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Heart Inflammatory Questions Can we go over endocarditis and pericarditis? We rushed through that in class. What are the most important s/s associated with endocarditis? Endocarditis – infection of the valves and inner lining of the heart; organisms will grow where there is increased turbulence of blood flow (ie. Congenital defects) or in areas of previous cardiac damage, the organisms create a characteristic lesion of vegetation, fibrin deposits and collagen; this lesion can break off and embolize somewhere else; usually caused by a bacteria but can be fungal or viral, can occur after an invasive procedure (ie. Minor surgery, dental procedures) – this is why they need prophylactic antibiotics before dental care and procedures Signs/symptoms – murmur, symptoms of emboli in spleen (ULQ pain, splenomegaly), kidney (flank pain, hematuria), brain (hemiplegia, decreased LOC), or peripherally (splinter hemorrhages in nailbeds, petechiae) Diagnostic studies – echocardiography, blood cultures Treatment – IV abx for 4-6 weeks, bed rest if cardiac damage, prophylactic abx for 3-5 years, may need surgery if there is severe valvular damage Complications - CHF, systemic emboli Pericarditis – inflammation of the pericardium; acute may be dry or may cause fluid accumulation, chronic causes fibrous thickening which inhibits cardiac filling during diastole; risk factors – infection, myocardial injury, hypersensitivity, renal failure Signs/symptoms – precordial pain, pericardial friction rub as the myocardium rubbing against the inflamed pericardium, pain increases with respiration (sitting may make the pain better), with chronic CHF symptoms occur and chest pain is usually not predominant Diagnostic tests – EKG changes, increased WBCs, CT scan Complications – pericardial effusion leading to cardiac tamponade Treatment - bedrest, anti inflammatory meds, pericardiocentesis if effusion or tamponade occurs Does rheumatic fever always come from strep throat? Yes, it is caused by the Group A beta-hemolytic streptococcus bacterium