Cardiovascular Medicine Flashcards

Question

Compare ACUTE versus SUBACUTE IE.

Answer 1

Subacute Infective Endocarditis: ✔️ HIGH RISK GROUPS – any patient, any age ✔️ RISK FACTORS – recent dental surgery, poor dental hygiene, indwelling central lines previous episode of IE, damaged / prosthetic heart valve ✔️ PATHOGENS – Strep. viridians, Enterococcus (lower virulence) ✔️ AFFECTED HEART SIDE – left sided ✔️ ONSET – gradual / insidious (weeks) ✔️ CHARACTERISTIC LESION – less destructive vegetations Acute Infective Endocarditis: ✔️ HIGH RISK GROUPS – IVDU, elderly, immunocompromised patients ✔️ RISK FACTORS – IVDU; native heart valves affected ✔️ PATHOGENS – Staph. aureus, Staph. epidermidis ✔️ AFFECTED HEART SIDE – right sided ✔️ ONSET – acute (hours, days) ✔️ CHARACTERISTIC LESION – necrotic / destructive lesions

Answer 2

``` SYSTEMIC FEATURES ✔️ fever ✔️ chills and rigours ✔️ fatigue + malaise ✔️ anorexia + weight loss ``` CARDIOVASCULAR FEATURES ✔️ dyspnoea, chest pain, clubbing (subacute) ✔️ congestive heart failure signs ✔️ new onset regurgitation murmur (mitral, aortic) ``` EMBOLIC FEATURES ✔️ petechiae ✔️ Janeway lesions ✔️ focal neurological signs ✔️ glomerulonephritis ``` IMMUNOLOGICAL FEATURES ✔️ Osler's nodes ✔️ Roth spots

Answer 3

MAJOR CRITERIA 1. Positive blood culture --> organisms identified on at least TWO seperate blood cultures 2. Evidence of endocardial involvement either: (a) . echocardiogram (b) . new regurgitant murmur MINOR CRITERIA 1. Positive risk factors (e.g. IVDU, immunocompromised, prosthetic heart valves). 2. Signs of embolic phenomenon / vascular involvement. 3. Signs of immunological phenomenon. 4. Fever > 38°C. 5. Blood culture suggestive of positive organisms, but does not fulfil the major criteria.

Answer 4

Bedside Ix ✔️ ECG ``` Laboratory Ix ✔️ FBC + WCC ✔️ Inflammatory markers ✔️ Blood cultures --> at least THREE cultures required from three different venipuncture sites ✔️ UECs ✔️ eLFTs ✔️ coags ``` Imaging Ix ✔️ echocardiogram (TOE)

Answer 5

IE requires 4 to 6 weeks of IV antibiotic therapy. Native Heart Valves --> gentamicin + vancomycin Prosthetic Heart Valves --> gentamicin + vancomycin + rifampicin + cefepime

Answer 6

``` ✔️ mitral valve regurgitation ✔️ aortic valve regurgitation ✔️ left or right sided HF; CHF ✔️ arrhythmia (particularly AF) ✔️ emboli and stroke formation ✔️ CNS infection ✔️ septicemia ✔️ glomerulonephritis ```

Answer 7

ARF is an auto-immune mediated reaction in which auto-antibodies form after exposure to GROUP A STREP (GAS) and cross-react with proteins within the body in a process called molecular mimicry. The condition manifests as a result of genetic, environmental and immunological factors. There is a 10-14 day delay / lag from time of infection to clinical presentation of ARF. ``` Risk factors include: ✔️ Aboriginal and Torres Strait Islander people ✔️ aged 4 to 15 years ✔️ poor hygiene and sanitation ✔️ over crowding ✔️ previous GAS infection ✔️ poor health literacy ✔️ poor education ✔️ poor access to medical services ```

Answer 8

RHD is a long-term complication of multiple, recurrent or severe episodes of ARF / GAS infection. This condition is characterised by irreversible damage / scarring to heart valves, leading to mitral valve regurgitation, stenosis, cardiac arrhythmia, congestive cardiac failure, increased risk of infective endocarditis and numerous other complications.

