Ischemic Heart Disease & Ineffective Endocarditis Flashcards by Carmela Jahn Marie Felix

NBTEs are

platelets and fibrin

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Empiric antibiotic treatment for acute native heart valve endocarditis

vancomycin plus beta-lactam

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Heparin is only successful when it used in combination with

cardiac catheterization

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The intact endocardium releases these substances that inhibit platelet action.

-NO and prostacyclin

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Common venous graft used in CABG.

-saphenous vein

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P2y12 receptor blockers.

-blocks ADP binding

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Prinzmetal’s angina is a rare form of angina characterized by extreme chest pain as a result of

coronary artery vasospasms

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The following are modifiable risk factors, except:
-gender, narcotic use, malnourishment, sedentary lifestyle

gender

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Characteristics are: unstable plaque, ischemia, increase O2 demand, and chest pain at rest.

-unstable angina

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True or False
± if gentamycin is working no need to give rifampin, if gentamycin is taking too long to effect give rifampicin

True

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Classification for Empiric Antibiotic (1) (2)

(1) Native Heart Valve Ineffective Endocarditis
(2) Prosthetic Heart Valve Ineffective Endocarditis

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Empiric Antibiotic for Acute Native IE ________ & if allergic ____

(1) Vancomycin + Beta Lactam
(2) Cefazolin, Naphazoline

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Empiric Antibiotic for Subacute Native IE ________ & if allergic ____

(1) Vancomycin + Ampicillin / Sulbactam
(2) Vancomycin + Ceftriaxon

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Empiric Antibiotic for Acute Prosthetic IE ________ or ____

(1) Vancomycin + Ceferine or
(2) Gentamycin ± Rifampicin

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Empiric Antibiotic for Subacute Prosthetic IE ________ & if allergic ____

(1) Vancomycin + Ampicillin / Sulbactam
(2) Vancomycin + Ceftriaxone or Gentamycin ± Rifampicin

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_____ direts the causative agent when blood culture is not done

Empiric Antibiotic

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In preventive measure consider the _____ and give _____

(1) px history
(2) antibiotic prophylaxis (Amoxicillin) 30-60 mins prior to dental procedure

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Surgery is done if px is in _____ state or _____

(1) Refractory state
(2) Valves are totally damages

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If damaged heart valve _________; If heart valve can be repaired _____

(1) Prosthetic HV or Valve Replacement Surgery
(2) Valvular repair

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Treatment Regime for IE (1) (2) (3)

(1) Surgery
(2) Preventive Measures
(3) Antibiotic

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Choose:
1 Staphylococcus Aureus (+)
2 Bacteremia
3 Streptococcus Viridians
4 Candida (+)
5 HACEK groups
6 Enterococcus (+)
7 Streptococcus Bovis/Gallolyticus
8 Staphylococcus Epidermis (+)

high affinity in prosthetic devices or pacemaker

8 Staphylococcus Epidermis (+)

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Choose:
1 Staphylococcus Aureus (+)
2 Bacteremia
3 Streptococcus Viridians
4 Candida (+)
5 HACEK groups
6 Enterococcus (+)
7 Streptococcus Bovis/Gallolyticus
8 Staphylococcus Epidermis (+)

Bac present in indiv w gastrointestinal disease, inflammatory bowel disease (Crohn’s disease)

7 Streptococcus Bovis/Gallolyticus

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Choose:
1 Staphylococcus Aureus (+)
2 Bacteremia
3 Streptococcus Viridians
4 Candida (+)
5 HACEK groups
6 Enterococcus (+)
7 Streptococcus Bovis/Gallolyticus
8 Staphylococcus Epidermis (+)

Bac can enter thru any form of dental procedure, Chain like structures, vulnerable ppl w poor dentition, subacute IE

3 Streptococcus Viridians

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Choose:
1 Staphylococcus Aureus (+)
2 Bacteremia
3 Streptococcus Viridians
4 Candida (+)
5 HACEK groups
6 Enterococcus (+)
7 Streptococcus Bovis/Gallolyticus
8 Staphylococcus Epidermis (+)

Bac present in urinary tract, inflammation of renal pelvis or genital procedure

6 Enterococcus (+)

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Choose: 1 Staphylococcus Aureus (+) 2 Bacteremia 3 Streptococcus Viridians 4 Candida (+) 5 HACEK groups 6 Enterococcus (+) 7 Streptococcus Bovis/Gallolyticus 8 Staphylococcus Epidermis (+) First discovered as primary cause of subacute IE, Bac can enter thru any form of dental procedure, Rug shaped

