Infective EndocarditisCausative 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 AneurysmsDefinition | 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 ArteritisDefinition 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 DiseaseRheumatic 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 InsufficiencyDefinition 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 veinsEtiology 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 diseaseEtiology 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 & DVTThrombophlebitis 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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