Inflammatory and Structural Heart Disorders

Infective Endocarditis (IE) definition

Disease of the endocardium (innermost layer of the heart) and heart valves

Endocardium

Innermost layer of the heart affected in infective endocarditis

Prosthetic Valve Endocarditis (PVE)

Type of IE involving an artificial heart valve

Subacute infective endocarditis

Affects patients with preexisting valve disease

Acute infective endocarditis

Affects patients with previously healthy valves

Most common cause of infective endocarditis

Bacterial infection

Most common organism causing IE

Staphylococcus aureus (~50%)

Other common IE organisms

Streptococcus viridans and coagulase-negative staphylococci

HACEK organisms

Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella

Source of HACEK organisms

Normal colonizers of the oropharynx

IV drug use risk in IE

Increases risk for bacterial and fungal infective endocarditis

Fungal infective endocarditis

Common in IV drug users

Major risk factor for IE: previous history

Prior history of infective endocarditis

Major risk factor for IE: devices

Prosthetic valves and intravascular devices

Healthcare-associated IE

Commonly associated with MRSA

Renal dialysis

increases IE risk

Bacteremia definition

Bacteria entering the bloodstream

Pathophysiology of IE

Bacteria adhere to endocardium causing inflammation and thickening

Septic vegetation

Infected clot on heart valves or endocardium

Septic embolization

Pieces of vegetation break off and travel through circulation

Right-sided IE emboli destination

Lungs

Left-sided IE emboli destinations

Brain, kidneys, spleen, extremities

Major complication of left-sided IE emboli

Stroke

General symptoms of IE

Fever, chills, malaise, fatigue, weakness, anorexia

Subacute IE symptoms

Arthralgia, myalgia, back pain, abdominal discomfort, weight loss, headache

Clubbing of fingers significance

Seen in subacute infective endocarditis

Petechiae definition

Tiny, flat pink or red dots on skin

Osler nodes

Tender lesions on fingertips or toes

Janeway lesions

Flat, non-tender lesions on palms, soles, fingers, or toes

Roth spots

Retinal hemorrhages seen in IE

Cardiac finding in IE

New or worsening systolic murmur

IE and heart failure

Heart failure can develop due to valve damage

Inflammatory heart condition labs

ESR and CRP are elevated

Duke Criteria

Purpose: diagnose infective endocarditis

Blood cultures in IE

Used for accurate identification of organism

Echocardiography in IE

Used to visualize vegetations and valve involvement

Prophylactic antibiotics indication

Dental procedures and surgeries involving infected tissue in high-risk patients

IV antibiotic therapy for IE

Long-term IV antibiotics via PICC line

Follow-up for IE treatment

Repeat blood cultures

Surgical treatment for IE

Valve replacement if indicated

Supportive care for IE

Antipyretics, fluids, rest

Acute pericarditis definition

Inflammation of the pericardium

Pericarditis complication: effusion

Accumulation of fluid in pericardial sac

Pericarditis complication: tamponade

Compression of the heart due to fluid accumulation

Pericarditis complication: constrictive pericarditis

Chronic stiffening of pericardium

Pulse pressure calculation

Systolic BP minus diastolic BP

Pulse pressure change in pericarditis

Narrow pulse pressure

Myocarditis definition

Inflammation of the myocardium

Most common cause of myocarditis

Coxsackie A and B viruses

Other causes of myocarditis

Radiation therapy, chemicals, drugs, autoimmune disorders

Myocarditis and cardiomyopathy

Linked to dilated cardiomyopathy

Primary reason for heart transplant

Myocarditis

Rheumatic heart disease cause

Complication of Streptococcus A pharyngitis

Systems affected by rheumatic fever

Heart, joints, skin, CNS

Cardiac effect of rheumatic heart disease

Valve deformities with regurgitation

Valves most affected in rheumatic heart disease

Mitral and aortic valves

Carditis signs in rheumatic heart disease

Murmur, cardiomegaly, heart failure, pericarditis

Joint involvement in rheumatic fever

Monoarthritis or polyarthritis

CNS manifestation of rheumatic fever

Sydenham chorea

Skin manifestations of rheumatic fever

Erythema marginatum and subcutaneous nodules

Major complication of rheumatic heart disease

Chronic rheumatic carditis

Diagnosis of rheumatic fever

Modified Jones Criteria