Answer 9

MAJOR CRITERIA 1. polyarthritis --> migratory, asymmetrical, affects large joints (N.B. polyarthralgia is sufficient for diagnosis in high risk populations) 2. carditis --> pancarditis (endocarditis + myocarditis + pericarditis) 3. Syndenham's Chorea --> jerky, uncontrolled movements that improve during sleep 4. erythema marginatum 5. subcutaneous nodules MINOR CRITERIA 1. fever > 38.5°C 2. elevated ESR 3. elevated CRP 4. polyarthralgia (monoarthralgia / arthritis is sufficient for diagnosis in high-risk groups) 5. prolonged PR internval on ECG EVIDENCE OF GAS INFECTION 1. ASO titre 2. Anti-DNAase B antibody 3. GAS on throat culture For NEW infection, diagnosis requires: ✔️ TWO major criteria ✔️ ONE major criteria plus TWO minor criteria For RECURRENT infection, diagnosis requires: ✔️ ONE major criteria plus ONE minor criteria ✔️ THREE minor criteria ✔️ TWO major criteria

Answer 10

Bedside Ix ✔️ ECG ✔️ throat swab --> MCS ``` Laboratory Ix ✔️ FBC + WCC ✔️ Inflammatory markers (ESR + CRP) ✔️ UECs ✔️ coags ✔️ blood culture ✔️ ASO titre ✔️ anti-DNA B antibodies ``` Imaging Ix ✔️ echocardiogram (TOE) ✔️ CXR

Answer 11

ERADICATION OF INFECTION - benzathine benzylpenicillin G (BPG) 1,200,000 units IM, stat FEVER - anti-pyretics (e.g. paracetamol) CARDITIS - frusemide for CHF, corticosteroids CHOREA - carbamazepine, sodium valporate ARTHRITIS - NSAIDs

Answer 12

All children with ARF require monthly injections of benzathine BPG 1,200,000 units IM for 10 years or until 21 years of age, which is LONGER.

Answer 13

``` ✔️ mitral valve regurgitation / stenosis ✔️ aortic valve regurgitation / stenosis ✔️ arrhythmia (particularly AF) ✔️ CHF ✔️ infective endocarditis ```

Answer 14

Pericarditis is inflammation of the pericardial lining of the heart. The majority of cases are VIRAL in origin.

Answer 15

A - autoimmune ✔️ SLE, RA, scleroderma ✔️ Dressler's Syndrome --> auto-immune pericarditis that occurs 1 to2 weeks following an acute MI ``` B - bacterial and viruses ✔️ Coxsackie virus A and B ✔️ echovirus ✔️ S. aureus ✔️ S. pneumoniae ✔️ TB ``` ``` C - cancer ✔️ lymphoma ✔️ breast cancer ✔️ lung cancer ✔️ colorectal cancer ``` D - drugs E - endocrine / metabolic ✔️ hyperuremia ✔️ hypothyroidism

Answer 16

``` ✔️ pleuritic chest pain --> worse with inspiration, leaning forward, radiation to back ✔️ dyspnoea ✔️ fever ✔️ lethargy + malaise ✔️ oedema ```

Answer 17

1. widespread ST elevation 2. PR depression 3. downsloping TP segment 4. reciprocal PR elevation in aVR

Answer 18

Mainstay treatment options are: ✔️ NSAIDs ✔️ colchicine Aspirin + colchicine therapy usually continues for 1 to 2 weeks and is guided by CRP levels. Hospital admission may be required when: ✔️ fever > 38.5°C ✔️ large pericardial effusion ✔️ subacute course ✔️ cardiac tamponade ✔️ failure to respond to NSAID therapy over 7 days

Answer 19

Syncope is transient loss of consciousness with spontaneous recovery. Key features of syncope are: ✔️ transient loss of consciousness (8 to 10 seconds) ✔️ spontaneous recovery ✔️ nil residual deficits

