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_________ is an infection of the innermost layer of the heart and heart valves.
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Infective endocarditis
How is infective endocarditis typically treated?
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With penicillin
Subacute forms of endocarditis affect people who....
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Have an existing valve disease
Acute forms of endocarditis typically impact people who...
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Have healthy heart valves. Presents as a radically progressive illness
_______ is the term used for the primary lesions associated with infective endocarditis. They consist of fibrin, leukocytes, and microbes that adhere to the valve surface or endocardium.
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Vegetations
Where are vegetations located in the left side of the heart most likely to embolize to?
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The brain, kidneys or spleen
Where are vegetations located in the right side of the heart most likely to embolize to?
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The lungs
What are the 5 major risk factors for development of infective endocarditis (IE)?
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Age over 50 (from calcified aortic stenosis), intravenous drug abuse, a prosthetic valve, a nosocomial infection from an intravascular device placement, or renal dialysis
What is the primary cause of left side endocarditis?
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Underlying heart disease and bacterial infection
What is the primary cause of right side endocarditis?
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Intravenous Drug Abuse
What are the s/s of infective endocarditis?
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Low grade fever, chills, weakness, malaise, fatigue, anorexia, arthralgias, myalgias, back pain, abdominal discomfort, weight loss, headaches, clubbing of fingers (subacute form). Splinter hemorrhages, petechiae in the eyes, mouth, ankles, feet and/or antecubital spaces, Osler's nodes on the fingertips or toes, Janeway's lesions on the palms and soles. Murmurs
Painful, tender, red or purple pea sized lesions on the fingertips or toes are called _________, and can be a sign of infective endocarditis.
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Osler's nodes
Flat, painless, small red spots on the palms of the hands and soles of the feet are called __________, and can be a sign of endocarditis.
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Janeway's lesions
What are Roth's spots?
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Hemorrhagic retinal lesions, a sign of endocarditis
What valves are the most likely to be the source of a new murmur developed from endocarditis?
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Aortic (early diastolic) or mitral (mid to late systolic)
Which type of murmur from infective endocarditis is most likely to herald an onset of heart failure in a patient's future?
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Aortic. 80% develop heart failure
What lab study is usually sufficient in diagnosing endocarditis?
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Two blood cultures drawn 30 minutes apart
For a patient with a cardiac condition that puts them at risk for endocarditis, what procedures necessitate prophylactic antibiotics?
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Any dental work with a risk of bleeding, tonsillectomy or adenoidectomy, surgeries/biopsies involving respiratory mucosa, bronchoscopy, endoscopy, colonoscopy, sigmoidoscopy or any surgery that disrupts mucosal lining of the GI tract, cytoscopy, laparoscopy or prostatic surgery.
Which types of infective endocarditis don't respond well to antibiotic therapy? How are they treated?
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Fungal infections or prosthetic valve endocarditis. They are treated with valve replacement and drugs. Heart failure and endocarditis don't respond well to anything.
How long is a patient with IE typically on antibiotic therapy for?
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4-6 weeks
________ pericarditis occurs within the initial 48-72 hours after an MI.
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Acute
_________ is pericarditis that appears 4-6 weeks after an MI.
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Dressler's syndrome
What are some ways pericarditis can be differentiated from an acute MI?
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Pericardial friction rub (timed with pulse), pain that is located in the trapezius muscle (shoulders and upper back)
What are the two major complications of pericarditis?
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Cardiac tamponade and pericardial effusion
________ is a complication of pericarditis that is characterized by the development of cough, dyspnea, tachypnea, hiccups, hoarseness and distant, muffled heart sounds with a normal BP.
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Pericardial effusion
_______ develops from a pericardial effusion from the pressure exerted as fluid builds. A patient will feel chest pain, and exhibit restlessness, confusion or anxiety. Often the patient will have tachypnea, tachycardia, distended neck veins and significant pulsus paradoxus.
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Cardiac tamponade
How is pulsus paradoxus measured?
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By taking the systolic pressure heard on expiration and subtracting the measurement at which an entire respiratory cycle can be heard. A difference greater than 10 mm Hg is suggestive of cardiac tamponade
What are the differences in an ST segment on an ECG that can help diagnose whether a client's chest pain is pericarditis or an MI?
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MI-ST segment has localized changes Pericarditis-ST segment has diffuse changes
_________ is a condition that usually begins with an initial episode of acute pericarditis and is characterized by fibrin deposition from an undiagnosed pericardial effusion.
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Chronic constrictive pericarditis
What condition causes a pericardial knock and what is it?
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Chronic constrictive pericarditis, a pericardial knock is a loud early diastolic sound heard on the left sternal border


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