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Cardiology (Victor) Flashcards

0
Q

Most often infective endocarditis is a complication of ___ or ___

A

Congenital

RHD

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1
Q

Three types of infective endocarditis

A

Acute
Subacute
Nonbacterial

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2
Q

T/F. Infective endocarditis can occur in children without heart diease

A

True

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3
Q

Rare in what age groups to have infective endocarditis

A

Infancy

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4
Q

The leading etiology of infective endocarditis

A

Streptococcus viridans

Staphylococcus aureus

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5
Q

Etiology in patient with infective endocarditis without heart disease

A

Staphylococcus endo

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6
Q

Etiology in patient with infective endocarditis after a dental procedure

A

Streptococcus viridans

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7
Q

Etiology in patient with infective endocarditis in lower bowels or GU manipulation

A

Group D enterococci

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8
Q

Etiology in patient with infective endocarditis with IV drug users

A

Pseudomonas

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9
Q

Etiology in patient with infective endocarditis after an open heart surgery

A

Fungal orgs

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10
Q

Etiology in patient with infective endocarditis with indwelling catheters

A

CONS

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11
Q

Two important factors in the pathogenesis of infective endocarditis

A

☑️ Presence of structural abnormalities of the heart

☑️ Bacteremia

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12
Q

Conditions that predispose to endocarditis:

A 
All CHD except ASD secundum
Rheumatic heart disease
Prostetic heart valves
MVP with mitral regurgitation
HOCM
Drug addicts
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13
Q

Vegetation of infective endocarditis are found in the __ pressure side of the heart

A

LOW

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14
Q

80-90% of patients with IE will have this sign

A

Fever (38-39)

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15
Q

100% of patients with IE will have this sign

A

New heart murmur

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16
Q

50% of the patients with IE will have the following skin manifestations

A

Petechiae
Oslers nodes
Janeway lesion
Splinter hemorrhages

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17
Q

Tender nodes at the fingers

A

Osler node

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18
Q

Hemorrhagic areas at palms and soles

A

Janeway lesions

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19
Q

Linear lesions beneath the nails

A

Splinter hemorrhage

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20
Q

Embolic phenomena in IE patients

A 
Pulmonary emboli
Seizure
Hemiparesis
Hematuria
Roth spots
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21
Q

