So not too much on valves then. Again, remember rheumatic fever and the mitral valve. So the rest of it is not really on your test at all. But good information to have.
Let's talk about infective endocarditis. Now this is a really big deal and life-threatening. So you get a microbial infection in the actual bubble. Endocardium.
Probably one of the most common things is from IV drug use. So valve replacements, systemic infections, structural cardiac defects, and sometimes dental procedures can cause this. So what happens is you get a platelet sort of fiber and vegetation forming on the damaged endothelium and that's... course platelets love to stick to one another and so that vegetation just enlarges as more platelets and more fiber get attached to the site it can be really quite quite large there's a slide next where you can kind of see a picture and so what are some signs and symptoms or manifestations of infective endocarditis well temperature over 101.5 typically flu-like symptoms, a cough, shortness of breath, sometimes even joint pain, fatigue, a heart murmur, just no appetite, so they have an anorexia, sometimes abdominal pain, and you can even see petechiae and the spleen may come enlarged.
So one of the biggest complications is emboli. So with that, with the platelets and with the vegetation, of course, a piece of that can just... dislodge and then you've got this emboli which can you know cause all kinds of problems can lead to heart failure it can lead to an abscess you can get an aneurysm and basically without treatment it's fatal so this is a really really serious thing to have infective endocarditis and they need to be on really big time strong antibiotics and need to be monitored So, and then surgery, as far as treatment goes, to replace those damaged valves and to remove that vegetation as well. And so typically they'll start with antibiotics, try to treat the patient that way, and then if that's not effective, they'll move to more serious measures like going in and removing that vegetation. Okay.
let's talk about pericarditis there's fair amount on the test about pericarditis so kind of listen up and make sure you understand the symptoms and how to diagnose it as well as a treatment so this is what it is inflammation or just alteration of the pericardium so that membranous sac that encloses the heart gets inflamed and that could become kind of a fibrous or serious you can just get fluid caught in there it can be hemorrhagic so blood can be an infection so you can get some purulent type drainage or it can be caused by some kind of cancer so neoplastic so neoplasms idiopathic infective organisms post mi is real common to get some pericarditis in fact it's not uncommon after mi to have a little bit of a rub a pericardial rub for about 24 hours, systemic connective tissue diseases and renal failure. So pericarditis is it's not uncommon. So there's a picture of some of pericarditis on the next slide.
You can see basically that the lining then is just inflamed. So you get a substernal or precordial pain. that pain is usually kind of a grating or harsh pain.
It's aggravated by breathing and sometimes even swallowing and coughing. So here's kind of something that you should pay attention to. Pain is worse when they're in a supine position and often better when sitting up.
So chest pain can be a little bit tricky. There's all sorts of different differential diagnosis, pericarditis being one of them. So you want to ask specifically about you know where is the pain when does it hurt and so one of the tail The real-tale things for pericarditis then is going to be the pain is worse when they're lying down, when they're in a supine position, and often better when sitting up. Kind of strange. So pericardial friction rub is something you might hear.
Monitoring the CVP, of course, that's going to go up with pericarditis. You might hear muffled heart tones. That's typically more with cardiac tamponade, but still.
Other tests that you might take a look at would be the white blood cell count, that might be up. EKG, that's going to be important. You're going to see widespread ST elevation all over that ST, or the EKG.
So that's another way of trying to diagnose it. CT scan can be helpful, echocardiogram, and of course a chest x-ray as well. So the next slide is an actual 12 lead EKG.
And when you look for an EKG, you might look at this one and you're like, holy smokes, this patient definitely has got ST elevation. I'm thinking about myocardial infarction. And then you notice it's all over the place.
And you might say, ah, this person has multiple vessel problems, probably needs a coronary artery bypass graft. But think about when it's widespread like this. that more than likely it's pericarditis. So now let's talk about some interventions. The acute pericarditis lasts for about two to six weeks.
So you want to monitor them pretty closely for complications. They don't need to be hospitalized, just made aware of potential complications. If they have increased edema or even chest pain, shortness of breath, that sort of thing, they should be seen. The most typical treatments are NSAIDs.
Colchicine, which is typically a gout medication, is used in the treatment of pericarditis. So NSAIDs and colchicine, sometimes corticosteroid therapy, so they can be placed on steroids, again, to decrease the inflammation. Antibiotics, if indicated, and pericarditis.
Cardio drainage so that can be done with a needle or if it's chronic where a patient just keeps having problems They can do something called a pericardial window and that's a surgical incision Of the pericardium so they basically just open that up a little bit So the drainage can be let out and it's not going to cause any problems So if that drainage stays in there you can develop cardiac tamponade. So this is really a life-threatening emergency. So this is an accumulation of fluid in that pericardial space and it results in the ventricles just being unable to fill properly.
So it's going to decrease your cardiac output. So basically that's going to lead to decreased tissue perfusion. You're not going to be able to perfuse your organs etc. So this type of shock is not cardiogenic.
It is obstructive. shock. So I want you to think about, yes, it's causing an obstruction to the cart, but it's not cardiogenic shock. It's causing the obstructive, and that is the reason for the decreased tissue perfusion. It absolutely is a medical emergency and needs to be taken care of.
And so I want you to think about signs and symptoms of cardiac tamponade, and this is something you really need to know, and that's Beck's triad. So these three things are are pretty hallmark then for cardiac tamponade low blood pressure distended neck veins so jvd and muffled heart tones so when those three things are put together i want you to think ah vex triad cardiac tamponade so you're going to see decreased urine output of course because of the lower cardiac output shortness of breath and an increase in your heart rate so causes can be The pericarditis, of course, as we discussed, and that could be caused by a bacterial or even viral infection. Heart surgery, you can get this complication.
You can get it post-MI. Trauma to the heart is fairly common. And of course, any kind of cancer or tumor in that area, they secrete fluid and that can cause that accumulation of fluid in the pericardial sac.
So again... We've got to get rid of this fluid and so it's a medical emergency. As much as like 20 to 50 mils can accumulate in that pericardium.
So pericardium Pericardial Synthesis is something that can be used. They insert an 8-inch 16-gauge pericardial needle into the pericardial space and then draw that fluid back and release that pressure and that obstruction so you can increase tissue perfusion. So when you think about, well, was the pericardial Synthesis successful? Well, think about Beck's triad and the symptoms that the patient's going to have for cardiac tamponade. So JVD, that will also be an increase in CVP, right?
So if the procedure is effective, then you're going to see a decrease in that JVD or a decrease in your central venous pressure. Your blood pressure should be going up and your heart tone should be more clear. So that's how we would tell if the pericardial synthesis.
was effective okay this winds up cardiac too so make sure that you go over the different signs and symptoms of all the different types of chest pain whether it be angina unstable angina an mi cardiac tamponade versus pericardial or i mean pericarditis So know the signs and symptoms and the difference for each one of them, as well as the EKG changes that you'll see for each of them. So, all right, see you in class.