Cardiology

Question 1

When is prophylaxis indicated for prosthetic heart valves?

Answer 1

Gingival manipulation or respiratory incision (strep viridans. AHA recommended Amoxicillin/Ampicillin

Question 2

When is prophylaxis indicated for prior infective endocaditis?

Answer 2

GU or GI tract procedure with active infection (enterococcus) AHA recommended Amoxicillin/Ampicillin

Question 3

When is prophylaxis indicated for structural valve abnormality in a transplanted heart?

Answer 3

Surgery on infected skin or muscle. AHA recommended Amoxicillin/Ampicillin

Question 4

When is prophylaxis indicated for unrepaired cyanotic congenital heart disease?

Answer 4

Surgical placement of prosthetic cardiac material (Staph) AHA recommended Amoxicillin/Ampicillin

Question 5

What are empiric antibiotics for native valve endocarditis? Prosthetic valve endocarditis?

Answer 5

For native valve endocarditis; Vancomycin plus Ceftriaxone OR gentamicin For prosthetic valve endocarditis; Vancomycin plus Gentamicin plus Rifampin

Question 6

What are indications for surgery in infectious endocarditis?

Answer 6

Valve dysfunction who have symptoms of heart failure Left-sided infective endocarditis due to Staphylococcus aureus, fungal pathogens, or other highly resistant organisms Annular or aortic abscess, heart block, or destructive penetrating lesions Bacteremia or fevers persisting ≥ 5-7 days

Question 7

What is HOCM? What is the epidemiology?

Answer 7

—Genetically determined heart muscle disease (60 to 70 percent) caused by mutations in one of several sarcomere genes

—Hypertrophied myocytes arranged in a chaotic and disorganized fashion with a varying amount of interstitial fibrosis intertwined among the myocyte

—Approx 1 out of every 500 adults (0.2 percent)

Question 8

How do you diagnose HOCM?

Answer 8

• LV wall thickening ≥15 mm anywhere in the LV wall w/o other identifiable causes (e.g., HTN, valve disease)
• (SAM) or hyperdynamic LV are not obligatory for diagnosis

Question 9

How do you medically manage HOCM?

Answer 9

• Less severe cases - IVF, beta blocker, CCB, disopyramide (2nd line).
• Severe obstruction

—Increase preload - elevation of the legs, IVF

—IV phenylephrine

—IV beta blocker (propranolol, esmolol)

—Surgical options – Myectomy, Alcohol Septal Ablation