Day 5 - CV3 Infx, HTN

Question 1

Indications for antibx ppx against endocarditis

Answer 1

Valvular damage (not MVP, unless assoc. MR), Prior endocarditis, Prosthetic valves

Question 2

Endocarditis PPX: GI/GU v. Dental procedures

Answer 2

(1) GI/GU - Amp/Gent before & Amoxicillin afterwards (2) Dental - Amoxicillin before & afterwards

Question 3

Negative culture endocarditis

Answer 3

HACEK = Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella

Question 4

Endocarditis Tx

Answer 4

Gentamicin + Beta lactam (ceftriaxone) OR Vancomycin Vancomycin often used empirically

Question 5

Pre-hypertension

Answer 5

Systolic 120-139 / Diastolic 80-89 (as defined by JNC7); Managed by antihypertensive if selected co-morbities (e.g., DM)

Question 6

Methods for Dx Renal artery stenosis

Answer 6

Renal arteriogram gold standard (invasive); MRA most frequently used; Renal artery duplex scan; Helical CT scan of renal arteries; Captopril renogram (or Captopril renal ultrasound)

Question 7

General trends in Shock: (1) MAP (2) SVR (3) HR (4) PCWP

Answer 7

(1) Low for all (2) Low for neurogenic or septic shock (3) Variable - Low for neurogenic shock; Usually high as compensation, unless cannot compensate such as in some cases of cardiogenic (4) Only low if issue w/ heart (e.g., cardiogenic shock)

Question 8

Hypovolemic shock: PCWP

Answer 8

Low volume; After fluid challenged, wedge pressure not change unless normovolemic; Tx: Cardiogenic shock

Question 9

Cardiogenic shock: PCWP & Tx; Similar/Special scenarios to consider

Answer 9

HR variable; PCWP high; After fluid challenge, PCWP even higher - NOT give fluids but Dobutamine; If hemothorax, looks like hypovolemic shock - Tx chest tubes; If extracardiac obstruction (e.g., cardiac tamponade), high PCWP, after fluids even higher, Tx pericardiocentesis

Question 10

Neurogenic/Septic shock: PCWP, Tx

Answer 10

PCWP low, after fluid challenge increases; Septic - fluids, antibx, NE; Neurogenic - IVF, pressors, atropine for HR