Cardio - RF , IEC , arrhythmia

Question 1

C\P of RF major points :
……….. , ……….. , ……….. , …………. , ………..

Answer 1

Arthritis , carditis , chorea, SC nodule , Erythema marginatum

Question 2

C\P of RF Minor points : ………………. ,…………………. , …………………… ,……………………. ,…………………..

Answer 2

previous attack of RF , fever >38.5c, prolonged PR interval , Arthralgia , acute phase reactants and inc ESR

Question 3

Diagnosis of RF :

Answer 3

Revised Jones : 2 major or 1 major and 2minor ++ Evidence of recent strept infection

Question 4

Evidence of strept infection ::

Answer 4

history of scarlet fever, anti streptolysin O titer >333 or rising titer , throat culture, rising Ag test for gp A strept

Question 5

If Anti Streptolysin O titer false negative (20%)&raquo_space;»

Answer 5

do Anti DNAse B

Question 6

ttt of RF : 1- 2- 3- 4-

Answer 6

1- Pt. education , 2- prevention , 3- medical , 4- surgical valve correction

Question 7

ttt of RF
Pt. education :

Answer 7

small frequent meals, salt restriction, Brisk walking

Question 8

1ry prevention of RF :

Answer 8

proper ttt of tonsillitis & pharyngitis&raquo_space; Methyl-Penicillin 500mg 3\day for 10 days

Question 9

2ry prevention of RF : ………………………………….
- no carditis = ………………………………
- mild carditis\moderate= …………………..
- sever carditis = ……………………………..

Answer 9

Benzathine Penicillin 1.2 - million unit IM every 3 weeks
- no carditis = 20yrs old or 5years from last attack which ever longer
- mild carditis\moderate= 25yrs old or 10 years \\\\\\\\\\\\
- sever carditis = 45yrs old 10 years \\\\\\\\\\\\\\\\\\\

Question 10

Medical ttt of RF :
- Arthritis & mild carditis&raquo_space;………………………………………………………….
- sever carditis&raquo_space;> ……………………………………………….
- chorea&raquo_space;> ………………………………….

Answer 10

• Arthritis & mild carditis&raquo_space;Aspirin 100mg\kg\d divided over 6 doses for 2 weeks then 60mg\kg\d for 3 weeks
  - sever carditis&raquo_space;> Prednisone 1 mg\kg\d over 6 divided doses for 3 weeks
  - chorea&raquo_space;> Haloperidol 1 mg\d

Question 11

Clubbing most common occurred in which cardiac dis&raquo_space;> …………………..

Answer 11

infective endocarditis

Question 12

inv for IEC&raquo_space; ………… ,…………… ,. ………….. ,………….

Answer 12

Blood culture , Echo , Lab (ESR,TLC,CRP), serology

Question 13

Modified Dule’s criteria (diagnosis of IEC) : ……………………………………..

Answer 13

2major \ 1major+3minor \ 5minor

Question 14

Major criteria IEC : …………….. ,……………….. ,……………..

Answer 14

+ve Blood culture ,+ve Echo findings , new regurgitation of valve lesion

Question 15

+ve blood culture for IEC = ………………………………

Answer 15

same organism in at least 2 of the 3 sets + known to cause IEC

Question 16

Minor criteria for IEC: …………………… ,…………….. ,………………. ,………………. ,……………..

Answer 16

history of PDfs , fever >38c , vascular phenomenon , immune phenomenon , +ve blood culture nor to major criteria

Question 17

TTT of IEC : ………. ,……….. ,…………..

Answer 17

prophylaxis , medical ,surgical

Question 18

Ttt prophylaxis before operations in IEC&raquo_space; ……………………

Answer 18

1 hr before > oral Amoxicillin 2g

Question 19

Ttt of acute endocarditis&raquo_space; …………………………

Answer 19

empirical Abs after Bl.culture

Question 20

Abs combination for G-ve and G+ve&raquo_space; ………………………….

Answer 20

IV Vancomycin+Ceftriaxone (both 2g\d)

Question 21

Ttt of sub acute IEC&raquo_space; ……………………….
- MRSA&raquo_space; ………………
- strept.&raquo_space; ………………..

Answer 21

symptomatic waiting cultures results after 5days
- MRSA&raquo_space; Vancomycin 2g\d
- strept.&raquo_space; penicillin G 24 million unit\d

Question 22

Indications of Surgical ttt of IEC :

Answer 22

failure to dec fever , congestive HF, Embolism, prosthetic valve dehiscence , fungal EC

Question 23

Late manifestation of Acute RF :

Answer 23

chorea

Question 24

Chorea aggravated during ……………..

Answer 24

pregnancy

Question 25

Vegetation in acute rf is ……………

Answer 25

aseptic

Question 26

The most commonly affected valve in drugs addicts :…………………

Answer 26

tricuspid valve

Question 27

Hand signs in IEC : ………… , …………….. , …………….. , ……………….

