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35 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Most common cause of pericarditis?
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EnteroViruses (Coxackie and Echo)
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Most common viral causes of pericarditis?
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Enteroviruses
Coxackie B - ichosahedral RNA virus, F-O spread, think hand/foot/mouth Echo - Picornaviridae family therefore naked RNA, either F-O or nasopharynx route |
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Symptoms/Indications and causes of Viral pericarditis
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Sharp substernal pain
Worse by inspiration or lying supine Coxackie and Echoviruses Friction rub Pulsus paradoxus Kussmaul’s sign (Jugular venous distention and abnormal jugular venous pulsations) Ewart’s sign (Decreased or muffled heart and lung sounds) Abnormal ECG (ST segment elevated in all leads; smiling face) Mild case= small amount of serous fluid with mononuclear cells and fibrinogen Severe case= large amount of neutrophil-rich bloody effusion Healing can result in adhesions Rarely constrictive and usually self-limiting |
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What does Coxackie B look like and what does it cause?
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Coxackie B - ichosahedral RNA virus, F-O spread,
Causes myocarditis, pericarditis, and hand/foot/mouth |
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What is an echovirus and what does it cause?
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Echo - Picornaviridae family therefore naked RNA, either F-O or nasopharynx route
Causes myocarditis |
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Non-viral causes of acute pericarditis are?
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Staphylococcus aureus (grows on Mannitol salt with fermentation, Is Novobiocin sensitive),
Streptococcus pneumoniae (alpha hemolytic on blood, Optichin sensitive) |
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Cause of chronic pericarditis.
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Mycobacterium tuberculosis
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What agent causes purulent pericarditis is Optichin sensitive and alpha hemolytic?
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Strep. pneumoniae
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What agent causes purulent pericarditis, is Novobiocin sensitive, and ferments Mannitol salt agar?
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Staph. a.
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What are the signs/symptoms and causes of purulent pericarditis?
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Sudden onset of fever and dyspnea
Less common to have chest pain No specific signs or symptoms Friction rub Pulsus paradoxus Kussmaul’s sign (Jugular venous distention and abnormal jugular venous pulsations) Ewart’s sign (Decreased or muffled heart and lung sounds) Abnormal ECG (ST segment elevated in all leads; smiling face) Staph A and Strep pneumoniae |
ECG?
heart sounds? Heart R&R Lung sounds? |
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What is Kussmal's Sign?
What does it tell you? |
Filling of jugular vein with inspiration
It is usually indicative of right ventricular dysfunction along with hypotension and "dry lungs" (absence of pulmonary edema) |
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What is Ewart’s sign?
What does it tell you? |
Dullness to percussion, egophony, and bronchial breath sounds may be appreciated at the tip of the left scapula when the effusion is large enough to compress the left lower lobe of the lung, causing consolidation or atelectasis.
It is often found in pericarditis. |
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What is the cause and treatment of purulent pericarditis?
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Staph a and Strep p are treated with oxacillin (B-lactam penicillinase) and ceftriaxone (2nd Gen cephlosporins cover G +'s well and have greater g - coverage than 1st Gens)
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What is the cause and treatment of chronic pericarditis?
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TB is treated with RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol)
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What is the cause and treatment of bacterial endocarditis?
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Strep. viridans, Staph. a., and HACEK
ampicillin (extended specturm penicillin of the B-lactams) and gentamicin (aminoglycoside (often used with penicillins because they are toxic in high doses and cause deafness) |
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Most common cause of myocarditis?
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coxackie B (ssRNA, icosahedral, enterovirus)
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Bacterial causes of mycocarditis?
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Legionella (weakly staining g-, grows on buffered charcoal yeast with cysteine), chlamydia (intracellular g-), borellia bergorferi (spirochete)
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What is the following agent and what heart problem is it likely to cause?
mannital salt fermentor, black growth on tellurite, Beta-hemolytic on blood, novobiocin sensitive, a part of a satellite phenomenon |
Staph a.
either heart valve or IV drug use endocarditis pericarditis NOT myocarditis |
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What is the following agent and what heart problem is it likely to cause?
No growth on MacConkey, growth on blood, Alpha hemolytic on blood, Optichin disk resisitant. |
Strep viridans
Native heart valve or post 2 month surgical, endocarditis |
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Causes of native valve or valve replacement surgery post 2 months.
