Heart valve and endocardial diseases

Question 1

Give 4 things associated with S3 heart sound in older adults

Answer 1

Dilated cardiomyopathy
Constrictive pericarditis
Left sided heart failure
Mitral regurgitation

Question 2

Give 3 things associated with S4 heart sound

Answer 2

HOCM
Aortic stenosis
Hypertension

Question 3

What type of hypersensitivity reaction is rheumatic fever?

Answer 3

Type II hypersensitivity

Question 4

What Jones criteria are required to diagnose rheumatic fever?

Answer 4

Evidence of recent Strep. infection and 2 major OR 1 major and 2 minor criteria

Question 5

What are 4 examples of evidence of recent Strep. infection?

Answer 5

Throat culture
Rapid strep antigen test
Elevated or rising anti-streptolysin O or anti-DNase B antibodies
Recent scarlet fever

Question 6

What are the major Jones criteria?

Answer 6

Carditis
Arthritis
Subcutaneous nodules
Erythema marginatun
Sydenham's chorea

Question 7

What are the minor Jones criteria?

Answer 7

Fever
Raised CRP
Arthralgia
Prolonged PR interval
Previous rheumatic fever

Question 8

How long should patient bed rest for rheumatic fever?

Answer 8

Until CRP normal for 2 weeks

Question 9

What is the antibiotic regimen for rheumatic fever?

Answer 9

Benzylpenicillin IM stat then oral phenoxymethylpenicillin for 10 days

Question 10

What is the antibiotic regimen for secondary prevention of rheumatic fever?

Answer 10

Antibiotics for up to 10 year, or to 25 years old (whichever is longer) if mild murmur; lifelong for severe murmur or post-surgery

Question 11

What bacterium causes endocarditis in people with no past medical history, prosthetic heart valves or IV drug users?

Answer 11

Staphylococcus aureus

Question 12

What bacterium causes subacute endocarditis and native valve endocarditis?

Answer 12

Streptococcus viridans

Question 13

What bacterium causes endocarditis due to indwelling lines and in patients during the first 2 months following valve surgery?

Answer 13

Staphylococcus epidermidis

Question 14

What bacterium causes endocarditis in colorectal cancer?

Answer 14

Streptococcus bovis

Question 15

What are the 2 major Duke criteria?

Answer 15

2 positive blood cultures

Evidence of endocardial involvement on echocardiogram

Question 16

What are the 5 minor Duke criteria?

Answer 16

Predisposing heart condition or IV drug use
Fever >38 degrees
Positive blood culture not meeting major criteria
Evidence of immunological phenomenon
Vascular abnormalities

Question 17

What is the empirical antibiotic management for endocarditis (indolent presentation)?

Answer 17

Amoxicillin +/- gentamicin

Question 18

What is the empirical antibiotic management for endocarditis (sepsis)?

Answer 18

Vancomycin + gentamicin (or vancomycin + meropenem if risk factors for multiresistant bacteria)

Question 19

What is the empirical management for endocarditis (prosthetic valve)?

Answer 19

Vancomycin + rifampicin + gentamicin

Question 20

What is Heyde syndrome?

Answer 20

Triad of aortic stenosis, acquired coagulopathy and intestinal angiodysplasia

Question 21

What is the diagnostic investigation for aortic stenosis?

Answer 21

Echocardiogram

Question 22

What are the indications for surgery in aortic stenosis?

Answer 22

Symptomatic OR valvular gradient >40mmHg with features such as valve area <1cm2 or lef ventricular dysfunction

Question 23

What is De Musset’s sign?

Answer 23

Head bobbing, associated with aortic regurgitation

Question 24

What is Quincke’s sign?

Answer 24

Nail bed pulsation, associated with aortic regurgitation

Question 25

What valve abnormality is associated with polycystic kidney disease?

Answer 25

Mitral valve prolapse