CVS Diverse Flashcards
What organisms typically causes infective endocarditis?
staph. aureus
What risk factors are there for IE?
Injection drug use Indwelling medical devices Diabetes AIDS Chronic skin infections/burns Genitourinary infections Solid organ transplant Homelessness Pneumonia
What are the specific signs of IE?
- Splinter haemorrhages - Janeway lesions
- Vasculitic rash
- Roth spots
- Oslers nodes
What are non-specific signs of IE?
Fever, malaise and fatigue
What constituents a high index of suspicion of IE?
- New murmur
- Pyrexia
- Known IE organism
- Prosthetic material
- Previous IE
- CHD
- Conduction disorder
What investigations are useful for IE?
- Inflammatory biomarkers
- Us and Es
- Bloods
- Urinalysis
- ECG
- CXR
- Echo
What are examples of inflammatory biomarkers?
- FBC
- CRP
- ESR
What is ESR?
Erythrocyte sedimentation rate
What can Us and Es be an indication of?
- Nephritis
- Infection
- Sepsis
What can staggered blood cultures tell you?
The effectiveness of antibiotic treatment
What does conduction delay in an ECG indicate?
Vegetation
What steps are required with echoes?
Do trans-thoracic, only if high suspicion do a trans-oesophageal
How is IE of native valves treated?
IV amoxycillin and gentamicin
How is IE of native valves with sepsis treated?
IV amoxycillin and vancomycin
How is IE of prosthetic valves treated?
Gentamicin, vancomycin and rifampicin
What types of cardiomyopathy are there?
- Restrictive
- Hypertrophic
- Dilated
- Myocarditis (Inflammation cardiomyopathy)
What are the characteristics of restrictive cardiomyopathy?
Stiffer and less compliant myocardium but no hypertrophy
What are the characteristics of hypertrophic cardiomyopathy?
Stiffer, bulky and hypercontractile heart muscle
What is dilated cardiomyopathy?
Where the heart chambers get larger
What is myocarditis?
Inflammation of the heart muscle
What are the genetics of hypertrophic cardiomyopathy?
Autosomal dominant mis-sense mutation of gene which codes for protein in the sarcomere
What is the clinical presentation of restrictive cardiomyopathy?
Diastolic heart failure and low amplitude/smaller QRS-complex
What is the clinical presentation of dilated cardiomyopathy?
Systolic heart failure, AV regurgitation, potential S3 heart sound
What is the clinical presentation of hypertrophic cardiomyopathy?
LVH accompanied by diastolic heart failure
What is the venturi effect?
Hypertrophy of the IV-septum causes higher flow rate of blood through the aortic valve which pulls the anterior leaflet of the mitral valve with the blood
What is the treatment plan for restrictive cardiomyopathy?
Treat underlying cause and heart transplant
What is the treatment plan for Dilated cardiomyopathy?
Left ventricular assistive device and heart transplant
What is the treatment plan for hypertrophic cardiomyopathy?
Beta-blockers and CCBs (rate limiting)
What are the two single gene disorders resulting in CVS disorders?
Noonan’s Syndrome and Noonan-like syndrome
What are the presentations of Noonas’s syndrome?
Excess nuchal folds, Pulmonary stenosis, Short stature, neck webbing, Cryptorchidism, Characteristic face, PTPNN11 gene (cr12)
What is cryptorchidism?
Absence of one or more testicles
What are the examples of Noonan-like syndromes?
Cardio-Facio syndrome
Leopard syndrome
Costello syndrome
What are the distinguishing features of cardio-facio syndrome?
Ectodermal problems and developmental delay
What are the distinguishing features of leopard syndrome?
Multiple lentigenes and deafness
What are the distinguishing features of Costello syndrome?
Thickened skin folds
Susceptible to warts
Cardiomyopathy
Later risk of cancer
What two chromosomal disorders are related to the CVS?
Turner and Downs syndrome
What is the profile of Turner syndrome?
30% mosaic
Coarctation of the aorta, short stature, gonadal dysgenesis, puffy hands
What is the profile of Downs syndrome?
15% AV septal defects cystic hygroma/lymphaginoma
What are the two micro deletion syndromes prevalent in the CVS?
22q11 deletion syndrome
Williams syndrome
What are the CATCH characteristics of 22q11 deletion syndrome?
C - cardiac malformations A - abnormal face T - thymic hypoplasia C - cleft palate H - hypoparathyroidism
What two other syndromes does 22q11 micro deletion syndrome encompass?
DiGeorge and Velocardiofacial (Sphritzen) syndrome
What other health issues are associated with 22q11 deletion syndrome?
Psychiatric issues
What are the signs and symptoms of DVT?
- Unilateral limb swelling
- Persisting discomfort
- Calf tenderness
- Warmth
- Erythema
- Can be clinically silent
What are the signs and symptoms of PE?
Pleuritic pain Breathlessness Haemoptysis Tachycardia Pleural rub
What are the intensified symptoms of massive PE?
Severe breathless Collapse Tachycardia Hypotension Raised JVP Altered heart sounds May cause sudden death
What are some clinical assessment criteria for the diagnosis of DVT?
Active cancer Paralysis Bed >3 days Leg/calf swelling Pitting oedema
What other investigations may be ordered to confirm a diagnosis of DVT?
D-dimer test and compression ultrasound
What imaging may be useful in the diagnosis of PE?
Isotope V/Q scan
CT pulmonary angiogram
How is VTE prevented in hospital?
- Early mobilisation
- Anti-embolism stockings
- Daily injections of low molecular weight heparin
What are the treatment options for VTE?
LMW heparin for >5 days
Vena caval filter and thrombolysis in massive PE
What are varicose veins?
Tortuous and dilated uperficial vein disease
Where does varicose veins usually occur?
In the great saphenous vein mostly
