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41 Cards in this Set

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Most common infectious cause of Myocarditis
Coxsackie B
(4) systemic diseases that causes Myocarditis
KISS:
- Kawasaki's
- Inflammatory conditions
- SLE
- Sarcoidosis
KISS
(4) Parasites that cause Myocarditis
Trypanosoma Cruzi (Chagas);
Toxoplasmosis;
Trichinella;
Echinococcus
(5) Bacterial causes of Myocarditis
women Trick Corny Men to Strip and Lie down:

Group A beta-hemolytic Strep (rheumatic fever);
Corynebacterium;
Meningococcus;
Lyme (B. burgdorferi);
Trichinella
women TRICk CORny MEN to STRiP and LY down
(8) viral causes of myocarditis
Coxsackie A or B;
HIV;
Echovirus;
EBV:
CMV;
HBV;
Influenza;
Adenovirus
In CHEEch And CHong
(3) drugs that cause pericarditis
It Hurts Pericardium:

Isoniazid;
Hydralazine;
Procainamide
It Hurts Pericardium
Etiology of Pericarditis (5)
Bacterial, viral or fungal infections;
Post-MI (Dressler's);
Uremia;
Serositis from: RA or SLE
Scleroderma;
Bacterial PUSS
Tx for pericarditis if:
- infection
- pain/inflammation
- Dressler's
- Recurrent cases
Infection - Abx;

Relieve pain + reduce inflammation - NSAIDs;

Dressler's - Steroids;

Recurrent Cases - Pericardectomy
(only of recurrent cases)
Dx:
Transient fall in BP > 10 mmHg during inspiration
Pulsus Paradoxus
Dx:
Physiologic result of rapid accumulation of fluid in the pericardial sac; impairs cardiac filling and reduces cardiac output
Pericardial Tamponade
Etiology of Pericardial Tamponade (3)
- Aortic dissection or ventricular rupture into pericardium
- Pericarditis
- Trauma
A PT
Beck's triad of the pericardial tamponade

(4) other signs/Sx
Beck's triad:
- JVD
- Muffled heart sounds
- Hypotension

Other Sx:
Tachycardia
Pulsus Paradoxus*;
Dyspnea;
Narrow Pulse Pressure
Tx for Pericardial Tamponade for:
1. unstable
2. stable
3. both
Unstable:
Immediate Pericardiocentesis;

Stable:
Pericardial window

Both:
Infuse fluids to expand volume
Failure of venous pressure to fall during inspiration
Kussmaul's sign
If pericardiocentesis has clots, what is likely source of blood?
Right Ventricle
Dx:
Patient has chest pain w/ inspiration that radiates to the left trapezial ridge; Pain is relieved by sitting up and leaning forward; does not respond to nitroglycerine
Pericarditis
additional signs/Sx for Constrictive pericarditis (versus pericarditis)
(4)
Extra fluid:

- JVD
- Kussmaul's sign
- peripheral edema
- LV failure
When a patient has VHD or previous endocarditis, what (3) procedure types must they obtain endocarditis prophylaxis medications?
Dental procedures
Urologic procedures
GI procedures
Dx:
acute onset of fever, chills and rigors; new cardiac murmur, possible associated meningitis or pneumonia
Acute Bacterial Endocarditis (ABE)
Infection of healthy heart valves by high-virulence organisms

MCC?

Px if not treated?
ABE

S. Aureus

Px:
fatal if not Tx w/i 6 weeks
Dx:
seeding of previously damaged heart valves by rheumatic fever, mitral prolapse, etc by low-virulence organisms

MCC?
What valve is affected the most?
Subacute Bacterial Endocarditis

Strep Viridans

Mitral valve
What valve is most commonly affected w/ IV drug users?

What bug?
Tricuspid

S. Aureus
what endocarditis bug is associated w/ colonic neoplasms?
Strep Bovis
Dx:
gradual onset of fever, sweats, weakness, anorexia, new murmur, splenomegaly, Osler's nodes, splinter hemorrhages, Janeway lesions, Roth spots
Subacute Bacterial Endocarditis (SBE)
Name sign:
Tender violaceous subcutaneous nodules on fingers & toes
Osler's nodes (SBE)
Name sign:
fine linear hemorrhages in the middle of nailbeds
Splinter Hemorrhages
Name sign:
multiple hemorrhagic nontender macules or nodules on palms & soles
Janeway Lesions
Name sign:
retinal hemorrhages w/ clear central areas seen on fundoscopy (w/ new murmur)
Roth's spots (SBE)
What is considered Major criteria in the Duke's criteria for endocarditis?
(2)
1. Two positive blood cultures
2. Echo showing vegetations
What are the (6) Minor criteria in the Duke's criteria for endocarditis?
1. Fever
2. Predisposing heart abnormality
3. Arterial emboli (Janeway)
4. Osler nodes or Roth's spots
5. positive blood culture not meeting major criteria
6. Echo suspicious of endocarditis, but not meeting major criteria
For the Duke's criteria of Endocarditis, what are the (3) ways to dx w/ major and minor signs?
1. (2) major criteria
2. (1) major + (3) minor
3. (5) minor criteria
Tx for endocarditis that cultures:

1. Strep

2. Staph

3. MRSA
1. Ceftriaxone or Penicillin G (4 weeks)

2. Naficillin (4 weeks)

3. Vancomycin (4 weeks)
What is the Tx for patients w/ Valular abnormalities if they are having dental procedures, GI or GU surgery? (2 possible)
Prophylactic:

1. Amoxicillin
or
2. Clarithromycin
Valvular dysfunction requiring surgery is common w/ which type of organism?
Fungi (Candida or Aspergillus)
Endocarditis type:
due to cancer seeding heart valves during metastasis what can it lead to?
Marantic endocarditis

leads to cerebral infarcts
Endocarditis type:
may be due to autoantibody damage of valves by SLE
Libman-Sacks endocarditis
MC valve affected by RHD
Mitral
Cause of Rheumatic fever?

What does it lead to?
Group A Strep leads to Rheumatic Heart Disease (RHD)

- immune complex deposits on valves
Major criteria (JONES criteria) for Dx Rheumatic fever (5)
JCNES:
Joints (arthritis)
Carditis (myo-, endo- or peri-)
Nodules (sub-Q)
Erythema marginatum rash
Sydenham's chorea (face, tongue, upper limb)
Minor criteria for Dx Rheumatic fever (5)
Pump FEAR:

Prolonged PR interval;
Fever;
Elevated ESR;
Arthralgias;
Recent Strep infection;
Pump FEAR
Tx for Rheumatic fever due to:

1. Strep

2. Arthritis

3. Carditis
Penicillin for strep;

ASA for arthritis;

Steroids for carditis