Positive blood culture in IE patients usually yields __%

A

90%

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22
Q

Anemia is associated with in IE patients

A

Leukocytosis

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23
Q

In echocardiography, these are seen in IE patients

A

Evidence of vegetations

Valve dysfunction

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24
Other laboratory findings:
``` Elevated ESR and CRP Microscopic hematuria Hypergammaglobulinemia Rheumatoid factor Azotemia ```
25
Presumptive impression of IE includes
Fever + underlying heart disease + any of the physical findings or laboratory changes
26
Definitive diagnosis of IE will include:
Positive blood culture or Demonstration of vegetation in ECHO
27
What criteria is to be used in diagnosis of IE
Duke's criteria
28
Duke criteria includes how many minor and/or major to have a definite endocarditis
1 major + 3 minors | 5 minors
29
Major criteria in Dukes
Positive blood culture | Evidence of endocarditis on Echocardiography
30
Minor criteria in dukes
Predisposing conditions Fever Embolic vascular sign Immune complex phenomena Single positive blood culture or serologic evidence of infection ECHO signs not meeting the major criteria
31
Prognosis in patients with IE and HF
50-60%
32
Treatment for IE
Penicillin or Oxacillin + GENTAMYCIN
33
Usual duration of treatment for IE
4-6 weeks
34
This IE has a poor prognosis and difficult to manage, give the treatment.
Fungal endocarditis = AMPHOTERICIN B
35
Prophylaxis with dental procedure is negligible in the following:
☑️ secundum ASD ☑️ surgical repair of ASD, VSD, PDA without residua or beyond 6 months repair ☑️ previous coronary artery bypass surgery ☑️ functional heart murmur ☑️ previous kawasaki or rheumatic heart disease without valve dysfunction ☑️ cardiac pacemakers ☑️ implantable defibrillators
36
Prophylactic regimen for IE patients: | Standard general prophylaxis
Amoxicillin Child: 50 mg/kg PO 1 hr before procedure Adult: 2g PO 1 hr before procedure
37
Prophylactic regimen for IE patients: | Unable to take oral medications
Ampicillin C: 50 mg/kg IM or IV 30 mins before procedure A: 2 g IM or IV within 30 minutes before procedure
38
Prophylactic regimen for IE patients: | Allergic to penicillin
CLINDAMYCIN orally before 1 hour C: 20 mg/kg A: 600 mg CEPHALEXIN orally before 1 hour C: 50 mg/kg A: 2 grams CEFADROXIL CLARITHROMYCIN orally before 1 hour C: 15 mg/kg A: 500 mg
39
Prophylactic regimen for IE patients: | Allergic to penicillin and unable to take oral medications
CLINDAMYCIN IM/IV within 30 mins C: 20 mg/kg A: 600 mg CEFAZOLIN IM/IV C: 25 mg/kg A: 1 gram
40
Inflammatory process mediated by an immunologic reaction initiated by strep infection occuring in certain susceptible individuals predispose to this disease
Rheumatic fever
41
The attack rate of rheumatic fever with prevalence of ___
3% | 1/1000
42
Incidence of both initial and recurrences of RF peak in children in ages ___
5-15 years
43
Worldwide this remains as the most common form of acquired heart disease in all age groups
Rheumatic fever
44
RF may affect many parts of the body particularly:
Joints Heart Brain Skin
45
The most serious complications of RF
Valvular damage
46
Highest predilection of valvular damage in RF
Mitral valve > aortic valve > tricuspid valve > pulmonary valve
47
In RF sx are seen ___ weeks after strep throat infection
3-5 weeks
48
Average latent period in RF
3 weeks after infection
49
Chorea in RF have a longer latent period of ___
3-6 months
50
S/sx of RF may be classified under __ criteria
Jones criteria
51
Risk factors in RF usually affects ___ age level
School
52
Risk factors of RF includes living in:
Crowded conditions Unsanitary conditions Malnutrition
53
``` Characteristic of strep throat as to: Age Onset Initial sx Apperance of throat Fever Other signs ```
``` 5-15 yo Sudden Sore throat with pain on swallowing Redness, Hyperemia, Edema, Enlargement of tonsils with exudates High - Tender anterior cervical LN - Scabby erosions on nostrils - Clinical picture of scarlet fever ```
54
``` Characteristic of non-strep throat as to: Age Onset Initial sx Apperance of throat Fever Other signs ```
``` All ages Gradual Mild sore throat Redness of pharynx Not so high - Cough - Hoarseness - Watery nasal discharge - Conjunctivitis ```
55
The initial acute attack of RF can be detected by the Jones criteria with how many major minor?
2 majors | 1 major + 2 minor
56
The major criteria in jones
``` Carditis Polyarthritis Erythema marginatum Subcutaneous nodules Chorea ```
57
The minor criteria in jones
Arthralgia Fever Increased acute phase reactants Prolonged QT intervals
58
Evidence of antecedent Group A strep infection
