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Clin Med II- Exam 1 > Pericarditis/Endocarditis > Flashcards

Pericarditis/Endocarditis Flashcards

1
Q

normal amount of ultrafiltrate in pericardial sac

A

15-50 mL

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2
Q

epidemiology of pericarditis

A

M>F; adults > children

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3
Q

Most common etiology in immunocompetent

A

Viral infection or Idiopathic (Coxsackie and influenza)

May be underlying manifestation of underlying disease

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4
Q

Sx of pericarditis

A

(2 of 4 for diagnosis)

chest pain (sharp/pleuritic)
Pericardial friction rub
ECG change: ST elevation or PR depression
pericardial effusion

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5
Q

Pericarditis chest pain

A

sharp, pleuritic
sudden onset
anterior chest
improve by sitting up and leading forwarm
worse: lying flat, deep inspiration, coughing, sneezing

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6
Q

Pericardial friction rub

A

heard at LSB when patient is sitting up and leaning forward

comes and goes

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7
Q

ECG

A

DIFFUSE changes (ST elevation) - due to inflammation of epicardium

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8
Q

EKG stages for pericarditis

A

Stage 1: hours-days- diffuse ST elevation w/ PR segment depression
Stage 2: w/i 1 week - normalization
Stage 3: diffuse T wave inversion AFTER normalization (not in all patients)
Stage 4: normalization or indefinite T wave inversion (chronic pericarditis)

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9
Q

Dx for pericardial effusion

A

echo

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10
Q

Pericardial tamponade

A

pressure on heart becomes too great so it can’t pump effectively

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11
Q

Sx of tamponade

A

Beck’s traid:
Hypotension
Muffled heart sounds
JVD (blood pack up)

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12
Q

Dx of pericarditis

A 
friction rub:
blood work (troponin)
CXR
ECG
Echo (urgent if tamponade)
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13
Q

Blood work for pericarditis

A

troponin, ESR & CRP (inflammation) and CBC
Blood culture if fever >100.4 (septic)

Support diagnosis but aren’t specific

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14
Q

Additional test for etiology

A 
TB test
ANA (rheum)
HIV serology
Chest CT w/ contract
cardiac MRI
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15
Q

CXR in pericarditis

A

normal; enlarged cardiac silhoutte w/ large effusion (>200 ml)

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16
Q

Beck’s traid

A

JVD
Muffled heart sounds
Hyptotension

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17
Q

Tx for pericarditis

A 
underlying cause
avoid strenuous activity - rest
high risk (fever, tamponade, immunosuppression): ADMIT
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18
Q

Meds for pericarditis

A

NSAID <2 weeks
GI protection (proton pump inhibitors)
+/- Colchicine
Glucocorticoids?

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19
Q

Failure to improve w/ NSAID

A

cause is not viral or idiopathic

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20
Q

Types of NSAIDs

A

ibuprofen, indomethacin, ASA, ketorolac

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21
Q

Colchicine

A

reduces sx, decreases recurrence

only used in addition to NSAID

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22
Q

When to use glucocorticoids in pericarditis

A
  1. sx not refractory to NSAID and colchicine
  2. Pericarditis due to CT disease, autoimmune pericarditis or uremic pericarditis (not responding to dialysis)
  3. Contraindication to NSAID therapy
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23
Q

Effects of glucocorticoids

A

increase recurrence and have unwanted SE

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24
Q

Tx for cardiac tamponade

A

drainage: pericardiocentesis or pericardiectomy/pericardial window

25
Q

Tx for recurrent pericarditis

A

NSAD + colchicine (NO GLUCOCORTICOIDS: makes recurrence worse)

26
Q

Constrictive pericarditis

A

scarring and consequent loss of normal elasticity of the pericardial sac; impaired cardiac filling

27
Q

constrictive pericarditis sx

A

typically chronic
pericardial thickening w/ or w/o calcification
can lead to tamponade

28
Q

Tx for constrictive pericarditis

A

pericardiectomy

29
Q

myopericarditis (perimyocarditis)

