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Y4 Paeds > Cardio > Flashcards

Cardio Flashcards

1
Q

state two infections can that affect the heart in children?

A

infective endocarditis

acute rheumatic fever

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2
Q

what congenital heart conditions can occur with IE?

A

ventricular septal defects
patent ductus arteriosus
aortic valve abnormalities
tetralogy of fallot

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3
Q

what is the triad features of IE?

A

endothelial damage
platelet adhesion
microbial adherence

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4
Q

what happens to the bacteria once they attach to the lesion of damaged endothelial ?

A

the bacteria are protected within the vegetation from phagocytic cells and host defense mechanisms and so can proliferate easily

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5
Q

what specific surface receptor does organisms that cause IE have ?

A

surface receptors to fibronectin that allow the microbe to adhere to the thrombus at the outset

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6
Q

what organisms commonly cause IE?

A

Staphylococcus Aureus, Streptococcus Viridans

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7
Q

what are the HACEK organisms?

A

Haemophillus, Actinobacillus, Cardiobacterium, Eikenella and Kingella

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8
Q

state some features of IE?

A

persistent low grade fever
heart murmur
splenomegally
- petechiae, oslers nodes, laneway lesions, splinter haemorrhages (embolic phenomena)

PE, haematuria (due to glomerular nephritis), cerebral emboli, roth spots on the retina

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9
Q

what investigations should be done for IE?

A

blood cultures

Echo

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10
Q

what criteria is used for diagnosing IE?

A

Dukes criteria

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11
Q

in order to confirm diagnosis how many major or minor should be present ?

A

2 major
1 major and 3 minor
5 minor

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12
Q

what are the minor criteria for dukes criteria?

A

predisposing heart condition

fever

vascular phenomena

immunological phenomena (roths, oslers, GN, RF)

+ blood cultures

echo findings

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13
Q

what are the two major criteria of the dukes criteria?

A

+ blood cultures for endocarditis (2 separate cultures take 12hrs apart)

evidence of endocardial involvement

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14
Q

what three factors increase the possible need for surgical intervention?

A 
vegetation (>1.5cm, mobile, increase of size)
valvular dysfunction 
perivalvular extension (new heart block, large abscess despite management, valvular rupture)
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15
Q

what are the antibiotics commonly used to treat IE?

A

IV penicillin or IV ceftriaxone for 4 weeks
or/and
IV gentamicin for 2 weeks

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16
Q

what antibiotic is used for methicillin IE?

A

vancomycin for 6 weeks

17
Q

what antibiotics are used for HACEK organisms IE?

A

ceftriaxone along with gentamicin for 4 weeks

18
Q

what are fungal IE treated with?

A

amphotericin B

19
Q

what increases the risk of IE?

A 
acquired valvular heart disease 
hypertrophic cardiomyopathy 
previous IE 
structural congenital heart disease 
valvular replacement
20
Q

what usually precedes acute rheumatic fever?

A

2-4 weeks after pharyngitis

21
Q

what organism most commonly causes acute rheumatic fever?

A

streptococcus pyogenes

22
Q

why can pharyngitis cause acute rheumatic fever?

A

cross-reactivity to group A β-haemolytic streptococcus (GAS)

23
Q

what gender is most affected by rheumatic fever?

A

females

24
Q

is streptococcus pyogenes a gram negative cocci?

A

no

- gram positive cocci

25
Q

what are the two cytolytic toxins produced by strep pyogenes?

A

streptolysin O and S.

26
Q

what is the pathophysiology of rheumatic fever?

A

strep pyogenes contain M proteins in their cell wall
B cells produce anti-M protein antibodies which cross react with tissues in the body
this is exacerbated by production of activated cross reactive T cells

27
Q

what are risk factors of rheumatic fever?

A 
extremes of age 
poverty 
overcrowding 
FHx
D8/17 B cell antigen positivity
28
Q

what criteria is used for rheumatic fever?

A

revised jones diagnostic criteria

29
Q

what valve in the heart is most affected by rheumatic fever?

A

mitral

30
Q

what two things are required for diagnosis of rheumatic fever?

A
  1. +throat culture for strep pyogenes or raised anti streptolysin A or anti-deoxyribonuclease B titre
  2. 2 major criteria or 1 major and 2 minor
31
Q

what is the major criteria for rheumatic fever? SPECS

A 
Sydenham’s chorea
Polyarthritis
Erythema marginatum 
Carditis
Subcutaneous nodules
32
Q

what is the minor criteria for rheumatic fever? CAPE

A

CRP or ESR – Raised acute phase reactant
Arthralgia
Pyrexia/Fever
ECG – Prolonged PR interval

33
Q

what are the DD for rheumatic fever?

A

septic arthritis
reactive arthropathy
infective endocarditis
myocarditis

34
Q

what two things is reactive arthritis associated with ?

A

urethritis

conjunctivitis

35
Q

what ECG changes might be seen with myocarditis ?

A

saddle ST segments or T wave changes

36
Q

what investigations can be done for rheumatic fever?

A 
Bloods - FBC, CRP, ESR, culture
rapid antigen detection test 
throat culture 
anti streptococcal serology 
ECG 
CXR 
ECHO
37
Q

what might the ECG show for rheumatic fever?

A

prolonged PR interval

38
Q

what is the management of rheumatic fever ?

A

Antibiotics e.g. benzathine benzylpenicillin

aspirin

assess for emergency valve replacement

39
Q

what prophylaxis can be given for rheumatic fever?

A

intramuscular Benzathine benzylpenicillin every 3-4 weeks, oral Phenoxymethylpenicillin twice daily, oral sulfadiazine daily, or oral azithromycin (in penicillin allergy)

Y4 Paeds (15 decks)

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