Pathophysiology
80% of endocarditis cases are due to which 2 organisms?
streptococci
staphylococci
What are the early symptoms of myocarditis?
Fatigue, dyspnea, chest pain, palpitations, and fever.
What are the late complication of Infective Endocarditis?
Valvular dysfunction
Congestive heart failure
Atrial fibrillation
What is the gold standard test for diagnosing infective endocarditis?
Blood cultures (3 sets from different sites)
What is the prophylaxis for patients undergoing procedures and features at risk for Infective Endocarditis?
2 g amoxicillin 1 hour prior
What are the causes of pericarditis?
-acute injury
-acute/post myocardial infarct
-autoimmune disease
-cancer
-cardiac surgery
-congenital
-HIV/AIDS
-idiopathic
-infectious
-radiation therapy
-reaction to medicine
-tuberculosis
What is the classic chest pain description in pericarditis?
Sharp, pleuritic, improves when sitting up and leaning forward, worsens with inspiration and lying flat.
How does pericardial tamponade develop in pericarditis?
Excess pericardial fluid compresses the heart, limiting ventricular filling and decreasing cardiac output.
Which type of echocardiographic detection method is most sensitive for Infective Endocarditis?
Transesophageal echocardiography (TEE)
What is the minimum duration of antibiotic therapy for native valve infective endocarditis?
4-6 weeks, depending on the causative organism and severity.
What events can lead to bacteremia further increasing risk of infective endocarditis?
Dental procedures
GI procedures
GU procedures
What is the most common symptom of infective endocarditis?
Persistent fever
How can myocarditis lead to dilated cardiomyopathy
Chronic inflammation and fibrosis weaken the myocardium, leading to ventricular dilation and reduced ejection fraction.
Has risks and not used for every case but is definitive for myocarditis?
Endomyocardial Biopsy
What is the treatment for pericarditis?
Analgesia; treat the cause; steroids; Colchicine
What are the causes of myocarditis?
-infectious agent
-environmental toxins
-drugs or adverse reaction to medication or vaccination
-autoimmune disorder
-chronic myocarditis may stem from a previous infection or injury
What classic manifestations are associated with infective endocarditis?
Osler's nodes, Janeway lesions, splinter hemorrhages, and Roth's spot
Why can infective endocarditis cause glomerulonephritis?
Immune complex deposition leads to inflammation and renal dysfunction.
What are the 4 key findings of pericarditis?
1. Pericardial friction rub
2. EKG changes-diffuse ST segment elevation
3. Sharp, stabbing chest pain that radiates to the shoulder; often relieved by sitting up, leaning forward, and avoiding deep breaths
4. New/worsening pericardial effusion
What is the treatment for myocarditis?
-Management depends on the underlying cause:
--->antibiotics are administered for bacterial infections
--->corticosteroids or other medications that suppress the immune system are administered for viral infections
- Other: diuretics, anticoagulants and antidysrhythmic agents
Why does myocarditis lead to ventricular dysfunction?
Inflammation damages cardiomyocytes, impairing contractility and causing systolic dysfunction.
Why do some pericarditis patients experience dyspnea?
Pericardial effusion or tamponade can compress the heart, reducing cardiac output and causing breathlessness.
Why can myocarditis cause syncope or sudden cardiac death?
It can lead to ventricular arrhythmias or severe heart failure.
What imaging test is most useful for detecting myocardial inflammation?
Cardiac MRI with contrast
How is cardiac tamponade managed?
Emergency needle pericardiocentesis
Others: pericardial window, pericardiectomy