Positive throat culture or rapid strep antigen test | Elevated rising strep Ab (ASO) titer of atleast two fold from base
59
3 circumstances not require strict adherence to Jones criteria
Chroea as only manifestation Indolent carditis as only manifestation Recurrences of ARF may not fulfill the jones criteria
60
The most common symptoms of RF which is 75%
Arthritis
61
Arthritis in RF affects large joints such as:
Knee Ankle Elbow Wrist
62
Besides the arthritis to be hot, red, swollen, and exquisitely tender its is also ___ and ___
Asymmetric | Polymigratory
63
Athritis in RF usually resolves spontaneously without leaving any deformity, it is usually treated by ___
Aspirin (salicylates)
64
Often there is an ___ relationship between the severity of arthritis to serverity of ____
Inverse | Carditis
65
The most serious complication of RF, which issues ___
Carditis | 50-60%
66
Carditis in RF varies in the sense it includes:
Organic heart murmur Heart enlargement Tachycardia Heart failure
67
Heart failure seen in carditis in RF is associated with
Cardiomegaly Hepatomegaly Peripheral and pulmonary edema
68
Carditis in RF is indicated by:
``` Apical systolic murmur Apical mid-diastolic murmur Basal diastolic murmur Friction rub Gallop rhythm ```
69
Carditis in RF may present as:
Chest pain Palpitation Dyspnea
70
Most cases of RF carditis will consist of either ___ or a ____
Isolated mitral valve involvement | Combined mitral and aortic valvular disease
71
This is characterized by a HIGH PITCHED APICAL HOLOSYSTOLIC MURMUCR radiating to the ___
Mitral regurgitation | Axilla
72
If carditis is associated with APICAL MID-DIASTOLIC MURMUR
Mitral stenosis
73
This is characterized by HIGH PITCHED DECRESCENDO DIASTOLIC MURMUR at the upper sternal border
Aortic insufficiency
74
This is the universal finding in carditis of RF
Endocarditis
75
ECG findings in carditis of RF
Disproportionate sinus tachycardia Prolonged PR interval Prolonged QT interval Conduction defects with AV block
76
This is not a pertinent finding in carditis in RF
Chamber enlargement
77
Chest xray finding in carditis in RF
Heart enlargement | Plumonary congestion to frank pulmonary edema
78
ECHO findings of carditis in RF
Mitral valve prolapse esp anterior leaflet Echodensities or focal nodularities of the leaflet Chamber enlargement (LA and LV) Decreased ventricular contraction Pericardial effusion Aortic and Mitral regurgitation Color flow abnormality in MR, AR, and TR
79
This accounts to 10-15% of RF manifestation
Chorea
80
Other name of Chorea in RF
St. vitus dance
81
Triad of chorea in RF
Involuntary muscle movement Muscle weakness Emotional disturbances
82
Chorea in RF is more common
Female
83
When will the manifestation of chorea in RF will disappear?
During sleep
84
Clinical maneuvers to elicit features of chorea
Milkmaid's grip Spooning and pronation of hands Wormian darting of tongue upon protusion Examination of handwriting to evaluate motor movements
85
This RF manifestation is a rare type which accounts to 10% and can be seen in patients with carditis
Erythema marginatum
86
Erythematous, serpiginous, macular lesion with pale centers, non pruritic, found in the extremities that spares the face
Erythema marginatum
87
This manifestation of RF is accentuated with warming of the skin
Erthyma marginatum
88
Another rare manifestation of RF which is small, non-tender pea sized nodules that appears in the extensor surface of jts
Subcutaneous nodules
89
Manifestation of RF which is in association of carditis
Erythema marginatum | Subcutaneous nodules
90
Subcutaneous nodules in RF is uncommonly seen because it only last for ____ weeks
1-2 weeks
91
This is a result of inflammation and scarring of heart valves csused by RF or as a complication of RF
Rheumatic heart disease
92
This is an absolute requirement for dx of ARF
Antecedent group A Strep infection
93
Increase ASO in __% in ARF patients
80-85%
94
Rise of ASO is seen in __ and peaks at __ decrease after __ months
1-2 weeks 4-6 weeks 2 months
95
ASO titer in children? Adult?
Children: >= 330 Adult: >= 250
96
The titers of ASO is normal in ___ and ___
Chorea | Chronic carditis
97
Primary prevention of RHD drugs to be given are:
``` Benzathine Pen G Pen V Erythromycin Estolate Ethylsuccinate Azithromycin ```
98
``` The duration of the following: Benzathine Pen G Pen V Erythromycin estolate Ethylsuccinate Azithromycin ```
``` Once 10 days 10 days 10 days 5 days ```
99
Dose of Benzathine Pen G
1.2 MU
100
Dose of Pen V
Children: 250 mg TID Adult: 500 mg TID
101
Dose of Erythromycin estolate
20-40 mg/kg/day, 2-4x/day (max 1 grams/day)
102
Dose of Ethylsuccinate
40mg/kg/d; 2-4x/d (max 1g/d)
103
Dose of azithromycin
500mg on 1st dose | 250 mg on next dose
