Cardiology 9 - Valves / Infective Endocarditis

Question 1

normal INR target range for warfarin and metallic valves too

Answer 1

2-3

for metallic valves 2.5-3.5

Question 2

major complications x 3 of mechanical heart valves

Answer 2

haemolysis - anaemia
infection - endocarditis
thrombosis - stroke

Question 3

what is TAVI used for?

Answer 3

severe aortic stenosis
via femoral or radial artery, ray guidance
bioprosthetic valves

Question 4

top 3 bacteria inf endocarditis

Answer 4

1 staph
2 strep
3 enterococcus

all gram positive

15% death rate
2.5% of surgical valve replacement get it, lower with TAVI

Question 5

infective endocarditis presentation

Answer 5

risk factors present - IVDU, heart valve, immunocompromised etc

FLAWS symptoms, splinter haemorrhage, chest pain

Question 6

Dukes Major x2

Minor x 5

Answer 6

Major - positive blood cultures x 2, 12 hours apart, echo findings
Minor - fever, other echo findings, vascular phenomenon, immuno phenomenon, risk factors (murmur, IVDU)

Question 7

treatment for inf endocarditis
strep viridans
staph

Answer 7

strep - BenPen + gent
MSSA - fluclox
MRSA - vancomycin
prosthetic valve - vancomycin, gentamycin, rifampicin

6 weeks IV

Question 8

criteria Dukes confirmation of diagnosis

Answer 8

2 major
1 major + 3 minor
5 minor