A

acute pericarditis that also demonstrates myocardial inflammation

30
Q

Sx of myopericarditis

A

higher troponin
tx. same
good prognosis

31
Q

IE

A

infectious endocarditis

32
Q

Endocarditis

A

infection of one or more of the heart valves or infection of intracardiac device (pacemaker)

33
Q

Types of endocarditis

A

native valve IE
prosthetic valve IE
can be acute (rapidly progress to death) or subacute (indolent)

34
Q

Fever of unknown origin

A

think endocarditis

35
Q

Risk factors for endocarditis

A

cardiac: prior IE, prosthetic valve or cardiac device, valvular or congenital HD

Non-cardiac: IVDU, IV catheter, immunosuppression, dental/surgical procedure, advanced age

36
Q

Most notable risk factors

A

> 60 YO, male, IVDU, poor dentition/infection

37
Q

Cause of endocarditis

A

staph (healthcare-assoc. and IVDU)

Staph and strep equal (community-acquired IE)

38
Q

IVDU endocarditis

A

right-sided valvular (tricuspid) disease

39
Q

Microrganisms in endocarditic

A

s. aureus, viridina sptre, s. gallalyticus, Hib, aggregatibacter, cardiobacterium, eikenlla, kinella (HACEK)

40
Q

Sx of endocarditis

A

FUO, murmurs, malaise, h/a, myalgia, night sweats, ab pain, cutaneous manifestations

41
Q

Cutaneous panifestations of Endocarditis

A 
petechia
splinter hemorrhages (nail bed)
(specific for IE)
janeway lesions
osler nodes
roth spotss
42
Q

Janeway lesion

A

ACUTE! non-tender erythematous macules on palms/soles;

microabscesses w/ neutrophil infiltration of capillaries

43
Q

Osler nodes

A

SUBACUTE! tender subcutaneous violaceious nodules on pads of fingers/toes, thenar and hypothenar; vascular occlusion by microthrombi leading to localized immune-mediated vasculitis

44
Q

Roth spots

A

exudative, edematous hemorrhagic lesions of reina w/ pale centers

45
Q

Roth spots due to

A

capillary rupture secondary to anoxia causing increased venous pressure; rare

46
Q

Endocarditis complications

A

septic emboli throughout body (sx of that body system):
cardiac: valvular insufficiency, HF
Neuro: embolic stroke, intracranial hemorrhage, brain abscess
septic emboli- infarct of kidneys, spleen, lungs
metastatic infection- vertebral osteomyelitis, septic arthritis

47
Q

Dx of endocarditis

A

fever (FUO) + risk factors
dx: clinical manifestation, blood culture, echo
DUKE CRITERIA

48
Q

Blood culture

A

HIGH diagnostic yield: should obtain 3 sets from separate venipuncture sites (over 30-60 minutes)

49
Q

Culture-negative IE

A

suspect in negative blood culture but persistent fever w/ .clinical findings

50
Q

Dx of endocarditis

A

TTE
TEE (higher sensitivity)

false neg: small vegetations and or embolized vegetations

51
Q

Tx for endocarditis

A

BACTERICIDAL agents: targeted to BC

52
Q

Tx for native IE

A

should cover staph, strep, entero

VANCOMYCIN x 4-6 weeks (stop when afebrile)

53
Q

Response to abx

A

afebrile 3-5 days post treatment

54
Q

Tx for prosthetic valve IE

A

more difficult to treat (may require surgical replacement of valve + abx)

abx for LONGER time

55
Q

Most common indication for cardiac surgery in IE

A

heart failiure

56
Q

Most common cause of death w/ IE

A

heart failure

57
Q

Higher mortality IE

A

prosthetic valve IE and IVDU IE

58
Q

Prophylaxis for IE

A 
Dental procedures:
prosthetic heart valves
prior IE
Congenital heart disease
procedures on infected skin or musculoskeletal

Clin Med II- Exam 1 (7 decks)

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