DSA- Cardiac Clinical Medicine Part 2

Question 1

Acute infective endocarditis typically is due to?

What does it develop on?

Answer 1

1) Staph aureus

2) Normal heart valve endothelium

Question 2

Subacute infective endocarditis typically is due to?

What does it develop on?

Answer 2

1) Streptococcus viridans and enterococcus

2) Damaged heart valve endothelium

Question 3

Nonbacterial thrombotic endocarditis (Marantic endocarditis) is typically seen in patients with?

Nonbacterial verrucous endocarditis (Libman-Sacks endocarditis) is typically seen in patients with?

Both of theses conditions typically present with?

Answer 3

1) Metastatic malignancy
2) SLE
3) New cardiac murmur in setting embolic disease

Question 4

What are some risk factors for infective endocarditis?

Answer 4

1) Older than 60
2) Male
3) IV drug use
4) Poor dentition
5) Structural heart disease
6) Implantable cardiac device

Question 5

IV drug use typically presents with what sided endocarditis?

What is the most common cause of this?

Answer 5

1) Right sided endocarditis

2) Staph aureus

Question 6

While less common what pathogen can cause infective endocarditis and is often associated with colon cancer or IBD?

Answer 6

Streptococcus bovis

Question 7

How does infective endocarditis classically present?

Answer 7

1) Fever
2) New cardiac murmur
3) Vascular embolic events

Question 8

What are some PE findings for infective endocarditis?

Answer 8

1) Petechiae
2) Splinter hemorrhages
3) Osler’s nodes (red, raised, painful lesions in distal extremities)
4) Janeway lesion (red, flat, painless lesions often on palms or finger)
5) Roth spots (retinal hemorrhages with white centers)

Question 9

What is performed on a modified duke criteria in order to diagnose infective endocarditis?

Answer 9

1) Echocardiography

2) Blood cultures

Question 10

What is the initial therapy for the treatment of infective endocarditis?

Answer 10

Vancomycin

Question 11

Endocarditis prophylaxis is recommended for what high risk patients?

Answer 11

1) Hx of infective endocarditis
2) Hx of prosthetic heart valve replacement
3) Hx of cardiac valve repair with prosthetic material
4) Hx of Cardiac transplantation with valvular regurgitation
5) Congenital heart disease
6) Dental procedures

Question 12

What are the most common causes of myocarditis?

Answer 12

1) Idiopathic

2) Viral infections

Question 13

What are the most common viral pathogens that cause myocarditis?

Answer 13

1) Coxsackie B virus
2) HHV-6
3) Parvovirus

Question 14

Definitive diagnosis of myocarditis is made on?

Answer 14

Endomyocardial biopsy

Question 15

What symptoms are seen prior to developing myocarditis?

Answer 15

Fever, myalgias, respiratory or GI symptoms due to viral prodrome

Question 16

What is cardiac tamponade?

What does it impair?

Answer 16

1) A life threatening accumulation of pericardial fluid that compresses the heart
2) Diastolic filling and decreases cardiac output

Question 17

What does constrictive pericarditis result from?

What does it cause?

Answer 17

1) Results from a scarred, thickened, and frequently calcified pericardium
2) Constricts the heart which impairs cardiac filling and cardiac output

Question 18

What are most cases of acute pericarditis due to in the developed world?

In the developing world?

Answer 18

1) Idiopathic or viral

2) TB

Question 19

How is the chest pain characterized for acute pericarditis?

Where does it radiate?

What body position makes it worse?

What body position makes it better?

Answer 19

1) Sudden onset, retrosternal, and pleuritic
2) To trapezius ridge or neck
3) Lying flat
4) Sitting up and leaning forward

Question 20

What is heard with acute pericarditis on auscultation?

Answer 20

Pericardial friction rub

Question 21

What is the diagnostic criteria for acute pericarditis?

Answer 21

At least 2 of the 4 following criteria:

1) Pericarditis chest pain
2) Pericardial rubs
3) ST elevation and/or PR depression
4) Pericardial effusion

Question 22

What ECG change is seen with acute pericarditis?

Answer 22

New widespread ST-segment elevation and/or PR segment depression

Question 23

What is the classic presentation of cardiac tamponade?

Answer 23

Beck’s Triad:

1) Hypotension
2) Muffled heart sounds
3) JVD

Question 24

What is heard with cardiac tamponade on auscultation?

Answer 24

Pericardial friction rub

Question 25

What jugular venous waveform changes are seen with cardiac tamponade because of lack of right ventricular filling?

Answer 25

Absent y descent

Question 26

What term associated with cardiac tamponade is characterized by abnormally large decrease in systolic blood pressure during inspiration?

Answer 26

Pulsus paradoxus

Question 27

What ECG change is seen with cardiac tamponade?

Answer 27

Electrical alternans which is alternating amplitude of QRS complex in any lead

Question 28

What is seen on CXR when diagnosing cardiac tamponade?

Answer 28

Enlarged cardiac silhouette (water-bottle sign)

Question 29

What is found on PE for constrictive pericarditis?

Answer 29

1) Jugular venous distention
2) Pulsus paradoxus
3) Kussmaul’s sign (JVP fails to decrease with inspiration)
4) Pericardial knock (high pitched diastolic sound that results from abrupt cessation in ventricular filling)

Question 30

What jugular venous changes are seen with constrictive pericarditis?

Answer 30

Prominent x and y descents

Question 31

What is found on CXR for constrictive pericarditis?

Answer 31

Pericardial calcifications

Question 32

What is the Tx for acute pericarditis?

Answer 32

NSAIDs (Indomethacin) and Colchicine

Question 33

What is the Tx for cardiac tamponade?

Answer 33

Remove pericardial fluid with pericardiocentesis

Question 34

What is the Tx for constrictive pericarditis?

Answer 34

Pericardiectomy