Cardiac Infections

Question 1

What is the main cause of myocarditis?

Answer 1

enteroviruses

Question 2

What is the meaning of dehiscence?

Answer 2

rupture

Question 3

What is the specific treatment for Staph. aureus (MSSA) endocarditis?

Answer 3

IV flucloxacillin

Question 4

What is used to diagnosis infective endocarditis?

Answer 4

two separate positive blood cultures and an echocardiogram

Question 5

What is microscopic haematuria?

Answer 5

red blood cells in urine, dipstick test

Question 6

What are the symptoms of myocarditis?

Answer 6

fever, chest pain, dyspnoea, palpations

Question 7

What is the specific treatment for MRSA endocarditis?

Answer 7

IV vancomycin and IV gentamicin, oral rifampicin after 3-5 days

Question 8

What are Janeway lesions?

Answer 8

non-tender lesions on palms or soles

Question 9

What is the pathogenesis of infective endocarditis?

Answer 9

heart valve damaged - turbulent blood flow over roughened epithelium - platelets/fibrin exposed - bacteraemia - organisms settle in fibrin/platelet thrombi - become a microbial vegetation - friable - break off - lodge in capillary bed - abscess or haemorrhage

Question 10

What are the symptoms of infective endocarditis?

Answer 10

fever, malaise, weight loss, tiredness, dyspnoea

Question 11

What is the empirical treatment for prosthetic valve endocarditis?

Answer 11

IV vancomycin and IV gentamicin, oral rifampicin after 3-5 days

Question 12

What is the specific treatment for Viridans strep. endocarditis?

Answer 12

IV benzylpenicillin and IV gentamicin (synergistic)

Question 13

What is the echocardiographic evidence of infective endocarditis?

Answer 13

valvular lesions, vegetation, abscess, new partial dehiscence of a prosthetic valve

Question 14

What cardiac infection is a cause of sudden death?

Answer 14

myocarditis

Question 15

What are the signs of myocarditis?

Answer 15

arrhythmias, cardiac failure

Question 16

What cardiac infection is more common in young people?

Answer 16

myocarditis

Question 17

What is myocarditis?

Answer 17

inflammation of heart muscle

Question 18

What is the main cause of pericarditis?

Answer 18

viruses

Question 19

What are Roth spots?

Answer 19

retinal haemorrhages with white or pale centres

Question 20

What is the specific treatment for Staph. epidermis endocarditis?

Answer 20

IV vancomycin, IV gentamicin and oral rifampicin

Question 21

What is infective endocarditis?

Answer 21

infection of the endothelium of the heart valve, usually left sided

Question 22

What is the specific treatment for Enterococcus sp. endocarditis?

Answer 22

IV amoxicillin/vancomycin and IV gentamicin

Question 23

What are the signs of infective endocarditis?

Answer 23

fever, new/changing heart murmur, finger clubbing, splinter haemorrhages, Roth spots, Janeway lesions, Osler nodes, microscopic haematuria

Question 24

What are the symptoms of pericarditis?

Answer 24

chest pain

Question 25

What does pericarditis often occur with?

Answer 25

myocarditis

Question 26

What can cause bacteraemia?

Answer 26

dental treatment

Question 27

What is associated with endocarditis in PWID?

Answer 27

septic pulmonary emboli

Question 28

When does early prosthetic valve endocarditis occur?

Answer 28

within 60 days of insertion

Question 29

What is the most common cause of endocarditis in PWID?

Answer 29

Staph. aureus

Question 30

What are the risk factors for infective endocarditis?

Answer 30

heart valve abnormality, prosthetic heart valve, PWID, IV lines

Question 31

What is the empirical treatment for endocarditis in PWID?

Answer 31

IV flucloxacillin - usually MSSA

Question 32

What side of the heart is affected in endocarditis in PWID?

Answer 32

right

Question 33

What are the most common causes of early prosthetic valve endocarditis?

Answer 33

Staph. epidermidis or aureus

Question 34

What is the empirical treatment for native valve endocarditis?

Answer 34

IV amoxicillin and IV gentamicin - usually Viridans strep.

Question 35

How is myocarditis diagnosed?

Answer 35

viral PCR, throat swab and stool for enterovirsues, throat swab for influenza

Question 36

How is endocarditis treated?

Answer 36

IV antibiotics for 4-6 weeks, monitor cardiac function, temperature and CRP, if falling on antibiotics refer for surgery early

Question 37

What is the treatment for myocarditis?

Answer 37

supportive treatment

Question 38

What are Osler nodes?

Answer 38

painful, red lesions on hands and feet

Question 39

What are the common organisms that cause infective endocarditis?

Answer 39

Viridans strep., Staph. aureus, Enterococcus sp., Staph. epidermidis

Question 40

What is the most common cause of infective endocarditis?

Answer 40

Staph. aureus

Question 41

What is the most common cause of infective endocarditis associated with poor dental hygiene or after dental procedures?

Answer 41

Strep. viridans