Cardiac Infections and Inflammatory Diseases (New for 2025)
4-6 wks
Endocarditis Abx
IV antibiotic duration
3
Blood Cultures
Minimum sets before antibiotics
2
Pericarditis Treatment
NSAIDs plus colchicine
Infective Endocarditis
long antibiotics, watch for emboliDraw 3 blood culture sets from different sites before antibiotics
Duke criteria for diagnosis (major and minor criteria)
IV antibiotics for 4-6 weeks (organism-guided after culture results)
Vegetation embolization risk (stroke, splenic infarct, renal infarct)
Janeway lesions (painless palms/soles) and Osler nodes (painful fingertips)
Surgical indications include valve failure, abscess, and refractory infection
Myocarditis and Pericarditis
Myocarditis is usually viral (coxsackie B most common)
Troponin elevation, heart failure symptoms, possible arrhythmias
Myocarditis management is supportive HF care, NO NSAIDs
Pericarditis presents with sharp pleuritic chest pain worse lying flat
Pericarditis ECG shows diffuse ST elevation with PR depression
Pericarditis treatment is NSAIDs plus colchicine
Pericardiocentesis for cardiac tamponade (Beck triad present)
In myocarditis, avoid NSAIDs. They worsen myocardial inflammation.
Key Values to Memorize
Endo abx = 4-6 weeks IV
3 blood culture sets
Myo = NO NSAIDs
Peri = NSAIDs + colchicine
Diffuse ST + PR depression
Duke criteria for dx
endo vs myo vs peri is a guaranteed exam question
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Practice CCRN QuestionsExam Traps
Endocarditis requires 4-6 weeks of IV antibiotics
Infective endocarditis vegetations are difficult to penetrate with antibiotics. Treatment requires prolonged IV antibiotics, typically 4-6 weeks. Patients often need a PICC line for outpatient IV therapy. Shorter courses are insufficient to sterilize the vegetations.
Three blood culture sets before antibiotics
Draw at least 3 sets of blood cultures from different sites before starting empiric antibiotics. This maximizes the chance of identifying the organism and guiding targeted therapy. Do not delay antibiotics in a septic patient, but get cultures first whenever possible.
Myocarditis means NO NSAIDs
NSAIDs are first-line for pericarditis but contraindicated in myocarditis. In myocarditis, NSAIDs worsen myocardial inflammation and may increase the risk of myocardial necrosis. Treatment focuses on heart failure management and supportive care.
Pericarditis treatment is NSAIDs plus colchicine
Pericarditis is treated with NSAIDs (ibuprofen or indomethacin) plus colchicine. Colchicine reduces recurrence rates. Steroids are reserved for refractory cases because they increase recurrence risk.
Myocarditis = NO NSAIDs
Pericarditis = NSAIDs + colchicine. Myocarditis = NO NSAIDs ever. They worsen myocardial inflammation. This is a favorite exam question.
Endocarditis Protocol
Three blood culture sets. 4-6 weeks IV antibiotics. Watch for embolic events (stroke, splenic infarct, Janeway lesions). Surgery if valve failure.
Bacteria have colonized the inside of the heart valves, building biofilm fortresses (vegetations). You need weeks of targeted antibiotics to penetrate and clear the infection. Pieces of vegetation can break off and travel (embolize) to the brain, spleen, or kidneys.
The heart muscle itself is inflamed, usually from a virus. The walls are weakened and cannot pump effectively. You support the heart with standard heart failure management. NSAIDs would be like throwing gasoline on the fire inside the walls.
The pericardial sac surrounding the heart is inflamed and irritated. It causes sharp pleuritic chest pain that worsens when lying flat and improves when leaning forward. NSAIDs calm the inflammation and colchicine prevents it from coming back.
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