104
This si given to patients who have already developed RF, this is to prevent recurrent attacks
Secondary prevention or prophylaxis
105
The chemoprophylaxis for recurrences of acute rheumatic fever
Pen G Benzathine Pen V Sulfadiazine or Sulfisoxazole Erythromycine
106
The dose of Pen G Benzathine
1.2 MU every 4 weeks
107
The dose for Pen V
250 mg BID
108
The dose of sulfadiazine or sulfisoxazole in 27?
0. 5 grams once a day | 1. 0 grams once a day
109
For chemoprophylaxis in patients with recurrence of acute rheumatic fever who are allergic to penicillin and sulfonamide drugs
Erythromycin
110
Erythromycin dose
250 mg BID
111
Duration of secondary prophylaxis: RF without carditis RF with carditis but no residual heart disease RF with carditis and with residual hear disease
5 yo to 21 yo 10 yo until adulthood Atleast 10 years until lifelong
112
Acute febrile illness condition primarily affecting young children
Kawasaki disease
113
Initially kawasaki disease is called __?
Mucocutaneous lymph node syndrome | Infantile polyarthritis mucosa
114
Suspected etiology of kawasaki disease
Bacterial toxin similiar to staphylococcal toxins of TSS
115
This is the leading cause of acquired heart disease in US and recognized worldwide
Kawasaki disease
116
Peak age incidence of Kawasaki disease
1-2 years
117
50% of cases of Kawasaki occur before the age of? How about the 80%? It is seldom seen in __ age
Before 2 years old Before 5 years old Beyond the age of 8
118
Highest incidence ratio males vs female of kawasaki
1.4:1
119
What are the 6 CHARACTERISTIC CLINICAL SIGNS of Kawasaki
Fever >5 days + : - Bilateral nonpurulent conjunctival injection - Changes in the mucosa of the oropharynx - Changes of the peripheral extermities - Erythematous rash - Cervical lymphadenopathy
120
In kawasaki disease fever is more than ___ days, high, sustained or continuoous/ abrupt, pesk of ___, it can even presist till ___, resolves in __ days with the IV globulin
More than 5 days Temperature exceeds 40'C Perisist for 12 days 1-2 days
121
In conjunctival injection of kawasaki its is term as clean because ___ and ___
No ocular discharge and No ulcers
122
Changes in the mouth of patients with kawasaki involves the changes in the lips? Oropharynx? Tongue?
Erythematous, Fissuring, Peeling, Bleeding Diffused erythema Strawberry tongue
123
Acute phase which involves __ days in kawasaki, peripheral extremities has ___ and ___
Firm induration of the hands and feet | Deep and diffuse erythema of the hands and sole
124
Subacute phase which is __ week will cause __ of the extremities
Desquamation of the finger and toes
125
Convalescent phase that happens __ months in kawasaki disease
2-3 months | Beau's line - transverse groove across the fingernails
126
Three forms of erythemal rash in kawasaki disease
- truncal, polymorphous, non-vesicular and without crust - maybe morbilliform, maculopapular, scarlantiniform - may resemble erythema multiforme
127
This clinical sign of kawasaki occurs in more than half of patients
Enlarged lymph node
128
Enlarged lymph node in kawasaki disease is usually ___ and ___, and measure ___, non fluctuant and non tender / slight tender
Unilater and Cervical | > 1.5 cms
129
Incomplete or atypical kawasaki is found in patients ___
< 1 year of age
130
What criteria can we used in an atypical kawasaki disease
Fever more than 5 days + 2/3 principal features of kawasaki disease
131
Laboratory findings in atypical kawasaki disease
``` Leukocytosis (>15,000) Anemia Elevated ESR and CRP Abnormal plasama lipid Hypoalbuminemia Hyponatremia Thrombocytosis Sterile pyuria Elevated serum transaminase 2d echocardiogram ```
132
Universal laboratory finding in kawasaki disease
Elevated ESR and CRP
133
Thrombocytosis in kawasaki disease usually appears __ week, peak __, gradual return __ week
2nd week 3rd week 4-8 weeks
134
Prognosis of kawasaki disease (2)
Complete recovery IN THOSE WITHOUT coronary vasculitis | 1-2% die due to cardiac complications: HF, ARRHYTHMIA, MI
135
Measles and varicella immunizations should be deffered for __ months after a child receives high dose of IVG
11 months
136
IVIG should be given within __ days from onset of fever in kawasaki disease
10 days
137
Disease of the heart muscle which is not associated with congenital, valvular, and coronary heart disease
Cardiomyopathies
138
Primary causes of cardiomyopathies? Secondary cause?
Genetics Infection Endocrine Metabolic Nutritional
139
Epidemiology of dilated cardiomyopathy vs hypertrophic, restrictive cardiomyopathy
36/100,000 | 2/100,000
140
The most common chamber dilation in dilated cardiomyopathy, as to systolic function
LEFT ventricle | Decreased
141
