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Infectious Diseases of the Heart

Infectious Diseases of the Heart

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Published by Darell M. Book

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Published by: Darell M. Book on Mar 11, 2010
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01/21/2013

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INFECTIOUS DISEASES OF THE HEARTA.RHEUMATIC ENDOCARDITIS
– a unique infective endocarditis syndrome caused bythe group A beta-hemolytic streptococcal pharyngitis which occurs most often in school agechildren. The diagnosis is made primarily on the basis of the patients symptoms &echocardiography.Major Diagnostic Criteria: JONES CriteriaMinor Diagnostic Criteria: ESR, C-reactive protein, ASO, low grade fever that spikes in theafternoon, history of RHD
Clinical Manifestations:
1.
Migratory Polyarthritis
– may last to 4 weeks2.
Carditis
– inflammation of the heart3.
Subcutaneous Nodules
– round, firm, painless, non-moving4.
 Erythema Marginatum
– macular, popular lesions, non-itchy rash on trunk & proximalextremities5.
Syden Hams Chorea
– rapid, purposeless, erratic, jerky, uncoordinated involuntarymovements of extremities and face.
Management:
Bedrest
Monitor VS (esp. PR)
Antibiotics (Penicillin, Cephalosporins, Erythromycin)
Control pain like Corticosteroids or Analgesics
For Chorea initiate seizure precautions
B.INFECTIVE ENDOCARDITIS
- microbial infection of the endothelial surface of the heartwhich is most common in older people. It is caused by several microorganisms usually with prosthetic heart valves and structural cardiac defects.
Duke Criteria
 
>
a collection of major and minor criteria are used to establish a diagnosis of endocarditis. A diagnosis can be reached in any of three ways: two major criteria, one major andthree minor criteria, or five minor criteria.
o
Major Criteria :
Positive blood culture with typical IE microorganism
Evidence of endocardial involvement with positive echocardiogram
o
Minor Criteria :
Predisposing factor: known cardiac lesion, recreationaldrug injection
Fever >38°C
Immunological problems:glomerulonephritis,Osler's nodes
Positive echocardiogram (that doesn't meet a major criterion)
Management:
Antibiotics
Surgical valve replacement
Monitor VS; signs & symptoms of embolization, pulmonary infarction & infiltrates
Prevention of infection

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