Pericarditis Vs. Endocarditis

Question 1

Inflammation of the Pericardium. A thorough hx is essential to making an accurate diagnosis

Answer 1

Pericarditis

Question 2

Infection of the endothelial surface of the heart. Usually affects the valves. A diagnosis of infective endocarditis must be considered and excluded in all patients with a heart murmur and fever of unknown origin

Answer 2

Endocarditis

Question 3

Viruses are the most common cause
Post myocardial infarction
renal failure
neoplastic, tuberculosis, septicemia
endocarditis
collagen diseases
drug/trauma induced
viral infection
idiopathic

Answer 3

Pericarditis

Question 4

Usually caused by bacteria
known valvular heart disease; especially in rheumatic, bicuspid aortic valve/mitral valve prolapse, w/ significant regurgitation
recent dental/oropharyngeal surgery
genitourinary instrumentation/surgery of the respiratory tract
congenital heart disease
prolonged use of IV catheters or total parenteral nutrtion
patients with burns
hemodialysis

Answer 4

Endocarditis

Question 5

Very localized retrosternal/precordial chest pain, pleuritic in nature
pain increased by deep inspiration, coughing, swallowing or recumbent
pain relieved by sitting fwd
SOB secondary to pain with inspiration

Answer 5

Pericarditis

Question 6

Fever and malaise
Night sweats and weight loss
General “sick” feeling

Answer 6

Endocarditis

Question 7

Pericardial friction rub
Pleural friction rub may also be present
Fever may be present depending on underlying cause

Answer 7

Pericarditis

Question 8

Murmur often present but may be absent in up to 30% of patients, especially those with right sided disease
Osler’s Nodes
Splinter hemorrhages
Janeway lesion
Roth spots

Answer 8

Endocarditis

Question 9

ST segment elevation in all leads
Return of ST segment to normal in a few days followed by temporary T wave inversion
Depression of PR segment highly indicative of pericarditis
ESR elevation
Blood Cx if bacterial cause is suspected
CVC to R/O infection
Echocardiogram to confirm presence of pericardial fluid or other abnormalities
Baseline BMP

Answer 9

Pericarditis

Question 10

WBC may be normal or elevated, but there is always a left shift with bands
Echocardiogram for valvular damage
Blood Cx for causative organism
Three separate cx at three sites in 1 hr
ESR virtually always elevated

Answer 10

Endocarditis

Question 11

NSAIDs are mainstay of treatment
1. indomethacin
2. Ketorolac
3. Ibuprofen
Corticosteroids are indicated only when there is total failure of high-dose NSAIDs over several weeks and with relapsing pericarditis. Can increase viral replication
Abx in cases of bacterial infection
Monitor for tamponade (hypotension, JVD [increased CVP], muffled/distant heart sounds, pulsus paradoxus)

Answer 11

Pericarditis

Question 12

For suspected cases of subacute endocarditis empiric therapy is generally not started until blood cx results identify the pathogen.
Acute endocarditis: usually d/t staph aureus (both MRSA and MSSA), streptococci, and enterococci; empiric therapy; vancomycin until cx results are available

Answer 12

Endocarditis