade
35
Accumulation of pericardial fluid under pressure, restricting venous return + filling from trauma, aortic dissection and/or rupture OR slow onset from cancer, inflammation, hypothyroidism
pericardial tamponade
36
Elevated intrapericardial pressure SV + arterial pulse fall HR + venous pressure increase RA+RV can collapse Decline of >10mmHG in SBP w/ inspiration + lower SV Raised JVP, muffled heart sounds, decreased EKG voltage CXR: effusion, cardiomegaly EKG: reduced voltage
pericardiac tamponade
37
pericardiac tamponade treatment
Urgent pericardiocentesis or cardiac surgery
38
diagnostic criteria for pericarditis
1. pericardic chest pain 2. pericardial rubs 3. new widespread STE or PR depression 4. pericardial effusion (new or worsening) additional: inflammatory markers, evidence through imaging technique