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Strep. viridans (alpha-hemolytic on blood, P disk resistant)
enterococcus (gamma-hemolytic on blood) Staph (Beta-hemolytic on blood, fermenter on manitol salt, coagulase and catalase positive, grows black on tellurite glycine agar, novobiocin sensitive, satellite phenomenon) |
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Causes of IV and post operative endocarditis.
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Staph a (Beta hemolytic on blood, black growth on tellurite glycine, fermentor on mannital salt, satellite phenomenon, novobiocin sensitive, catalase and coagulase positive)
g -'s S. viridans (alpha hemolytic on blood, optichin disc resistant) |
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Symptoms and Dx of endocarditis.
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Many are asymptomatic
Flu-like illness with chest pain ECG (esophogeal is best) Arrhythmias cardiac enzymes (troponin I and creatine kinase-MB) increased CBC= leukocytosis High ESR; elevated acute phase proteins Chest radiograph- pulmonary edema with CHF and cardiac dilatation (Signs of left- and right-sided congestive heart failure) blood cultures q 15 minutes Definitive Dx; endomyocardial biopsy |
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Signs and symptoms of acute endocarditis.
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Rapid onset (hours to days)
High fever Rigors Very ill Extravascular complications more common: Roth spots or flame-shaped hemorrhages in retina Petechia in conjunctiva, buccal mucosa, palate, extremities Splinter hemorrhages Janeway lesions Osler’s nodes (only present for a few hours) Nail clubbing, Anemia Sed rate and C-reactive protein elevated Rheumatoid factor Abnormal urinalysis Other: splenomegaly, arthralgia, sudden loss of peripheral pulse, confusion, severe headache, focal neurologic deficits |
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Predisposing factor examples for endocarditis.
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Any heart lesion...
Rheumatic heart disease Congenital heart disease Mitral valve prolapse Degenerative heart disease Prosthetic valve placement Previous endocarditis episode IV drug users |
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How to diagnose Endocarditis.
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2 of 3
1) 3 blood cultures 15 minutes apart, before starting meds (2 have to be positive to know it isn't contaminated) 2) ECG (esophageal is best) indication 3) Positive Q fever serology (anti-phase I IgG greater than 1:800) or single blood culture positive for Coxiella burnetii Or a mix of positive signs/symptoms with at least 1 from above, or 5 signs and symptoms |
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What disease are these symptoms often associated?
Roth spots Petechia Splinter hemorrhages Janeway lesions Osler’s nodes |
endocarditis
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What is a Roth spot?
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flame-shaped hemorrhages in retina
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What is the name for a flame-shaped hemorrhages in retina?
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Roth spot
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What is the cause and treatment of Rheumatic fever?
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Strep pyogenes (M protein types)
Treat with penicillin |
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What are the signs and symptoms of Rheumatic fever?
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Hx of GAS (Group A Strep) ~5 weeks prior with/without positive ASO titer, throat culture, or recent scarlet fever
Major signs: Erythema marginatum Subcutaneous nodules (caused by cross reaction) Chorea (caused by cross reaction) Carditis 1) visible on CXR 2) as a prolonged P-R interval on ECG 3) New murmur (Mitral> aortic> tricuspid> pulmonary) 4) Pancarditis- (most serious) Chest pain, dyspnea, pleuritic chest pain, edema, cough, orthopnea 5) Congestive heart failure or pericarditis Minor signs: Fever (101-104oF) Migratory polyarthritis usually seen in knees, elbows or wrists- most common (due to cross reactive antibody protection from the hyaluronic M protein) Tachycardia |
Skin?
movements? pains? |
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Strep pyogenes of certain M types causes what sequelae of events/disease?
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Strep throat followed 5 weeks later by Rheumatic fever.
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What is the autoimmune reaction/cause of Rheumatic fever signs/symptoms?
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The GAS is antiphagocytic
Our body makes antibodies to it's M protein that also cross react with the heart, valves, smooth muscle, hyaluronic acid etc. |
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Erythema marginatum is found in conjunction with what heart problem?
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Rheumatic fever.
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Someone with a positive ASO, strep throat culture, or scarlet fever is at risk for what disease?
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Rheumatic fever ~5 weeks after the strep throat.
Treat with Pen |
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What are these symptoms indicative of?
Carditis 1) visible on CXR 2) as a prolonged P-R interval on ECG 3) New murmur (Mitral> aortic> tricuspid> pulmonary) 4) Pancarditis- (most serious) Chest pain, dyspnea, pleuritic chest pain, edema, cough, orthopnea 5) Congestive heart failure or pericarditis |
Rheumatic fever
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