Cardiac Inflammation: Endocarditis vs Pericarditis vs Myocarditis — Layer, Presentation, Complication
All three are "cardiac inflammation," but the wrong layer changes everything — embolic stroke versus tamponade versus sudden heart failure. The NCLEX gives you a cluster of findings and expects you to match it to the correct -itis in seconds. Mixing them up means choosing an intervention that misses the life threat.
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Practice nowComparison
- Endocardium/valve lining
- S. aureus, S. viridans
- IV drug use, prosthetic valves
- Pericardium (outer sac)
- Post-MI (Dressler), uremia
- Viral infection
- Myocardium (heart muscle)
- Viral infection
- Autoimmune
- ★Janeway lesions, Osler nodes
- Fever + new regurgitant murmur
- Splinter hemorrhages
- ★Sharp chest pain, eased leaning forward
- Worse supine and with deep breath
- ★New HF in a young, healthy patient
- Vague chest pain, fatigue
- Palpitations, dysrhythmias
- Blood cultures ×3 before antibiotics
- Echo shows valve vegetations
- ★Diffuse concave ST elevation + PR depression
- Echo for effusion
- ↑ Troponin/CK-MB
- Echo shows ↓ EF
- Endomyocardial biopsy definitive
- Neuro checks for embolic stroke
- Trend fevers
- Pericardial friction rub (scratchy)
- Watch tamponade: pulsus paradoxus >10
- S3 gallop
- Telemetry + daily weights
- Activity restriction
- Prolonged IV antibiotics 4–6 weeks
- Valve surgery if vegetation/failure
- NSAIDs + colchicine
- Pericardiocentesis for tamponade
- Supportive HF therapy
- Manage dysrhythmias
- Rest: limit physical activity
- Antibiotics before dental work
- Report fever, new emboli signs
- Sit up / lean forward eases pain
- Finish full NSAID/colchicine course
- Restrict exertion during recovery
- Report worsening dyspnea or edema
- Stroke or limb ischemia (emboli)
- ★Beck triad: JVD, muffled tones, ↓BP
- VT or complete heart block
- Septic emboli: stroke, splenic/renal infarct
- Effusion leading to tamponade
- Dilated cardiomyopathy
- Sudden cardiac death
Endocarditis
- Endocardium/valve lining
- S. aureus, S. viridans
- IV drug use, prosthetic valves
Pericarditis
- Pericardium (outer sac)
- Post-MI (Dressler), uremia
- Viral infection
Endocarditis
- ★Janeway lesions, Osler nodes
- Fever + new regurgitant murmur
- Splinter hemorrhages
Pericarditis
- ★Sharp chest pain, eased leaning forward
- Worse supine and with deep breath
Endocarditis
- Blood cultures ×3 before antibiotics
- Echo shows valve vegetations
Pericarditis
- ★Diffuse concave ST elevation + PR depression
- Echo for effusion
Endocarditis
- Neuro checks for embolic stroke
- Trend fevers
Pericarditis
- Pericardial friction rub (scratchy)
- Watch tamponade: pulsus paradoxus >10
Endocarditis
- Prolonged IV antibiotics 4–6 weeks
- Valve surgery if vegetation/failure
Pericarditis
- NSAIDs + colchicine
- Pericardiocentesis for tamponade
Endocarditis
- Antibiotics before dental work
- Report fever, new emboli signs
Pericarditis
- Sit up / lean forward eases pain
- Finish full NSAID/colchicine course
Endocarditis
- Stroke or limb ischemia (emboli)
Pericarditis
- ★Beck triad: JVD, muffled tones, ↓BP
Endocarditis
- Septic emboli: stroke, splenic/renal infarct
Pericarditis
- Effusion leading to tamponade
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Play full screen for XPClinical Pearl
Rub + lean forward = pericarditis; vegetations + emboli = endocarditis; new HF after flu = myocarditis.
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