5 HACEK groups (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, & Kingella)

Choose: 1 Staphylococcus Aureus (+) 2 Bacteremia 3 Streptococcus Viridians 4 Candida (+) 5 HACEK groups 6 Enterococcus (+) 7 Streptococcus Bovis/Gallolyticus 8 Staphylococcus Epidermis (+) colonize prosthetic heart valve seen in immunocompromised px (HIV, AIDS) the only fungi, infective nonbacterial yeast that causes endocarditis

4 Candida (+)

Choose: 1 Staphylococcus Aureus (+) 2 Bacteremia 3 Streptococcus Viridians 4 Candida (+) 5 HACEK groups 6 Enterococcus (+) 7 Streptococcus Bovis/Gallolyticus 8 Staphylococcus Epidermis (+) S. aureus enter thru penetration causes CUS (_____)

2 Bacteremia C - Catheters, Prosthetic HV U - Use of dirty IV needles S - Skin boils or pigsa

Choose: 1 Staphylococcus Aureus (+) 2 Bacteremia 3 Stephtococcus Viridians 4 Candida (+) 5 HACEK groups 6 Enterococcus (+) 7 Streptococcus Bovis/Gallolyticus 8 Staphylococcus Epidermis (+) arranged in clusters; can directly cause IE if colonized heart valve the only bac that can colonized endo despite no history of abnormal heart valve

1 Staphylococcus Aureus (+)

advance state of S. Auerus infection in skin | a rare bac infection, spreads quickly in the body & can cause death

Necrotizing fasciitis

Organisms involved in IE (SBS CHESS)

1 Staphylococcus Aureus (+) 2 Bacteremia 3 Stephtococcus Viridians 4 Candida (+) 5 HACEK groups 6 Enterococcus (+) 7 Streptococcus Bovis/Gallolyticus 8 Staphylococcus Epidermis (+)

Acute IE caused by _______l Subacute IE caused by _____

(1) Staphylococcus Aureus (2) Streptoccocus Virdians

symptoms/signs of Subacute IE (1) (2) (3)

(1) Fatigue (2) Diff breathing (3) Low grade fever

symptoms/signs of Acute IE (1) (2) (3) (4)

(1) Sepsis (2) Murmurs (3) Very sick indiv (4) Very high fever

NBTEs is short for __________, after formation of this it can cause ______

(1) Non Bacterial Thrombo Endocarditis (2) Bacterial Colonization

Heart valves: ______; Bicuspid Aortic Valves: _____

(1) prone to infection (2) 30% develop endocarditis

How does IE start? px should/have (1) (2) (3) (4)

(1) Bicuspid heart valve or Prosthetic heart valve (2) RHD Rheumatic Heart Disease (3) Abnormal heart valve (4) History of IE

Procedures to increase revascularization (PC)

(1) Percutaneous Coronary Intervention (2) Coronary Artery Bypass Graft

Aftercare treatment for PCI

(1) Angioplasty (2) DAPT Dual Anti Platelet Theraphy (3) After 1 yr Aspirin

True of False CABG category/qualification 1. main vessel or coronary artery is affected. 2. if there are multiple sites for reperfusion

True

True or False There is no possibility of re-thrombosis and it is a combination of angioplasty + stunt

First false, Second is true

The treatment regime for RHD is considered the gold standard

Increase Revascularization of Vessel

(1) ______Method that gives Tissue Plasminogen Activator, inc activity of plasma & disollves clot. Not commonly used SE & should be only used w (2) _______

(1) Thrombolysis (2) PCI: Percutaneous coronary intervention

Choose: (1) Nitroglycerin, (2) Beta Blockers (3) Morphine both dilator of veins & arteries;

(1) Nitroglycerin

Choose: (1) Nitroglycerin, (2) Beta Blockers (3) Morphine reduces contractility of heart = reduce HR

(2) Beta Blockers

Choose: (1) Nitroglycerin, (2) Beta Blockers (3) Morphine Reduces POSA _______

(3) Morphine P - preload | O - oxygen demand | S - SV | A - Afterload

_____ anti cholesterol drugs; _____ anti hypertensive drug

(1) Statin; (2) Ace Inhibitors

_____ blocks thromboxane A2; ______ blocks ADP

(1) Aspirin; (2) P1Y12 Receptor Inhibitor

____ reduce LDL & increase HDL

Statins

Ace Inhibitors reduces _______

cardiac remodeling

______ inhibits clotting factor X & thrombin; * both involved in formation of fibrin monomers, form on the surface of platelet & form reticulum of clot

Anti Thrombin III

Why do platelets clamp together?

