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26 Cards in this Set

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Etiology of acute pericarditis
-Idiopathic (most common)
-Acute MI
-Viral (most common infectious)
-Autoimmune (Rheumatic fever)
Clinical presentation of acute pericarditis
-sudden onset of severe pleuritic CP that refers to back & L trap ridge, worsens w/ inspiration
-Pericardial friction rub
-EKG shows ST seg elevation in MULTIPE leads
-Periardial effusion (faint hs & Ewart's sign: dull patch to percussion under angle of L scapula)
Diagnostic studies for acute pericarditis
-EKG
-Echo
-CXR
Management of acute pericarditis
-Tx underlying disorder
-Tx inflammation w/ NSAIDs or ASA if post MI (due to vasoconstriction)
-Pericardiocentesis
Pathophysiology of Acute Pericarditis
-Infiltration of PMNs into pericardium causing inflamed pericardial layers rubbing against each other during contraction (acute). Persistent inflammation can lead to fibrin deposits in pericardial space (chronic)
Pathophysiology of Chronic Constrictive Pericarditis
-Thick, calcified pericardium causes rise in intracardiac P's-->reduced filling time, but V fnx remains intact
Etiology of Chronic Constrictive Pericarditis
-Idiopathic
-Acute pericarditis
-Malignancy
-TB
Clinical presentation of CCP
-Dyspnea, ascites, edema, weakness
-Increased JVP
-Pericardial knock-S3
-Pulsus paradoxus in 1/3 of pts
Diagnostic studies for CCP
-CXR: normal size heart +/- calcification
-CT: thick pericardium, displaced IVC
-EKG: low voltage QRS
-Echo: Dilated IVC, thick pericardium
-Cath: Elevated P's
Management of CCP
-Pericardial resection
-Na+ restriction
-Diuretics
-Tx underlying cause
Pathophysiology of Cardiac Tamponade
-Restriction of inflow of Vs caused by pericardial fluid
-Increased intracardiac P & atrial P
-Decreased V filling & CO
-Acute requires 200ml
-Chronic requires 2000ml
Etiology of Cardiac Tamponade
-Neoplasm
-Idiopathic
-Uremia
-Cardiac Sx
Clinical presentation of Cardiac Tamponade
Beck's Triad:
-HOTN
-Elevated JVP
-Faint hs
Other Sx:
-Dullness to percussion
-Clear lungs
-Small QRS
-Pulsus paradoxus
Management of Cardiac Tamponade
-Medical Emergency!
-Pericardiocentesis (subxiphoid)
-Avoid vasodilators & diuretics
What is the cause of Pulsus Paradoxus?
Normally during inspiration, systolic blood pressure decreases ≤10 mmHg, and pulse rate goes up slightly. An exaggeration (>10mmHg) of the normal variation during inspiration, in which the blood pressure declines as one inhales is considered PP. Upon clinical examination, one can detect beats on cardiac auscultation during inspiration that cannot be palpated at the radial pulse. It results from an accentuated decrease of the blood pressure
What is the significance of Pulsus Paradoxus?
It can indicate the following:
-cardiac tamponade
-pericarditis
-chronic sleep apnea
-asthma
-COPD
DDx of Pericardial Effusion
-Viral infection
-TB
-Inflammation from collagen vascular Dz
-Malignancy
-Blood from injury/trauma
-Volume overload from CHF
*Dx via Echo
Pathophysiology of Endocarditis
-Infectious dz centered around a heart valve resulting in it's dysfnx from inflammation, abscess formation, +/or obstruction from thrombus or vegetation
-Leads to CHF, pulmonary infarcts, CVA, MI, & renal dz
Etiology of Endocarditis
-Dental, TEE, Endoscopy, Colonoscopy, TURP
Native valve, NIVDU:
-40% Viridans strep
-30% Staph aureus
Native valve IVDU:
-60% Staph aureus
-20%Strep
Prosthetic valve:
-50-70% Viridans strep
At risk for Endocartitis
-IVDU
-Prosthetic valve
-Hx of Endocarditis
Clinical presentation of Subacute Endocarditis
-Low grade fever
-Anorexia
-Osler's nodes: tender nodes on fingertips
-Splinter hemorrhages: linear streaks on proximal nailbeds
-Roth's spots: oval retinal hemorrhages w/ pale center
-Janeway lesions: nontender palm & sole hemorrhages
Clinical presentation of Acute Endocarditis
-High grade fever
-HOTN
-Multi-organ failure
-New onset murmur
Management of Endocarditis
-IV Abx via Hickman line
--Start empirical Tx with Nafcillin or Oxacillin (Vanc for PCN allergy)
-Begin specific Tx after return of cultures
-If fever recurs after initial Tx think: resistant organism, Abx rxn, superinfection, abscess formation
-Sx with recurrent infection, prosthetic valve dz, septal abscess
Complications of Endocarditis
-Embolic event: often presenting Sx, risk increased w/ Mitral valve infection, prosthetic valve, S aureus, fungal, tobacco use
-CHF: most common indication for Sx
Duke criteria for Diagnosis of Endocarditis
Definite IE if:
-2 major, 1 major+3 minor, or 5 minor
Major criteria:
-Positive blood culture
-Evidence of endocardial involvement (+ Echo, oscillating intracardiac mass, abscess, or valve dehiscence/regurge)
Minor Criteria:
-Predisposing heart condition or IVDU
-Fever >100.4
-Vascular phenomena
-Immunologic phenomena
-Microbiologic evidence
Indications for Abx prophylaxis in dental procedures
-prosthetic valve or material
-Hx of Endocarditis
-Certain congenital heart Dzs
-Heart transplant recipients w/ valve Dz