Infective Endocarditis Lightning Lecture

• Pathophysiology: Usually starts with an insult to the endothelium, leading to formation of sterile vegetations. Then, an episode of transient bacteremia may seed an infection to these pre-existing vegetations
• Infected vegetations often embolize, leading to a wide range of symptoms and secondary effects
• Prevalence is as high as 10-15% in those who abuse IV drugs
• The Modified Duke Criteria is used for diagnosis
• When you suspect IE, three blood cultures from three different sights should be drawn
• Antibiotic selection varies depending on native or prosthetic valve

Pericarditis and Myocarditis Lightning Lecture

• Myocarditis is inflammation of the muscle cells of the heart. Can be acute, subacute or fulminant
• Wide range of etiologies including viral/ bacterial infections and autoimmune diseases
• Can lead to dilated cardiomyopathy and heart failure
• Up to 80% of cases of pericarditis have an idiopathic etiology. Other causes include infections, radiation, Dressler’s syndrome
• Pericarditis can lead to effusions/ adhesions, leading to constrictive pericarditis or even tamponade
• Pericarditis does have some characteristic EKG findings. Important to differentiate from a STEMI

Pediatric Congenital Heart Disease

• CHD is the most frequently occurring birth defect
• Cyanotic lesions- think the “Five T’s” plus pulmonary atresia
• When you’re concerned about a ductal-dependent lesion, don’t hesitate to give prostaglandins; biggest side effect is apnea, which can be managed
• First two things to get when a newborn presents with suspicion of a CHD: All four extremity BPs and preductal+ postductal O2 sats
• First two things to do during a suspected tet-spell: Squat/ knees to chest and give O2
• If a baby is tachycardic, try to address potential secondary causes before giving adenosine

EKGs

• When interpreting EKGs, especially early on you need to be systematic
• A “significant” Q wave will be > 1/3rd the height of the R wave
• When you see STD, you should be asking yourself “where is the STE?”
• Most important factor to consider when evaluating for ischemia is the history, don’t get caught up too much on risk factors or lack thereof
• Hyperacute T waves are broad-based, become asymmetric as the J point begins to elevate
• Convex STE is very specific for ischemia
• Don’t forget to get serial EKGs when there’s any suspicion; If you’re repeating troponin, you should also repeat EKGs. Don’t be afraid to get a quick repeat in 15-20 minutes when they’re actively in chest pain and you’re concerned

R3 Procedure Sim: Pericardiocentesis + Transvenous Pacing

• Pericardiocentesis has three different approaches. No consensus on which is best
• If performing the parasternal approach be careful to avoid the thoracic artery
• Major indications for transvenous pacing include unstable bradycardia, sick sinus syndrome with pauses or failure to pace with the transcutaneous approach
• RIJ is the preferred approach for floating a transvenous pacer