Cardio

Question 1

New HF medicines
1)SGLT2 inhib Pbs only for DM and HF pts
2) recent evidence of VICTORIA trial
For Vericiguat NO-sGC-CGMP stimulator, increased responsive to endocardial endothelium secreted NItric oxide (in HF, NO-CGMP axis is dysregualted causing impaired diastolic relaxation and microvasc dysfunction)

Answer 1

What are new HF therapies?

Question 2

What is max IV frusemide for HF and CKD?

Answer 2

Hf:
max 240 mg daily then Iv frusemide infusion-> dialysis
CKD: 600 mg IV daily

Question 3

What is nonpharm therapies for HF?

Answer 3

CRT and AICD
Advanced:

Lft vent assist device (commenced only if transplant candidate )
Heart transplant

Question 4

Why ACE preferred over ARB?

Answer 4

Cheap and more evidence based

Question 5

When can we use epilirnone with trial of spiro?

Answer 5

In MR

Question 6

what are predesposong condition for IE as per ICE cohort

Answer 6

• Native Valve predespostion
• Invasive surgery in previous 60 days
• Congential Heart Disease
• Ch IV access
• Current IV drug abuse
• Previous IE

Question 7

HOw IE epidemiology is changing ?

Answer 7

More now in elderly and co morbid pts.

Question 8

what organsim are responsible for IE in decending order ?

Answer 8

Staph Aureus 
Viridin 
Coagulase -ve(S .Epidermidis)
Enterococcus
Culture -ve
S bovis 
HACEK

Question 9

why eneterococcus faecalis has reduced affinity to pencillin and resistance to Cephlosporins

Answer 9

It is due to low affinity penicillin binding proteing PBP -5. They can do transpeptidation in th epresence of theses abx

Question 10

what is the mechanism of synergy BW beta lactm Abx and aminoglycoside?

Answer 10

Bacteria uptake of aminiglycoside increases when cell wall glycopeptides reduced by Beta lactam

Question 11

what MOA of synergy between Cefotaxine and amoxicillin in Enterococcus faecalis ?

Answer 11

IT Is due to different saturation of PBP
Penicillin partially saturated PBP 4 and 5
While cefotaxime bind to 2 and 3 at low concentaration

Question 12

when can TTE exclude IE

Answer 12

Nosocomial acuisation of Staph
Subsequent -ve Blood cultures
Nil Prosthetic device
Nil clinical or secondary foci of infection

Question 13

what is optimal Rx duration of staph bacteremia ?

Answer 13

–>uncomplicated 2 week
Nil IE, Nil prosthetic device , -ve cultures , Nil metastatci infection,Nil MRSA groth, Deferevesence in 72 hours

–>Complicated 4-6 weeks

Question 14

what are th erecent advnaces in E Faecalis IE?

Answer 14

Ampicillin and ceftriaxone as effective as Amp+Gent (Infact better if Crcl < 50)
Gent can be given single daily doses.
Gent can be given only for 2 weeks.