Endocarditis Overview

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Questions and Answers

What is the primary cause of myocarditis?

Autoimmune disorders

Environmental toxins

Viral infections (correct)

Genetic factors

Which laboratory tests are relevant for diagnosing myocarditis?

Troponin, CK MB, Natriuretic peptide (correct)

CBC, ESR, TSH

BUN/Cr, Cardiac MRI, BNP

ANA, HIV, QuantiFERON

What are the common symptoms associated with myocarditis?

Fever and abdominal pain

Headache and dizziness

Shortness of breath and chest pain (correct)

Joint pain and rash

What type of imaging can show cardiomegaly indicating heart failure in myocarditis?

Chest X-ray (B) Signup and view all the answers

What is the gold standard for diagnosing myocarditis?

Endomyocardial biopsy (D) Signup and view all the answers

Which of the following treatments is NOT commonly used in myocarditis management?

Chemotherapy (D) Signup and view all the answers

In the case of pericardial effusion, what is the recommended approach for large effusions?

Pericardiocentesis (A) Signup and view all the answers

Which symptom would LEAST likely indicate myocarditis?

Skin rash (C) Signup and view all the answers

What condition can result from severe myocarditis?

Dilated cardiomyopathy (A) Signup and view all the answers

Which of the following is true regarding the treatment of myocarditis?

Supportive care is the mainstay approach. (A) Signup and view all the answers

What is the most common causative agent of infective endocarditis?

Staphylococcus aureus (A) Signup and view all the answers

Which type of endocarditis is characterized by the formation of sterile platelet and fibrin thrombi?

Non-infective endocarditis (B) Signup and view all the answers

What is a key diagnostic method for confirming suspected infective endocarditis?

Blood culture (A) Signup and view all the answers

What symptom is more common in infective endocarditis than in non-infective endocarditis?

Fever (B) Signup and view all the answers

Which of the following organisms is commonly associated with endocarditis following dental procedures?

Streptococcus viridans (D) Signup and view all the answers

Which imaging technique is preferred for evaluating pericardial effusion?

Echocardiogram (A) Signup and view all the answers

What is the primary treatment for viral or idiopathic pericarditis?

NSAIDs or high-dose ASA (D) Signup and view all the answers

What are Osler nodes commonly associated with?

Infective endocarditis (B) Signup and view all the answers

Which condition can result from untreated infective endocarditis?

Heart failure (A) Signup and view all the answers

Which physical examination finding is classic for pericarditis?

Pericardial friction rub (B) Signup and view all the answers

What is the characteristic EKG finding in acute pericarditis?

ST segment elevation (B) Signup and view all the answers

Why might a patient with infective endocarditis need prophylactic antibiotics before dental work?

To prevent the introduction of bacteria into the bloodstream (B) Signup and view all the answers

In pericardial effusion leading to cardiac tamponade, which vital sign is typically observed?

Muffled heart sounds (A) Signup and view all the answers

Study Notes

Endocarditis

What: Inflammation of the inner lining of the heart and valves. Infective endocarditis (IE) is more common than non-infective, which involves the formation of sterile platelet and fibrin thrombi.
Cause (Infective): Bacterial (e.g., staph, strep viridans, strep pneumo, HACEK organisms, fungi), often following damage to the endothelium (inner lining).
Cause (Non-Infective): Rheumatic endocarditis, impacting mitral valves more than aortic, occurs due to damage to endothelium which allows for platelet and fibrin deposition and bacteria invasion.
Classifying Endocarditis:
- Acute (sudden onset, often staph) vs. Subacute (gradual onset, often strep viridans)
- Native valve (community acquired, IV drug use) vs. Prosthetic valve
- Left-sided vs. Right-sided (IV drug use)
Clinical Signs/Symptoms (more common in IE): Fever, night sweats, fatigue, anorexia, weight loss, myalgias/arthralgias, splinter hemorrhages, Osler nodes, Janeway lesions, Roth spots, new or changing murmurs (mitral regurgitation, tricuspid regurgitation).
Diagnosis:
- Echocardiography (TTE initial, TEE for negative TTE): assesses heart valves and structures.
- Blood cultures: 3 sets from different sites prior to antibiotic treatment.
- Inflammatory markers (ESR, CRP): elevated.
- Other tests: ECG, CXR, CT, MRI (to rule out other causes or evaluate for complications).
Treatment (Infective): Empiric antibiotics (e.g., vancomycin + gent, ceftriaxone; nafcillin + gent) followed by a longer course of antibiotics (4 to 6 weeks). Consult ID, cardiology, CT surgery. Native valve patients: vancomycin + gentamicin OR ceftriaxone.prosthetic valve patients: Vancomycin, gent, rifampin. Ongoing blood cultures monitored.
Risks: Patients with native valve endocarditis, prosthetic valves or are IV drug users require prophylactic antibiotics before dental or other invasive procedures (e.g., amikacin, ceph, or clinda). A history of rheumatic heart disease, congenital heart disease, prior infection, and poor dentition place individuals at higher risk.
Complications: Cardiac complications (perivalvular infections, valve insufficiency, valve rupture, HF, endocarditis-related pericarditis), renal complications (glomerulonephritis, antibiotic-induced nephrotoxicity), and metastatic infections, are potential consequences.

