Cardiovascular Infections

Flowchart nodes

• CARDIOVASCULAR INFECTIONS

• CARDITIS

• ENDOCARDITIS

• MYOCARDITIS

• PERICARDITIS

• Infection of the endocardial surfcace

• Healthy valve

• Damaged / Prosthetic valve

• heart valves are affected most commonly   (may also affect septal defects or mural endocardium) 

• RISK FACTORS: Rheumatic heart disease Congenital heart disease Mitral valve prolapse Degenerative valve disease Prosthetic valve

• NBTE

• Flora on Mucus membrane/ other heavily colonized surface

• BACTEREMIA

• TRAUMA

• Dental manipulations Pulmonary, Gastrointestinal, Urological procedures and Tonsillectomy

• FROM - JANE  Fever Roth's spots Osler's nodule  Murmur Janeaway lesions Anemia Nail hemorrhage (splinter H) Emboli 

• RISK FACTORS: Age >60 Male sex Injection drug use Poor dentition and dental infection CO-MORBID CONDITIONS: Structural heart disease Valvular disease Congenital heart disease Presence of an intravascular device Chronic hemodialysis HIV infection

• Staphylococcus aureus: health-care associated Acute fulminant endocarditis Viridans Streptococci: Community-acquired and seen in older patients  Subacute bacterial endocarditis

• POST-OPERATIVE (PROSTHETIC VALVE) Early infection: (<2 months) Staphylococcus aureus, CoNS, GNBs and Candida (Nosocomial) Late infection: (>12months) Viridans Streptococci, Staphylococcus aureus, CoNS, Enterococci

• Enterococcus species and Streptococcus gallolyticus associated with colon carcinoma or colonoscopy

• IVDA Most common is Staphylococcus aureus ​​​​​​ Second most common is Pseudomonas aeruginosa

• VIRULENCE FACTORS: Dextran production Surface adhesin Adherence to specific components of NBTE Glycocalyx and slime layer 

• fibronectin and fibrinogen binds to the specific component of NBTE

• septic embolization and deposition of immune complexes: O, J, R 

• MODIFIED DUKE'S CRITERIA MAJOR and MINOR

• 2 MAJOR 1 MAJOR + 3 MINOR 5 MINOR

• DIAGNOSIS: Electrocardiogram Echocardiography Blood culture (3 samples over 24 hours) Molecular methods (culture-negative IE)

• Viridans Streptococci

• Gram positive cocci in chains Alpha-hemolysis greenish discoloration NOT lysed by bile NOT sensitive to optochin

• Enterococcus species

• Enterococcus faecium Enterococcus faecalis Gram positive cocci in pairs (spectacle-like) Carbohydrate antigen - D No Hemolysis Grows in 6.5% NaCl Tolerates 40% bile Hydrolyze bile esculin

• Staphylococcus aureus 

• Gram-positive cocci in clusters Beta-hemolysis on blood agar Catalase positive Coagulase positive [Coagulase negative - CoNS] Methicillin sensitivty / resistance

• RHEUMATIC HEART DISEASE

• Non-suppurative complications of Strep pharyngitis  Rheumatogenic strains of Streptococcus pyogenes Cross-reactivity between antibodies produced and body tissue Type II Hypersensitivity reactions: Molecular mimicry Pancarditis - mainly heart valve damage JONES criteria: Major and Minor  JONES CAFE-PAL

• Infectious agents: VIRUS: Coxsackie B virus Adeno virus Echo virus Parvovirus B19 PROTOZOA: Trypanosoma cruzi

• Acute phase Subacute phase  Chronic phase

• Contact - droplets from nose and throat

• RISK GROUPS: Children  age 20-40 longterm steroid and NSAIDS treatment Alcoholics Nutritional deficiencies 

• DIAGNOSIS: ECG Echocardiogram  CMRI EMB Elevation of Cardiac enzymes PCR for viral NA

• CHAGA'S DISEASE: Trypanosoma cruzi Reduviid bug (kissing bugs; triatomine bugs) Amastigote (aflagellate) & Trypomastigote (flagellate) Chagoma - bite site Romana's sign - periorbital swelling

• Viral Pericarditis - Coxsackie A and B Echovirus, Herpes, Adeno, HIV, Mumps Purulent pericarditis - Muliple etiology - Staph. aureus, Strep. pneumoniae, M. tuberculosis 

• Echocardiography ECG:  'saddle-back' concave ST segment elevation and low QRS voltage ELECTRICAL ALTERNANS CT & MRI