Heart Week 2: Mtui/Endocarditis

Question 1

What’s the first sign of the heart developing in utero?

Answer 1

angioblastic cords at week 3

Question 2

Which 3 veins drain into the sinus venosus?

Answer 2

1. Vitelline
2. Umbilical
3. Common Cardinal

Question 3

What is formed by the endocardial cushions?

Answer 3

Both AV canals.

Question 4

the limbuS of the fossa ovale comes from what?

Answer 4

Septum Secundum

Question 5

the flooR of the fossa ovale comes from what?

Answer 5

septum pRimum

Question 6

What structure becomes the coronary SINUS?

Answer 6

Left horn of the SINUS venosus.

Question 7

What does the R horn of the sinus venosus become?

Answer 7

sinus venarum

Question 8

musuculi pectinati comes from what?

Answer 8

primitive atrium

Question 9

the left atrium is derived from what primitive structure?

Answer 9

primitive atrium

Question 10

What are MSCRAMMS (microbial surface components recognizing adhesive matrix)?

Answer 10

Little things on bacteria that help them bind to platelet deposits, then they get buried in the vegetation and the infection proceeds.

Question 11

In endocarditis, where is the most common place for bacteria to nest?

Answer 11

areas of turbulent blood flow.

Question 12

What are the major criteria Dx of endocarditis?

Answer 12

1. • blood culture for infective endocarditis
     - viridans streptococci, streptococcus bovis, bacteria in the HACEK group, staph aureus
     - must have two + cultures drawn >12 hours apart, or positive results of all three, (and more)
2. Evidence of endocardial involvement
   - + echo for infective endocarditis
   - new valvular regurge

Question 13

What are the minor criteria for Dx of endocarditis?

Answer 13

• predisposition: predisposing heart disease or IV drug use
• fever > 38C
• vascular phenomenon: major emboli, intracranial hemmorrhage, septic pulmonary infarct, mycotic aneurysm, conjunctival hemmorrhage
• microbiologic evidence: + blood culture, but with no major clinical criterion met or serologic evidence of active infection with an organism consistent with infective endocardidits.

Question 14

What are the pros and cons of cardiac caths?

Answer 14

Pros: diagnostic and therapeutic, gold standard for obstructive coronary disease, gold standard for hemodynamic assessment

Cons: invasive (hematoma, emboli, stroke, bleeding), sometimes requires adjunctive therapies (heparin), iodinated die can be nephrotic, radiation exposure

Question 15

What are the pros and cons of nuclear cardiology?

Answer 15

Pros: great prognostics and risk stratifications, ability to assess different aspects of myocardium (ischemia, viability, hibernation), potential for more info based on newer agents

Cons: high radiation exposure, high cost, false +/- with serious consequences

Question 16

What are the pros and cons of CXR?

Answer 16

Pro: fast, cheap, portable, can be a little diagnositc (pneumothorax and can confirm placement of leads)

Con: radiation exposure, limited resolution, liquids all look alike, limited diagnostic ability

Question 17

What are the pros and cons of Echo?

Answer 17

Pro: portable, fast, diagnostic, gold standard for endocarditis of LA appendage clot, can combine with stress and look for ischemia, can do hemodynamics

Con: imagine can be hard in some patients especially the very ill with mechanical valves leading to under (AS) or missed (LV dysfunction) diagnoses. This all depends on the axis of the echo.

Question 18

What are the pros and cons of cardiac CT/MRI?

Answer 18

Pro: best assessment for ventricular volumes and fxns particularly RV, best in vivo imaging for myocardium, probably the gold standard for viability of myocardium for revascularization

Con: long time in small tube, can’t image patients with metal things, pts with kidney disease must weigh risk of using gadolinium contrast agents.