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26 Cards in this Set

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  • Back
what is endocarditis? which one is worse, acute or chronic?
microbial infection of the endocardium of the heart, predominantly involving the valvular surface.

acute is worse
The source of endocarditis is _____, the source of pericarditis is ______
bacterial
viral
what population has the greatest overall incidence of endocarditis? what population has the greatest individual risk?
prosthetic valves
IVDA
what are the congenital cardiac anomalies that get endocarditis?
PDA
VSD
Bicuspid aortic valve
what is the most common overall organism of endocarditis in non-traumatic and non valvular diseae? which pathogen is most common associated w/ IVDA in traumatic and valvular dz?
S. viridans
S. aureus
what bug is most likely the cause of endocarditis within 60 days of valve surgery?
s. epidermidis
what is the pathophysiology of endocarditis?
injury to the endothelium (high velocity jet impacting on surface, flow form high to low Pressure area, flow through narrow orifice) --> platelet adherence and initiation of the clotting cascade --> bacterial resistance to immunity
what are the four clinical complications of endocarditis?
Local destructive effects of bacteria
Embolization of bland or septic fragments
Hematologic seeding of remote sites
Chronic antibody response with host vs host reaction
what are the clinical features of endocarditis?
Fever
New Heart Murmur
Splenomegaly
Petechiae
Splinter hemorrhages
Osler’s nodes
Musculoskeletal symptoms
Systemic emboli
Neurological symptoms
Congestive Heart Failure
Renal insufficiency or failure
how do you make a definitive diagnosis of endocarditis?
positive blood cultures and visible vegetations
or
2 major criteria
or
one major and 3 minor criteria
what bug is most likely the cause of endocarditis within 60 days of valve surgery?
s. epidermidis
what is the pathophysiology of endocarditis?
injury to the endothelium (high velocity jet impacting on surface, flow form high to low Pressure area, flow through narrow orifice) --> platelet adherence and initiation of the clotting cascade --> bacterial resistance to immunity
what are the four clinical complications of endocarditis?
Local destructive effects of bacteria
Embolization of bland or septic fragments
Hematologic seeding of remote sites
Chronic antibody response with host vs host reaction
what are the clinical features of endocarditis?
Fever
New Heart Murmur
Splenomegaly
Petechiae
Splinter hemorrhages
Osler’s nodes
Musculoskeletal symptoms
Systemic emboli
Neurological symptoms
Congestive Heart Failure
Renal insufficiency or failure
how do you make a definitive diagnosis of endocarditis?
2 major criteria
or
one major and 3 minor criteria
what are the major criteria for diagnosing endocarditis?
positive blood cultures (at least 2 drawn 12 hours apart at different sites)
visible vegetative lesion on echocardiogram
new valvular regurgitation
what are the minor criteria for diagnosing endocarditis?
Persistent fever
Vascular phenomena (emboli, stroke, conjunctival hemorrhage)
Immunologic phenomena (rheumatoid factor, Roth’s spots, Osler’s nodes, renal inflammation)
Thickened valves on echo without clear vegetation
how do you tx endocarditis nonsurgically?
combo of bacteriocidal and bacteriostatic abs--IV administration for about 6 weeks
when do you surgically tx endocarditis?
refractory bacteremia
severe valve distruction
major or recurrent emboli
very large vegetations
perivalvular abcess
what situations/ heart conditions warrant antibiotic prophylaxis to prevent endocarditis?
valvular stenosis or regurgitation
VSD
any valve replacement
mitral valve prolapse w/ regurg
any prior endocarditis
what is the definition of myocarditis?
inflammation/infection of the myocardium; injury to the functional myocardial tissue
what are the etiologies of myocarditis?
VIRUS- MC
coxsackie but in all viral infections except common rhinoviruses
can be caused by parasitic (chagas dz)
what does myocarditis often present with?
rapidly progressive congestive heart failure
how do you diagnose myocarditis?
clinical symptoms
echo to confirm LV involvement
testing for particular viral agent
how do you tx myocarditis?
by txing CHF: Diuretics, ACE-I, B-blocker
what percentage of myocarditis pts spontaneously resolve?
50%