Cardiac - Infections/inflammation

Question 1

Infective endocarditis bacteria (culture positive)

Answer 1

Strep. viridans 
Strep. bovis 
Staph. aureus 
Staph. epidermidis 
Enterococci
pseudomonas

Question 2

Infective endocarditis bacteria (culture negative)

Answer 2

HACEK 
Haemophilus 
Actinobacterium
Eikenella
Kingella
Coxiella 
Chlamydia

Question 3

“Non-infective” causes

Answer 3

SLE

Marantic - associated with rheumatoid arthritis, some cancers (marantikos = wasting away)

Question 4

IE criteria

Answer 4

Dukes criteria 
Dx if:
- 2 major
- 1 major and 3 minor 
- All 5 minor

Question 5

Major Dukes criteria

Answer 5

Culture positive

major echo findings

Question 6

Minor Dukes criteria

Answer 6

Minor echo findings
Minor culture positive
Fever >38
Immune phenomenon - GN, oslers nodes, roth spots
Embolic phenomenon - septic infarcts, splinter haem., janeway lesions

Question 7

Extra-cardiac features of IE

Answer 7

Fever + rigors
night sweats 
Weight loss 
Anaemia 
Splenomegaly
clubbing

Question 8

Cardiac features of IE

Answer 8

new/changed murmur (MR 85%, AR 55%)
AV block
LVF

Question 9

Management of IE

Answer 9

Acute empiric:
Fluclox + gent IV
Subacute empiric:
Benpen + gent IV
Depends upon culture results 
Consider surgery

Question 10

Indications for surgery in IE

Answer 10

Heart failure
Emboli
Valve obstruction
Prosthetic valve

Question 11

Rheumatic fever bacteria

Answer 11

Strep viridans

Question 12

Criteria for dx rheumatic fever

Answer 12

Jones criteria
Dx when:
2 major criteria
1 major and 2 minor

Question 13

Major Jones criteria

Answer 13

Pancarditis 
arthritis 
subcutaneous nodules
erythema marginatum
sydenhams chorea

Question 14

Minor jones criteria

Answer 14

Fever
Raised CRP/ESR
Arthralgia 
prolonged PR intervals 
previous rheumatic fever

Question 15

Features of rheumatic fever

Answer 15

pancarditis 60%
arthritis 75%
subcutaneous nodules 2-20%
Erythema marginatum 2-10%
Sydenhams chorea 10%

Question 16

Blood tests for RF

Answer 16

ASOT (antistreptolysin titre)

Strep Ag test

Question 17

Mx of RF

Answer 17

benpen 06-1.2mg IM for 10 days
analgesia
steroids - if CCF or cardiomegaly
haldol or diazepam for chorea

Question 18

Causes of acute pericarditis

Answer 18

Viral - coxsackie, flu, EBV, HIV
Bacterial - pneumonia, RF, TB, staph
Fungal
Other - MI, dresslers syndrome
Drugs - penecillin, isonazid, procainamide, hydralazine
Other:
Uraemia, RA, SLE, Sarcoid and radiotherapy

Question 19

Pericardial conditions

Answer 19

Pericarditis (Acute and constrictive)
Pericardial effusion
Tamponade

Question 20

Features of pericarditis

Answer 20

sharp pain 
central or retrosternal 
worse lying down 
improved by sitting up
Fever

Question 21

ECG signs of pericarditis

Answer 21

saddle shaped ST-elevation +/- PR depression

Question 22

Mx of pericarditis

Answer 22

analgesia (ibuprofen)
consider steroids
Treat cause

Question 23

Percardial effusion causes and features

Answer 23

Any cause of pericarditis 
Features:
Dyspnoea 
raised JVP 
Ewarts sign - bronchial breathing at left base
?signs of cardiac tamponade

Question 24

Constrictive pericarditis features

Answer 24

• RHF with raised JVP
• Kussmals sign (NB NOT breathing) - JVP raised and pulsitile on inspiration
• Hepatosplenomegaly
• Acities, oedema