Infective Endocarditis
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Causative organisms Staph. aureus, group D strep, enterococci, HACEKs
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Organism in IVDA Staph. aureus (tricuspid valve*)
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Organisms prosthetic valve endocarditis Staph, gram-, fungi (first 2 months) and staph/strep after that
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Regurgant valve defect Seen in most endocarditis pts, makes them more susceptible
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How infections occur Direct intravascular contamination or from bacteremia from surgeries
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Classic features Osler nodes, Janewar lesions, Roth spots, petechiae, splinter hemorrhages
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Duke Criteria Used to establish diagnosis
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Treatment Vancomycin + Ceftriaxone
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Indications for Abx Prophylaxis If pts. with prosthetic valves, congenital heart disease, valve disorder, transplants are going to get dental work or surgery
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Prophylactic abx Amoxicillin
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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
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Definition Systemic inflammatory condition of medium & large vessels, pts. >50yo, often coexists with PMR
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Most commonly-affected arteries Temporal artery
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Consequence of not treating aggressively Blindness
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Clinical Features Headache, scalp tenderness, jaw claudication, throat pain, visual abnormalities
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Lab Studies ESR + CRP both elevated
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Definitive diagnostic Temporal artery bx
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Treatment High-dose prednisone x few months + ASA
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Rheumatic Heart Disease
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Rheumatic Fever A systemic immune response occurring 2-3 weeks after a Beta-hemolytic strep. pharyngitis
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Valve most commonly involved Mitral valve (75-80%), then aortic valve (30%)
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Jones Criteria Diagnostic criteria to establish diagnosis
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Treatment Bedrest, salicylates, IM penicillin, and early treatment of strep pharyngitis for prevention*
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PVD--Chronic Venous Insufficiency
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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
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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
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General Treatment General: leg elevation, avoidance of sitting/standing, compression hose.
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Treatment for Stasis Dermatitis Wet compresses, HC cream, Zinc oxide, anti fungal cream (ulcerations may need graft)
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PVD--Varicose veins
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Etiology Superficial venous insufficiency and valvular incompetance
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Clinical features Dilated, tortuous veins, esp. long saphenous vein
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Treatment Compression stockings, leg elevation, exercise, laser ablation, endovenous radiofrequency, compression sclerotherapy
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PVD--Peripheral arterial disease
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Etiology Atherosclerosis or thromboembolism (trauma, hyper coagulable states, etc.)
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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
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The "Ps" of extremity occlusion Pain, pallor, pulselessness, paresthesias, paralysis, poikilothermia
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Lab studies/diagnostics Doppler flow studies, ABI,
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Treatment Cilostazol + antiplatelet rx + lifestyle (NO smoking, more exercise), surgery and revascularization
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PVD--Thrombophlebitis & DVT
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Thrombophlebitis Involves occlusion of a vein + inflammatory changes
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Virchow's Triad Stasis + vascular injury + hyper-coagulability (predispose veins)
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Most common place to find a DVT Lower extremities and pelvis
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Risk factors for DVT Major surgery (total hip), long plane ride, hormone/contraceptive therapy, prolonged bed rest
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Features of superficial thrombophlebitis Dull pain, erythema, tenderness, induration. Most common in long saphenous vein.
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Class findings of DVT Swelling of the involved area and redness
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Diagnostic Studies Duplex U/S
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D-Dimer Highly sensitive, if <500 then negative, can r/o DVT
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Treatment Anticoagulation with LMWH (Lovenox), or heparin then warfarin
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a really helpful one
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