acquired cardiac disorder

Question 1

bacterial endocarditis (BE)

Answer 1

inflammatory process resulting from infection of the valves and inner lining of the heart

Question 2

when is there an increased risk of bacterial endocarditis

Answer 2

CHD or acquired heart disease

following dental procedures, surgery with intracardiac lines

Question 3

most common causative agents for bacterial endocarditis

Answer 3

streptococcus viridans
staphylococcus aureus
gran negative bacteria such as candida albicans

Question 4

how does bacterial endocarditis form?

Answer 4

organism enters blood stream from localized infection
vegetation and fibrin deposits, and thrombi form
lesions may invade adjacent tissues or break off and embolize elsewhere

Question 5

manifestations of BE

Answer 5

low grade intermittent fever
anorexia
malaise
wt loss
joint pain
*positive blood culutre
*new heart murmur or change in existing one
*petechia of mucous membranes
*janeway lesions
*osler nodes
*splinter hemorrhages of nails

Question 6

therapeutic management of BE

Answer 6

IV abx 2-8 weeks

surgical removal of emboli or valve replacement

Question 7

prevention of BE

Answer 7

prophylactic abx for 1 hour before risky procedures

Question 8

patient teaching for BE

Answer 8

teach about prophylactic abx
teach family when to give prophylactic abx
symptomatic relief
monitor for emboli

Question 9

rheumatic fever

Answer 9

systemic inflammatory disease that follows group A strep.
autoimmune reaction to strep antibodies
rheumatic heart disease may form

Question 10

aschoff bodies (RF)

Answer 10

inflammatory hemorrhagic bullous lesions that are formed and cause swelling, fragmentation, and alterations in connective tissue

Question 11

what age group is rheumatic fever commonly seen

Answer 11

school age

Question 12

what appears 2-6 weeks prior to the first symptom of rheumatic fever

Answer 12

antecedent upper respiratory infection

Question 13

major manifestations (symptoms) of RF

Answer 13

polyarthritis
carditis 
chorea -jerky involuntary movements affecting especially the shoulders, hips, and face.
erythema marginatum
subq nodules

Question 14

minor manifestations (symptoms) of RF

Answer 14

arthralgia
low grade fever
elevated ASO titer
abdominal pain

Question 15

therapeutic management of RF

Answer 15

eradication of beta strep
prevent cardiac damage
prevent reoccurrence and endocarditis

Question 16

how do you prevent cardiac damage from RF

Answer 16

salicylates (ASA) 2 weeks for inflammation
steroids to decrease inflammation
bed rest

Question 17

how do you prevent recurrence of RF and endocarditis

Answer 17

prophylactic antibiotics

Question 18

kawasaki diease

Answer 18

acute systemic vasculitis of unknown cause

Question 19

incidence of kawasaki disease

Answer 19

pre-pubertal children, usually boys under 2
more frequently seen winter and spring
usually self limiting and resolves without tx

Question 20

acute phase of kawasaki disease

Answer 20

lasts 8-10 days
fever
pruritic polymorphic rash
cervical lymphadenopathy
dry, red, cracked lips
strawberry tongue
bilateral conjunctivitis without exudation 
erythema and swelling of palms and soles

Question 21

subacute phase of kawasaki disease

Answer 21

lasts 10-35 days
begins with resolution of fever and lasts until all clinical signs have disappeared
vasculitis
desquamation of toes, feet, fingers and palms
arthritis
thrombocytosis

Question 22

convalescent or recovery phase of kawasaki disease

Answer 22

lasts up to 10 weeks
symptom free
this phase is complete when all blood values have returned to normal.
*THIS IS THE MOST DANGEROUS STAGE

Question 23

signs and symptoms of MI in children

Answer 23

abdominal pain
vomiting
restlessness
inconsolable crying
pallor
shock