Due to SAT (Serotonin, ADP, Thromboxane A2) attract platelet & clamp them together

Anti Platelet Drugs are (1-5)

(1) Statins (2) Heparin (3) Aspirin (4) P1Y12 Receptor Inhibitor (5) Ace Inhibitors

Drugs that Reduce Oxygen Demand (1-3)

(1) Nitroglycerine (2) Beta blockers (3) Morphine

Increase Revascularization of Vessel (1-2)

(1) Percutaneous Coronary Intervention (2) Coronary Artery Bypass Graft

time between atrial depolarization and ventricular depolarization, suggestive of AV conduction time

PR Interval

____ stimulate vasoconstriction, blocked ok

Alpha & Beta 1 Receptor

Beta 2 Receptors stimulate _______ and ______

(1) Vasodilation (2) blocked not ok

Treatment for Prinz Metal Angina

(1) Give Calcium Channel Blockers (2) Give Nitroglycerin BUT do not give Beta Blocker

EXAMINATION or SYMPTOMS for Prinz Metal Angina

(1) Px similar symptoms IHD (2) Normal BMI or BP (3) No familial history or diabetes (4) Young female w alcohol abuse, narcotic use and long term smoking (5) Px has migraines from taking triptanes (cause vasospasm CA & lessens lumen

Diagnosis for PMA

(1) EC no ST Elevations (2) Blood Chem: 0 or (-) tropnin

Stable Angina: _______; Unstable & Subendocardial Infarction: ______ and Transmural Infarction _____

(1) 70% Occlusion, 30% Lumen (2) 90% Occlusion, Near Total Occlusion (3) 100% Occlusion, Total Occlusion of BV

_______ stable plaque, Encapsulated w fibrous capsule, COE ______ and angina is ____

(1) Stable Angina (2) Ischemic but not dead (3) Exertion

______ is unstable plaque, Fibrous capsule very weak, ruptures or fissures exposing plaque, Platelets converge = thrombus but COE ______

(1) Subendocardial Infarction (2) Infarction, Dead & No oxygen supply

NSTEMI _______; STEMI ______

(1) Non ST Elevation Myocardial infarction (2) ST Elevation Myocardial Infarction

In transmural infraction: Plaque ______; Platelets: _____l Blood chem _____, ____ is affected, dead, infarction & Angine is felt at rest with _____

(1) unstable (2) occlude entire lumen (3) hi level of troponin (4) Walls of the heart -epi,myo, endo (4) compressing

_____ is due to to vasospasm or vasoconstriction, no _____ & ____. Affected area _______ & Angina: at rest with _______

(1) Prinz Metal Angina (2) Relation to ischemia or angina (3) Plaque formation (4) Compressing pain left shoulder, head & neck

The (1) (2) (3) are categorized as ______ syndrome

(1) Unstable angina (2) Subendocardial Infarction (3) Transmural Infarction (4) Acute Coronary

Instances that require HIGH OXYGEN demand (4)

(1) Inc Heart Rate (2) Left ventricle hypotrophy (3) Inc thyroid hormone prod (indiv ppl w hyperthyroidism (4) Exercise

Instances that require LOW OXYGEN demand (3)

(1) Formation of EMBOLI or THROMBUS in major CA (2) VASCULITIS: Inflamm CV (3) VASOSPAMS: constrtion CA

RISK FACTORS for Atherosclerosis or IHD

(1) BMI equal or more than 30 (obese) (2) Age equal or more than 60 (elderly) (3) Diabetes (4) Familial (5) Alcohol use (6) Tobacco or Vaping (7) Hyperlipidemia

Hyperlipidemia is ______ & _____

(1) Inc LDL (Low-Density Lipoprotein) (2) Dec HDL (High Density Lipoprotein)

______ cant be changed; _____ can be changed

(1) Non modifiable risk factors (2) Modifiable risk factors

Treatment for Atherosclerosis

Angioplasty

most or main cause of CAD/IHD | “plaque formation”

Atherosclerosis

fatty or cholesterol deposits, reduces the diameter of blood vessel therefor less blood is moving into the tissues distal where the plaque is

Plaque

coronary artery forms plaque that occludes lumen of blood vessels

Atherosclerosis

Hospital Term for IHD

Coronary Artery Disease (CAD)

Less blood = Less oxygenation = _______ = Ischemia = _____

(1) Hypoxemia (2) Infarction

____ is triggered when not enough oxygen in heart tissue

SNS

occlusion on coronary artery & low oxygen supply

ischemic heart disease

Ischemic Heart Disease & Ineffective Endocarditis Flashcards

(80 cards)