Cardiovascular Infection

Question 1

What are cardiovascular infections?

Answer 1

Infections affecting the heart structures, including the pericardium, myocardium, endocardium, valves, and blood vessels.

Question 2

What are the common causes of cardiovascular infections?

Answer 2

Viruses, bacteria, fungi, and parasites.

Question 3

What is myocarditis?

Answer 3

An inflammatory disease of the heart muscle, often caused by viral infections or immune-mediated responses.

Question 4

What is the most common cause of myocarditis?

Answer 4

Viral infections, especially coxsackievirus and adenovirus.

Question 5

What are the bacterial causes of myocarditis?

Answer 5

Streptococci, staphylococci, pneumococci, gonococci, and mycobacterium.

Question 6

What is eosinophilic myocarditis?

Answer 6

A form of myocarditis characterized by eosinophilic infiltration, often associated with hypersensitivity reactions or parasitic infections.

Question 7

What are the clinical outcomes of acute myocarditis?

Answer 7

Can lead to heart failure, ventricular arrhythmias, or progress to dilated cardiomyopathy.

Question 8

What is pericarditis?

Answer 8

Inflammation of the pericardium, which can be infectious, inflammatory, or secondary to other conditions.

Question 9

What are the common viral causes of pericarditis?

Answer 9

Coxsackievirus, echovirus, cytomegalovirus, and hepatitis B virus.

Question 10

What is infective endocarditis (IE)?

Answer 10

A microbial infection of the endocardial surfaces of the heart, including valves and implanted devices.

Question 11

What are the risk factors for infective endocarditis?

Answer 11

Prosthetic valves, congenital heart disease, IV drug use, central lines, and poor dental hygiene.

Question 12

What are the classifications of infective endocarditis?

Answer 12

Native valve IE, prosthetic valve IE, IV drug abuse IE, and nosocomial IE.

Question 13

What is the most common cause of acute native valve infective endocarditis?

Answer 13

Staphylococcus aureus.

Question 14

What is the most common cause of subacute native valve infective endocarditis?

Answer 14

Streptococcus viridans group.

Question 15

What is the most common cause of infective endocarditis in IV drug users?

Answer 15

Staphylococcus aureus, affecting the tricuspid valve.

Question 16

What is prosthetic valve endocarditis (PVE)?

Answer 16

Infective endocarditis occurring in patients with prosthetic heart valves.

Question 17

What is the difference between early and late prosthetic valve endocarditis?

Answer 17

Early PVE occurs within 60 days of surgery and is caused by Staph epidermidis and Gram-negative bacilli, while late PVE occurs after 60 days and is often caused by streptococci and Staph aureus.

Question 18

What is the most common causative organism of nosocomial infective endocarditis?

Answer 18

Staphylococcus aureus.

Question 19

Which heart valve is most commonly affected in infective endocarditis?

Answer 19

Mitral valve (28-45%).

Question 20

What are the major complications of infective endocarditis?

Answer 20

Heart failure, embolic stroke, septic emboli, renal failure, and valve destruction.

Question 21

What are Janeway lesions?

Answer 21

Non-tender, erythematous macules on the palms and soles seen in infective endocarditis.

Question 22

What are Osler’s nodes?

Answer 22

Painful, raised nodules on the fingers and toes seen in infective endocarditis.

Question 23

What are Roth spots?

Answer 23

Retinal hemorrhages with a white center seen in infective endocarditis.

Question 24

What is the Duke’s criteria for diagnosing infective endocarditis?

Answer 24

Requires 2 major, 1 major + 3 minor, or 5 minor criteria.

Question 25

What are the major Duke’s criteria for infective endocarditis?

Answer 25

Positive blood cultures for typical organisms, echocardiographic evidence of vegetation, new valvular regurgitation.

Question 26

What are the minor Duke’s criteria for infective endocarditis?

Answer 26

Fever, predisposing cardiac condition, vascular/embolic phenomena, immunologic phenomena, positive blood culture not meeting major criteria.

Question 27

What is the gold standard for diagnosing infective endocarditis?

Answer 27

Blood cultures and echocardiography.

Question 28

What is the first-line imaging for infective endocarditis?

Answer 28

Transthoracic echocardiography (TTE), but transesophageal echocardiography (TEE) is more sensitive.

Question 29

What is the primary treatment for infective endocarditis?

Answer 29

IV antibiotics for 4-6 weeks.

Question 30

Which antibiotics are used for native valve endocarditis caused by penicillin-sensitive streptococci?

Answer 30

IV penicillin G or ceftriaxone, plus gentamicin for 2 weeks.

Question 31

What is the treatment for suspected Staphylococcus aureus endocarditis?

Answer 31

IV vancomycin and gentamicin for 6 weeks.

Question 32

When is surgery indicated in infective endocarditis?

Answer 32

Heart failure, persistent infection, large vegetations, embolic complications, or prosthetic valve involvement.

Question 33

What are the indications for prophylaxis against infective endocarditis?

Answer 33

Patients with prosthetic valves, congenital heart disease, prior IE, and heart transplant recipients with valvulopathy.

Question 34

What antibiotic is used for IE prophylaxis before dental procedures?

Answer 34

Amoxicillin 2g orally 30-60 minutes before the procedure.

Question 35

What are the fungal causes of infective endocarditis?

Answer 35

Candida species and Aspergillus species.

Question 36

What is the most common cause of myocarditis in developed countries?

Answer 36

Viral infections, particularly coxsackievirus B.

Question 37

How does myocarditis present clinically?

Answer 37

Chest pain, heart failure, arrhythmias, and sudden cardiac death.

Question 38

What is the most common cause of pericarditis?

Answer 38

Viral infections, particularly coxsackievirus and echovirus.

Question 39

What is the classic ECG finding in pericarditis?

Answer 39

Diffuse ST-segment elevation and PR-segment depression.

Question 40

What is the most common bacterial cause of pericarditis?

Answer 40

Mycobacterium tuberculosis.

Question 41

What is the treatment for viral pericarditis?

Answer 41

NSAIDs and colchicine.

Question 42

What is the classic triad of cardiac tamponade?

Answer 42

Beck’s triad: hypotension, muffled heart sounds, and jugular venous distension.

Question 43

What is the gold standard for diagnosing pericardial effusion?

Answer 43

Echocardiography.

Question 44

What is the most common site of embolization in infective endocarditis?

Answer 44

Brain, leading to embolic stroke.

Question 45

What is the most common cause of infective endocarditis in patients with poor dental hygiene?

Answer 45

Streptococcus viridans.

Question 46

What is the most common nosocomial pathogen causing infective endocarditis?

Answer 46

Staphylococcus aureus.

Question 47

Which heart valve is most commonly affected in IV drug users with endocarditis?

Answer 47

Tricuspid valve.

Question 48

What is the mortality rate of untreated infective endocarditis?

Answer 48

Nearly 100%.

Question 49

What is the role of anticoagulation in infective endocarditis?

Answer 49

Generally not recommended due to increased risk of embolization.

Question 50

What is the recommended treatment duration for fungal endocarditis?

Answer 50

IV amphotericin B or fluconazole for at least 6 weeks, often requiring surgery.