Cardio

Question 1

state two infections can that affect the heart in children?

Answer 1

infective endocarditis

acute rheumatic fever

Question 2

what congenital heart conditions can occur with IE?

Answer 2

ventricular septal defects
patent ductus arteriosus
aortic valve abnormalities
tetralogy of fallot

Question 3

what is the triad features of IE?

Answer 3

endothelial damage
platelet adhesion
microbial adherence

Question 4

what happens to the bacteria once they attach to the lesion of damaged endothelial ?

Answer 4

the bacteria are protected within the vegetation from phagocytic cells and host defense mechanisms and so can proliferate easily

Question 5

what specific surface receptor does organisms that cause IE have ?

Answer 5

surface receptors to fibronectin that allow the microbe to adhere to the thrombus at the outset

Question 6

what organisms commonly cause IE?

Answer 6

Staphylococcus Aureus, Streptococcus Viridans

Question 7

what are the HACEK organisms?

Answer 7

Haemophillus, Actinobacillus, Cardiobacterium, Eikenella and Kingella

Question 8

state some features of IE?

Answer 8

persistent low grade fever
heart murmur
splenomegally
- petechiae, oslers nodes, laneway lesions, splinter haemorrhages (embolic phenomena)

PE, haematuria (due to glomerular nephritis), cerebral emboli, roth spots on the retina

Question 9

what investigations should be done for IE?

Answer 9

blood cultures

Echo

Question 10

what criteria is used for diagnosing IE?

Answer 10

Dukes criteria

Question 11

in order to confirm diagnosis how many major or minor should be present ?

Answer 11

2 major
1 major and 3 minor
5 minor

Question 12

what are the minor criteria for dukes criteria?

Answer 12

predisposing heart condition

fever

vascular phenomena

immunological phenomena (roths, oslers, GN, RF)

+ blood cultures

echo findings

Question 13

what are the two major criteria of the dukes criteria?

Answer 13

+ blood cultures for endocarditis (2 separate cultures take 12hrs apart)

evidence of endocardial involvement

Question 14

what three factors increase the possible need for surgical intervention?

Answer 14

vegetation (>1.5cm, mobile, increase of size)
valvular dysfunction 
perivalvular extension (new heart block, large abscess despite management, valvular rupture)

Question 15

what are the antibiotics commonly used to treat IE?

Answer 15

IV penicillin or IV ceftriaxone for 4 weeks
or/and
IV gentamicin for 2 weeks

Question 16

what antibiotic is used for methicillin IE?

Answer 16

vancomycin for 6 weeks

Question 17

what antibiotics are used for HACEK organisms IE?

Answer 17

ceftriaxone along with gentamicin for 4 weeks

Question 18

what are fungal IE treated with?

Answer 18

amphotericin B

Question 19

what increases the risk of IE?

Answer 19

acquired valvular heart disease 
hypertrophic cardiomyopathy 
previous IE 
structural congenital heart disease 
valvular replacement

Question 20

what usually precedes acute rheumatic fever?

Answer 20

2-4 weeks after pharyngitis

Question 21

what organism most commonly causes acute rheumatic fever?

Answer 21

streptococcus pyogenes

Question 22

why can pharyngitis cause acute rheumatic fever?

Answer 22

cross-reactivity to group A β-haemolytic streptococcus (GAS)

Question 23

what gender is most affected by rheumatic fever?

Answer 23

females

Question 24

is streptococcus pyogenes a gram negative cocci?

Answer 24

no

- gram positive cocci

Question 25

what are the two cytolytic toxins produced by strep pyogenes?

Answer 25

streptolysin O and S.

Question 26

what is the pathophysiology of rheumatic fever?

Answer 26

strep pyogenes contain M proteins in their cell wall B cells produce anti-M protein antibodies which cross react with tissues in the body this is exacerbated by production of activated cross reactive T cells

Question 27

what are risk factors of rheumatic fever?

Answer 27

``` extremes of age poverty overcrowding FHx D8/17 B cell antigen positivity ```

Question 28

what criteria is used for rheumatic fever?

Answer 28

revised jones diagnostic criteria

Question 29

what valve in the heart is most affected by rheumatic fever?

Answer 29

mitral

Question 30

what two things are required for diagnosis of rheumatic fever?

Answer 30

1. +throat culture for strep pyogenes or raised anti streptolysin A or anti-deoxyribonuclease B titre 2. 2 major criteria or 1 major and 2 minor

Question 31

what is the major criteria for rheumatic fever? SPECS

Answer 31

``` Sydenham’s chorea Polyarthritis Erythema marginatum Carditis Subcutaneous nodules ```

Question 32

what is the minor criteria for rheumatic fever? CAPE

Answer 32

CRP or ESR – Raised acute phase reactant Arthralgia Pyrexia/Fever ECG – Prolonged PR interval

Question 33

what are the DD for rheumatic fever?

Answer 33

septic arthritis reactive arthropathy infective endocarditis myocarditis

Question 34

what two things is reactive arthritis associated with ?

Answer 34

urethritis | conjunctivitis

Question 35

what ECG changes might be seen with myocarditis ?

Answer 35

saddle ST segments or T wave changes

Question 36

what investigations can be done for rheumatic fever?

Answer 36

``` Bloods - FBC, CRP, ESR, culture rapid antigen detection test throat culture anti streptococcal serology ECG CXR ECHO ```

Question 37

what might the ECG show for rheumatic fever?

Answer 37

prolonged PR interval

Question 38

what is the management of rheumatic fever ?

Answer 38

Antibiotics e.g. benzathine benzylpenicillin aspirin assess for emergency valve replacement

Question 39

what prophylaxis can be given for rheumatic fever?

Answer 39

intramuscular Benzathine benzylpenicillin every 3-4 weeks, oral Phenoxymethylpenicillin twice daily, oral sulfadiazine daily, or oral azithromycin (in penicillin allergy)