Transcript Endocarditis

EKG Changes indicative of Disease
Processes other than STEMI
Bundle of His
Janeway lesions are seen in people with acute bacterial
endocarditis. They appear as flat, painless, red to bluish-red
spots on the palms and soles.
Osler’s nodes and splinter hemorrhages
(longitudinal streaks in nail).
Sinus tachycardia
PR depression
ST elevation
ST-T Wave Changes in Myocarditis
Common Causes of Infectious Pericarditis
Bacteria
Haemophilus influenzae
Mycobacterium
Neisseria gonorrhoeae
Neisseria meningitidis
Salmonella
Staphylococcus aureus
Streptococcus pneumoniae
Virus
Coxsackievirus A and B
Echovirus
Epstein-Barr virus
HIV
Influenza virus
Paramyxovirus
Parvovirus B19
Fungi
Aspergillus
Blastomyces
Candida
Coccidioides immitis
Cryptococcus neoformans
Histoplasma capsulatum
PR depression is seen in the early phase of
pericarditis and is followed by changes such as:
ST segment elevation
Normalization of the ST segment
T-wave inversion
Normalization of all changes over several days to
weeks
Low-voltage complexes are seen in pericarditis
with pericardial effusion.
Mitral Valve Vegetation
TAKE HOME POINTS
In patients diagnosed with an infectious disease,
electrocardiography can be used to evaluate for
cardiac involvement, provide information on prognosis,
and assess the effect of treatment.
Abnormalities on the electrocardiogram (ECG) of
a febrile patient in whom late-stage Lyme disease is
suspected can point to the diagnosis; conduction
and rhythm disturbances are the most common
ECG findings.
In a patient with known endocarditis and persistent
fever despite appropriate therapy, heart block on
repeated ECG may indicate the presence of complicated
valve abscess.
Myocarditis is caused by many infectious agents
and may produce a number of ECG abnormalities:
Adams-Stokes syndrome, conduction disturbances,
pseudoinfarction pattern, ST-segment and T-wave
abnormalities, and premature ventricular contractions.
Physicians should know the QTc interval in a patient
to be treated with a quinolone or macrolide
as these agents have proarrhythmic effects.
Lyme carditis is becoming a more frequent complication of Lyme disease,
primarily due to the increasing incidence of this disease in the United
States. Cardiovascular manifestations of Lyme disease often occur within
21 days of exposure and include fluctuating degrees of AV block, acute
pericarditis or mild left ventricular dysfunction and rarely cardiomegaly or
fatal pericarditis. AV block can vary from first-, second-, third-degree
heart block, to junctional rhythm and asystolic pauses. Patients with
suspected or known Lyme disease presenting with cardiac symptoms, or
patients in an endemic area presenting with cardiac symptoms with no
other cardiac risk factors should have a screening electrocardiogram
along with Lyme titers. We present a case of third-degree AV block due to
Lyme carditis, illustrating one of the cardiac complications of Lyme
disease. This disease is usually self-limiting when treated appropriately
with antibiotics, and does not require permanent cardiac pacing.
Adams- Stokes Syndrome
The preferred name is cardiovascular
syncope caused by heart block.
It is marked by a sudden collapse into
unconsciousness caused by a slow or
absent pulse resulting in fainting with or
without convulsions.
An inside View of Infective Endocarditis
This cross-section shows vegetations (blood clots & bacteria) on
the four heart valves.
Excised valve leaflets with large vegetation on ventricular side.
Mitral Valve Endocarditis
Prinzmetal Angina or variant angina
EKG taken minutes later showing changes
ST Segments normalized only nine minutes later.
Prinzmetal’s angina, also known as
variant angina, is a syndrome typically
consisting of angina (cardiac chest
pain) at rest that occurs in cycles. It is
caused by vasospasm, a narrowing of
the coronary arteries caused by
contraction of the smooth muscle
tissue in the vessel walls rather than
directly by atherosclerosis (buildup of
fatty plaque and hardening of the
arteries). It was first described in 1959
by the American cardiologist Dr. Myron
Prinzmetal (1908-1987).
EKG Changes indicative of COPD
Acute pericarditis classically shows
widespread, concave-upward STsegment elevation with PR-segment
depression and PR-segment elevation
in lead aVR. The ECG abnormalities
may evolve through 4 phases:
Stage I: diffuse ST-segment elevation
and PR-segment depression (60-80%
of cases);
Stage II: normalization of the ST and
PR segments, with flattening of the T
wave;
Stage III: widespread T-wave
inversions; and
Stage IV: normalization of the T waves.
The prompt institution of therapy may
prevent the appearance of all 4 stages.