Other Forms of Heart Disease

Other Forms of Heart Disease

Other Forms of Heart Disease

-Acute Bacterial Endocarditis

-Streptococcus virdans is the main bacteria from the mouth that has a tendency to affect heart leaflets

-Can come from procedures or instrumentation (oral, GU procedures, hemodialysis catheter, or IV catheters)

-Untreated Strep Tonsillitis and IV drug users 

-Bacteria lodge on heart valves that bear platelet fibrin thrombi and produce valve damage

-The ability to adhere fibrin thrombi comes from production of extracellular dextran by streptococcal strains

-May present 2-5 weeks after precipitating procedure or infection

-If organism slow growing symptoms may be slower up to 6 months

-Symptoms-fever, chills, shortness of breath, night sweats, weight loss, and anorexia

-TEE is useful for assessing vegetation

-Penicillin G and Gentamicin is ideal

-Vancomycin also helpful

-Surgery is needed for refractory infection or valvular heart damage

-Jones Criteria-Rheumatic Disease

-Major Criteria

-Carditis (Pleuritic pain, friction rub, heart failure

-Polyarthritis

-Chorea

-Erythema Marginatum

-Subcutaneous Nodules

-Minor Criteria

-Fever

-Arthralgias

-Previous Rheumatic Fever or rheumatic heart disease

-Acute rheumatic fever can be diagnosed if 2 major, or 1 major and 2 minor criteria are met

-Penicillin is indicated to treat strep infection

-Salicylates are helpful for fever and arthritis symptoms

-Acute Pericarditis

-most time the cause is unknown but presumed viral

-Pericardial friction rub may be present

-EKG-tachycardia with diffuse ST elevation 

-ECHO helpful if effusion present also

-Causes-viral, fungal, TB, bacterial, MI, post surgical, myxedema, drug induced, uremia, neoplasm, radiation

-Treatment with salicylates or NSAIDS help with pericardial inflammation and decrease chest pain

-Cardiac Tamponade

-dependent on the size of the effusion

-Pericardium can accommodate 80-100 mL of fluid before pressure rises

-Acute tamponade acutely ill with signs of cardiogenic shock

-Tachycardia to maintain CO

-Pulsus Paradoxus-rise and fall of more than 10 mmHg with inspiration

-The diagnosis is made on clinical findings-ECHO is useful to help 

-Treatment requires immediate drainage.  Vasopressors may be needed temporarily

-Pericardial Effusion

-Abnormal accumulation of fluid in the pericardial sac

-Drainage should be reserved (>2 weeks)

-If slow can accumulate 2 liters of fluid before increase in intracardiac pressure