Answer 20

``` Syncope: 1. orthostatic ✔️ hypovolemia ✔️ dehydration ✔️ severe anaemia 2. vasovagal ✔️ severe pain ✔️ sight of blood / bodily fluids ✔️ micturition 3. cardiogenic ✔️ third degree heart block ✔️ aortic stenosis ✔️ sudden cardiac arrest ``` ``` Non-Syncopal Causes: 1. neurological ✔️ subarachnoid haemorrhage ✔️ haemorrhagic stroke ✔️ epilepsy ✔️ TIA ✔️ concussion / traumatic brain injury 2. metabolic ✔️ hypoglycaemia ✔️ hyponatremia 3. other ✔️ toxic substance ingestion ✔️ psychogenic / psychological ```

Answer 21

``` Bedside Ix: ✔️ ECG ✔️ blood glucose level ✔️ ABG +/- ✔️ urine toxicology screen ``` ``` Laboratory Ix: ✔️ FBC + WCC ✔️ Inflammatory markers ✔️ UECs ✔️ blood glucose levels ✔️ blood toxicology screen ✔️ TFTs ``` Imaging Ix: ✔️ echocardiogram ✔️ non-contrast CT head ✔️ EEG --> if seizure concern

Answer 22

AF is a supra-ventricular arrhythmia characterised by (1). absence of P waves (2). irregularly irregular rhythm

Answer 23

P - pulmonary causes (e.g. COPD, chronic PE, OSA) I - ischemia (e.g. IHD, CAD) R - rheumatic heart disease / valvular pathologies (e.g. aortic stenosis) A - anaemia T - thyrotoxicosis E - endocrine abnormalities (e.g. hypokalaemia) S - sick sinus syndrome

Answer 24

✔️ paroxysmal AF - episodes last < 1 week ✔️ persistent AF - episodes last > 1 week ✔️ long-term persistent - episodes last > 12 months ✔️ permanent AF - resistant to cardioversion

Answer 25

RACE R - rate control A - anticoagulation C - cardioversion or flecanide / amiodarone E - etiology / underlying cause

Answer 26

Rhythm control is indicated in patients who remain symptomatic, despite adequate / appropriate rate control. There are two ways of achieving rhythm control: 1. electrical cardioversion 2. medical cardioversion Medical cardiversion is via IV flecanide infusion. Long term medical rhythm control may be achieved via flecanide 50 PO, BD increasing to 150mg BD PO if required. Rhythm control may be acquired through electrical cardioversion in patients that are stable. If AF has persisted for < 48 hours, the electrical cardioversion can occur without oral anticoagulation. If AF has persisted for > 48 hours, then electrical cardioversion requires oral anticoagulation for three weeks minimum.

Answer 27

``` Rate control should be considered in the following circumstances: ✔️ younger patients ✔️ severe CHF ✔️ significant symptoms ✔️ paroxysmal / persistent AF ``` The aim of rate control is to control HR < 110bpm. Usually, oral therapy is significant and may take means of: 1. atenolol 2. metoprolol IV infusion is rarely required.

Answer 28

``` C - congestive heart failure H - hypertension A - age > 75 years (2 points) D - diabetes mellitus S - stroke / TIA (2 points) V - vascular disease A - age > 64 years Sc - sex category (female) ``` CHADSVASc is used to stratify risk of a patient with AF experiencing a stroke, and therefore, whether it is appropriate for them to commence on pharmacotherapy . Score 0 - no need for anticoagulation Score 1 - consider anticoagulation Score 2 - commence anticoagulation with warfarin (valvular AF) or a NOAC (non-valvular AF)

Answer 29

``` ✔️ right sided heart failure ✔️ congestive cardiac failure ✔️ stroke and VTE ✔️ ischemic heart disease ✔️ sudden cardiac arrest ```

Cardiovascular Medicine Flashcards

(53 cards)