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Cardio IV: Endocarditis, Rheumatic, PVD Cheat Sheet by

Cardiology

Infective Endoca­rditis

Causative organisms
Staph. aureus, group D strep, entero­cocci, HACEKs
Organism in IVDA
Staph. aureus (tricuspid valve*)
Organisms prosthetic valve endoca­rditis
Staph, gram-, fungi (first 2 months) and staph/­strep after that
Regurgant valve defect
Seen in most endoca­rditis pts, makes them more suscep­tible
How infections occur
Direct intrav­ascular contam­ination or from bacteremia from surgeries
Classic features
Osler nodes, Janewar lesions, Roth spots, petechiae, splinter hemorr­hages
Duke Criteria
Used to establish diagnosis
Treatment
Vancomycin + Ceftri­axone
Indica­tions for Abx Prophy­laxis
If pts. with prosthetic valves, congenital heart disease, valve disorder, transp­lants are going to get dental work or surgery
Prophy­lactic abx
Amoxic­illin

Aortic Aneurysms

Definition
Weakness and subsequent dilation of the vessel wall, usually from a genetic defect or athero­scl­erotic damage to the intima
Most common cause
Athero­scl­erosis (can see in Marfan's or Ehlers­-Danlos though)
Classic clinical scenario
Elderly male smoker with CAD, emphysema, and renal impairment
Where are they found
90% abdominal, 10% thoracic
Clinical features
Pulsatile abdominal mass +/- abdominal or back pain
Symptoms of AAA rupture
Severe back, abdominal, or flank pain. Hypote­nsion + shock
Lab Studies
Abdominal U/S followed by CT w/ contrast
Treatment
Endova­scular or open surgical repair

Giant Cell Arteritis

Definition
Systemic inflam­matory condition of medium & large vessels, pts. >50yo, often coexists with PMR
Most common­ly-­aff­ected arteries
Temporal artery
Conseq­uence of not treating aggres­sively
Blindness
Clinical Features
Headache, scalp tender­ness, jaw claudi­cation, throat pain, visual abnorm­alities
Lab Studies
ESR + CRP both elevated
Definitive diagnostic
Temporal artery bx
Treatment
High-dose prednisone x few months + ASA
 

Rheumatic Heart Disease

Rheumatic Fever
A systemic immune response occurring 2-3 weeks after a Beta-h­emo­lytic strep. pharyn­gitis
Valve most commonly involved
Mitral valve (75-80%), then aortic valve (30%)
Jones Criteria
Diagnostic criteria to establish diagnosis
Treatment
Bedrest, salicy­lates, IM penici­llin, and early treatment of strep pharyn­gitis for preven­tion*

PVD--C­hronic Venous Insuff­iciency

Definition
Loss of wall tension in veins, resulting ins tasks of venous blood and often assoc. with a hx of DVT, leg injury, or varicose veins
Clinical Features
Progre­ssive edema starting at ankle, skin changes, itching, dull pain with standing and ulcera­tion, skin is shiny/­thi­n/a­trophic with dark pigmentary change and subcut­aneous indura­tion, stasis ulcers above ankle
General Treatment
General: leg elevation, avoidance of sittin­g/s­tan­ding, compre­ssion hose.
Treatment for Stasis Dermatitis
Wet compre­sses, HC cream, Zinc oxide, anti fungal cream (ulcer­ations may need graft)

PVD--V­aricose veins

Etiology
Superf­icial venous insuff­iciency and valvular incomp­etance
Clinical features
Dilated, tortuous veins, esp. long saphenous vein
Treatment
Compre­ssion stockings, leg elevation, exercise, laser ablation, endovenous radiof­req­uency, compre­ssion sclero­therapy
 

PVD--P­eri­pheral arterial disease

Etiology
Athero­scl­erosis or thromb­oem­bolism (trauma, hyper coagulable states, etc.)
Clinical features
lower leg pain with exercise which is relieved by rest (AKA interm­ittent claudi­cat­ion), progresses later to pain at rest, numbness, tingling, ischemic ulcera­tions, gangrene
The "­Ps" of extremity occlusion
Pain, pallor, pulsel­ess­ness, parest­hesias, paralysis, poikil­oth­ermia
Lab studie­s/d­iag­nostics
Doppler flow studies, ABI,
Treatment
Cilostazol + antipl­atelet rx + lifestyle (NO smoking, more exercise), surgery and revasc­ula­riz­ation

PVD--T­hro­mbo­phl­ebitis & DVT

Thromb­oph­lebitis
Involves occlusion of a vein + inflam­matory changes
Virchow's Triad
Stasis + vascular injury + hyper-­coa­gul­ability (predi­spose veins)
Most common place to find a DVT
Lower extrem­ities and pelvis
Risk factors for DVT
Major surgery (total hip), long plane ride, hormon­e/c­ont­rac­eptive therapy, prolonged bed rest
Features of superf­icial thromb­oph­lebitis
Dull pain, erythema, tender­ness, indura­tion. Most common in long saphenous vein.
Class findings of DVT
Swelling of the involved area and redness
Diagnostic Studies
Duplex U/S
D-Dimer
Highly sensitive, if <500 then negative, can r/o DVT
Treatment
Antico­agu­lation with LMWH (Lovenox), or heparin then warfarin
                   

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