Answer 27

clubbing , splinter Hge, Jane way sign , osler’s nodules

Question 28

Fundoscopic findings in IEC : ……………..

Answer 28

Roth spots

Question 29

Emergency management of arrhythmia:
1- Supra-ventricular tachycardia (PSVT m.c. on a normal heart):
Hemodynamically unstable » ………………
If Hemodynamically stable&raquo_space; VAGAL MANEUVERS (Carotid sinus massage or Valsalva) = if AVN → this may terminate SVI
If failed → IV (jugular cannula) ADENOSINE (Given as 6 mg (wait for 2 mins) = if failed » increased to 12 mg (wait 2 mins) up to 2x
If failed → IV VERAPAMIL 5 mg over 2 mins If failed » another 10 mg can be given after 10 mins
If failed → IV PROPRANOLOL 1 mg over 1 mins Can be repeated every 5 min up to 5x
If all pharmacological measures failed → Synchronized Cardioversion

Answer 29

Synchronized Cardioversion

Question 30

Emergency management of arrhythmia:
1- Supra-ventricular tachycardia
If Hemodynamically stable&raquo_space; ……………….. = if AVN → this may terminate SVI
If failed → ………………………..
if failed »…………………………..
If failed → ……………………..
If failed » ……………………..
If failed → …………………………………
If all pharmacological measures failed → ………..

Answer 30

f Hemodynamically stable&raquo_space; VAGAL MANEUVERS (Carotid sinus massage or Valsalva) = if AVN → this may terminate SVI
If failed → IV (jugular cannula) ADENOSINE (Given as 6 mg (wait for 2 mins) = if failed » increased to 12 mg (wait 2 mins) up to 2x
If failed → IV VERAPAMIL 5 mg over 2 mins If failed » another 10 mg can be given after 10 mins
If failed → IV PROPRANOLOL 1 mg over 1 mins Can be repeated every 5 min up to 5x
If all pharmacological measures failed → Synchronized Cardioversion

Question 31

Emergency management of arrhythmia:
Atrial flutter


Answer 31

IF DIAGNOSED AS SVT & GIVEN IV NON-DHP OR B-BLOCKERS THE RATE WILL SLOW DOWN BUT THE RHYTHM WON’T BE CORRECTED
TTT AS A. FIB.


Question 32

Atrial Fibrillation (m.c. arrhythmia on a structural heart ds) with rapid ventricular response:
Hemodynamically unstable&raquo_space;……………………..

Answer 32

Bolus of Unfractionated Heparin 80 IU/Kg followed by DC cardioversion

Question 33

Atrial Fibrillation
Hemodynamically stable →
* If < 48 hrs = …………………….

Answer 33

Cardioversion (Medical or electrical):

Question 34

Atrial Fibrillation
Hemodynamically stable
* If < 48 hrs
& No structural heart ds:
…………………………………………..

Answer 34

PROPAFENONE 600 mg

Question 35

Atrial Fibrillation
Hemodynamically stable
* If < 48 hrs
- With structural heart ds:………………………………………………….

Answer 35

AMIODARONE 5 mg/Kg loading then 50 mg/hr for 24 hrs

Question 36

Atrial Fibrillation
Hemodynamically stable
If ≥ 48 hrs
Or Pt. is uncertain
or Previous thromboembolism or Rheumatic MS

Answer 36

Rate control if the Pt. is distressed

Start Warfarin for 1 mn cross-bridged with LMWH till INR 2-3
Arrange for elective TEE + Cardioversion

Rate control: (target 80 - 110 BPM): a- No heart failure » IV Verapamil or -Blockers
b- if Heart failure IV Amiodarone or IV Digoxin

Question 37

Ventricular tachycardia
- Hemodynamically unstable (Cardiac Arrest) → …………….» failed → ……….→ Failed
→………………………….
→ ……………………..

Answer 37

DC Shock » failed → CPR (2mins) → Failed
→ IV Adrenaline every 5 mins
→ IV Amiodarone or Lidocaine

Question 38

Ventricular tachycardia:
-Hemodynamically stable
if on top of M. Infarction or Heart failure « …………………………..
if Monomorphic VT → ……………..

Answer 38

if on top of M. Infarction or Heart failure « IV Amiodarone
if Monomorphic VT → IV Lidocaine

Question 39

Premature Ventricular contraction:
if no structural heart ds & no symptoms → ………………..
if no structural heart ds but having symptoms e.g. COP = ………………….
If structural Ht. ds » …………………………..

Answer 39

If no structural heart ds & no symptoms → Reassure
if no structural heart ds but having symptoms e.g. COP = Non-DHP or _Blockers
If structural Ht. ds » Refer for evaluation