In hypertrophic cardiomyopathy there will be an ____ in ventricular myocardial wall thickness, as to systolic function, as to diastolic
Increased Normal or increased Decreased
142
How is the chambers on restrictive cardiomyopathy? Ah to systolic function, as to diastole
Normal ventricular chamber size Normal or combined with systolic dysfunction Dramatically impaired diastole
143
In arrythmogenic RV cardiomyopathy how is the systolic function?
Normal to decreased systolic function
144
This is a form or dilated or restrictive cardiomyopathy
LV noncompaction
145
ECG diagnosis of restrictive cardiomyopathy
Prominent P waves Atrial fibrillation Supraventricular tachycardia
146
CXR in restrictive cardiomyopathy
Mild to moderate cardiomegaly | Pulmonary congestion or effusion
147
Diagnostic ECHO of restrictive cardiomyopathy
Enlarged atria and small to normal sized ventricles
148
Most common type of cardiomyopathy
Dilated cardiomyopathy
149
Etiologies of dilated cardiomyopathies
NM Inborn error of metabolism Genetics Idiopathic
150
Incidence of dilated cardiomyopathy
Higher in males African american < 1 yo
151
Pathophysio of dilated cardiomyopathy
Varying degrees of mycocyte hypertrophy and fibrosis | Weakening of systolic contraction associated with dilation of the four chambers
152
ECG in dilated cardiomyopathy
Sinus tachycardia | Nonspecific T wave abnormalities
153
CXR of dilated cardiomyopathy
Cardiomegaly
154
ECHO of dilated cardiomyopathy
Dilatation of heart | Poor contractility
155
About __ of patients die from intractable heart failure within __ years after the onset of symptoms of CHF
2/3 | 4 years
156
Familial disorder of the heart muscle
Hypertrophic cardiomyopathy
157
30-60% of hypertrophic cardiomyopathy is transmitted as __ trait
AD
158
The most characteristic abnormality is ___ with ventricular cavity usually ___ or ___ in hypertrophic cardiomyopathy
Hypertrophic LV | Normal or small
159
50% of patients with hypertrophic cardiomyopathy will be presenting with __
Murmur
160
Family history usually __% for the disease of hypertrophic cardiomyopathy
30-60%
161
Sudden death may occur in hypertrophic cardiomyopathy with an incidence of __/year
4-6%
162
In PE what can be seen in patients with hypertrophic cardiomyopathy
Overactive precordial impulse with a lift or heave Abnormal peripheral pulse MR murmur is often present
163
ECG findings in patients with hypertrophic cardiomyopathy
LVH with or without ST DEPRESSION | Abnormally deep q wave
164
The CXR of hypertrophic cardiomyopathy
Mild cardiomegaly with prominence of LV
165
ECHO of hypertrophic cardiomyopathy
LVH predominantly affecting the interventricular septum Concentric hypertrophy of LV LV outflow obstruction
166
Risk of sudden death in hypertrophic cardiomyopathy is seen in:
``` Hx of Cardiac arrest VTAC Exercise hypotension Syncope Excessive LV thickness >3cm LVOT gradient of > 30 mmHg ```
167
Refers to inflammation, necrosis or mycocytolysis of myocardial cells
Myocarditis
168
The etiology of myocarditis
Adenovirus Coxsackie virus Enterovirus
169
Suspected if child presents with unexplained shortness of breath or fatigue, a new arrhythmia or acute cardiac failure just following a viral illness
Myocarditis
170
In myocarditis, the younger the patient, more toxic presentation: Early infancy Toddler or young childern Older children
Acute, Fulminant Less fulminant Asymptomatic
171
ECG of a myocarditis
Low QRS voltage ST T changes Arrhythmia
172
The most important clinical sign of myocarditis
Varying degree of cardiomegaly in CXR
173
This test is elevated in association with a ST segment elevation on ECG
CK MB
174
This test is elevated in IDIOPATHIC MYOCARDITIS
LDH
175
This test is elevated upto one month after infection in myocarditis but it is NONSPECIFIC for the disease
Troponin I
176
Standard criterion in the diagnosis of Myocarditis
Endomyocardial biopsy
177
Management of myocarditis
``` Bed rest and limitation of activities Anticongestive High dose of immunoglobulin Arrhythmia treated aggressively Vasodilators Corticosteroids ```
178
75% in neonates that have myocarditis will present with
Mitral regurgitation
179
Majority of patients with mild inflammation in myocarditis will:
Recover completely
180
Patients who develop chronic mycarditis will also present:
Persistent cardiomegaly
181
Myocarditis may be a precursor to:
Idiopathic dilated cardiomyopathy
182
Acute inflammation of the pericardium
Pericarditis
183
Drugs that causes pericarditis
``` Procainamide INH Hydrazalaine Cromolyn dantrolen Methysergide Anticoagulants Thrombolytic Phenytoin PCN Phenybutazone Doxorubicin ```
184
Constrictive pericarditis is usually observed in what etiology?
Bactrial and TB

Pediatrics A (9 decks)

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