Pericarditis

What: Inflammation of the pericardium (the double-layered sac surrounding the heart).
Cause: Idiopathic, viral infection (coxsackievirus B), bacterial infections, cardiovascular conditions (e.g., post-MI Dressler syndrome), cancers, medications, or autoimmune diseases.
Clinical Signs/Symptoms (Acute): Severe, sharp, pleuritic chest pain that may radiate to neck, shoulder, or arm; worsens when lying supine, improving when leaning forward; potential for dyspnea, neck vein distention, pericardial friction rub (heard best on expiration while leaning forward).
Clinical Signs/Symptoms (Chronic): May be less severe or absent, could cause dyspnea (SOB).
Diagnosis: EKG (ST-segment elevation, PR depression, and often diffuse ST segment elevation is acute; PR depression in chronic); Echocardiogram (identify any effusion/edema).
Treatment (Viral/Idiopathic): NSAIDs or high-dose aspirin (7 to 14 days). Potential for colchicine to also be used to decrease recurrence. Steroids if no improvement with NSAIDs.
Complications: Cardiac tamponade (fluid buildup compresses the heart), pericardial effusion, constrictive pericarditis, which can cause right-sided heart failure symptoms.

Pericardial Effusion and Cardiac Tamponade

What: Pericardial effusion is the accumulation of fluid within the pericardial sac; Cardiac tamponade is a serious consequence of rapid fluid accumulation that impairs cardiac filling.
Causes: Viral infections, bacterial infections, malignancy, trauma, medication effects.
Signs/Symptoms (with Tamponade): Dyspnea, cough, chest pain, lightheadedness, syncope, palpitations, hoarseness, fatigue. The triad of hypotension, muffled heart sounds, and weak pulse is significant.
Signs/Symptoms (without Tamponade): Often asymptomatic, symptoms relate to the underlying cause.
Diagnosis: EKG, CXR, echocardiogram (TEE preferred), blood tests (important to evaluate for ESR, CRP, and CBC)
Treatment: Treatment depends on the underlying cause and stability: may include administering O2, IV fluids, pericardiocentesis (for large effusions), surgical intervention (for certain cases) if necessary.

Myocarditis

What: Inflammation of the myocardium (heart muscle).
Causes: Idiopathic, Viral (e.g., Coxsackie B virus, other viruses), bacterial, protozoal, fungal infections, immune-mediated disorders (e.g., rheumatologic conditions), medications, and environmental factors (e.g., black widow venom).
Signs/Symptoms: Fever, chest pain, dyspnea, orthopnea, loss of appetite, fatigue, palpitations, and heart failure signs, JVD/edema, murmurs (MR/TR).
Diagnosis: EKG, CXR, echocardiogram, Endomyocardial biopsy (gold standard). Blood tests may be done to check other conditions. Cardiac MRI.
Treatment: Supportive treatment focused on heart failure management (e.g., diuretics, ACE inhibitors, beta-blockers), managing arrhythmias, and addressing underlying causes.

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Description

This quiz covers the essential aspects of endocarditis, including its definitions, causes, classifications, and symptoms. Learn about the differences between infective and non-infective endocarditis, as well as the clinical signs that can help in diagnosis. This knowledge is crucial for understanding cardiovascular health.