Infective Endocarditis

-Inflammation,of the inner tissue of the heart,such as its valves

-Symptoms & Signs :

.fever

.malaise

.fatigue

.heart murmur

.roth's spots

.osler's nodes

.janeway lesions

.anemia

.nail hemorrhage

.septic embolism

.wight loss

.clubbing

.splenomegaly

.hematuria

.anorexia

-Causes :

.bacteremia (streptococcus viridans, staphylococcus aureus)

-Classifications :

.subacute bacterial endocarditis SBE(M.C is streptococcus vinidans)

.acute bacterial endocarditis ABE (M.C is staphylococcus aureus)

-Diagnosis :

+Major criteria include :

.positive blood culture

.positive echo + vegetation

+Minor criteria include :

.known cardiac lesion,recreating drug injection

.fever >38c

.evidence of embolism (arterial emboli,pulmonary infarcts,janeway lesions,conjunctival hemorrhage)

.immunological problems (glomerulonephritis,osler`s nodes)

-Treatment :

.high dose antibiotics (2-6 weeks)

+M.C bacteria in prosthetic valve is (staphylococcus epidermidis)

+Streptococcus bovis, associated with colon cancer

+M.C valveaffected (mitral valve)

+The site of endocarditis in drug abusers is Tricuspid valve

+The most common organism in infective endocarditis is Streptococcus viridans

Rheumatic Fever

-Is an inflammatory disease that can involve the heart, joints, skin, and brain.The disease typically develops two to four weeks after a throat infection (occur post streptococcal infection ‘tonsilitis’)

-Cause by antibody cross-reactivity,that can involve the heart,joints,skin and brain / commonly appears in children between the ages of 6-15age

-Symptoms & Signs :

.two to four weeks after a throat infection fever

.multiple painful joints

.nvoluntary muscle movements

.itchy rash known as erythema marginatum (major)

.atrial fibrillation

.infection of the valves

.abdominal pain

.nose bleeds

.polyarthritis carditis (major)

.sydenham`s chorea(major)

.erythema nodosum(minor)

.subcutaneous nodules (major)

.arthralgia (mainor crieteria)

.raised ESR

.arthralagia (minor)

.arthrities (major)

.C-reactive protein,leukocytosis,WBS elevated

.ECG (prolonged PR interval) (minor)

-Treatment :

.high dose antibiotics (pencillin)

.NSAID (Aspirin)

.erythromycin,prednisone

+Lipid lowering agents :

.statine

.fibrates (gemafibrozil)

.bile acid binding

.nicotinic acid

.fish oil (omega 3)

Syncope

-Is defined as a short loss of consciousness and muscle strength, characterized by a fast onset, short duration, and spontaneous recovery

-Cardiac Syncope (is sudden without warming and complete recovary / last for 1-2min

-Causes of cardiac syncope :

.arrhythmia (bradycardia and tachycardia)

.obstructive cardiac lesion (Aortic stenosis and mitral stenosis)

.acute aortic dissection

.pericardial tamponade

.pulmonary embolism

.pulmonary hypertension.

.hypertrophic cardiomayopathy

+Conntraindications of exercise electrocardiography (stress test) :

.unstable angina

.recent MI (within 10days)

.sever hypertrophic cardiomyopathy

.sever aortic stenosis

.malignant HTN

.heart failure

+Causes of sinus tachycardia :

.fever

.anemia

.hear failure

.thyrotoxiacosis

.drugs (atropin,adrenaline)

+Causes of atrial fibrillation :

.ischamic heart diseas (IHD)

.rheumatic heart disease

.idiopathic

.hyperthyroidism

.pneumonia

.pericarditis

.cardiac surgery

.alcohol

.congenital heart disease

+Wolf parkinson white syndrom WPW :

-ECG (delta wave) / usually associated with atrial fibrillation / drug to choice is (amiodarone)

+Atrial Flutter :

-ECG (saw-tooth appearance) / management like atrial aibrilliation

Pulmonary Edema

-Causes :

.MI

.mitral regurgitation

.mitral stenosis

.aoratic regurgitation

.arrhythmia

+Pulmonary edema is caused by :

.Fallot Tetralogy

.Acute glomerulonephritis

.Aspiration of hydrocarbons

.Left to right shunt

-Sumptoms :

.dyspnea

.tachycardia

.cyanosis

.cough with expectoration (pink frothy sputum)

.gallorythm

.crackless

-Diagnosis :

.by Chest X-ray -bilateral shadow (butterfly) / Kerley B lines / Effusion

-Treatment :

.oxygen

.ferosamide I.V

.morphin

.aminophylin

Date: 2016-04-22; view: 598