HF + cardio Flashcards by Ria Marwaha

List 5 peripheral signs of Infective endocarditis;

Petechiae
Janeway lesions
Splinter haemorrhages
Osler nodes
Roth spots

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Describe PETECHIAE

dots of blood due to leaking from capillaries - non specific finding; also seen in vasculitis.

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Describe OSLER NODES

Tender subcutaneous nodules located on the distal pads of digits.

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Describe JANEWAY LESIONS

Non tender maculae on the palms and soles.

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Describe SPLINTER HAEMORRHAGES

Dark red linear lesions on the nail beds.

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Describe ROTH SPOTS

Retinal haemorrhages with small, clear centres (rare and observed in only 5% of patients w/ IE).

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The modified Duke criteria for the diagnosis of IE requires what combinations of major and minor criteria?

2 major
1 major + 3 minor
5 minor

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name 2 MAJOR CRITERIA.

2 positive blood cultures (typical microorganism IE)

and

evidence of endocardial involvement

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MAJOR CRITERIA - positive echo for IE;

oscillating intra cardiac mass on valve
abscess
new partial dehiscence of prosthetic valve
new valvular regurgitation

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What does negative blood cultures for IE indicate?

IE in which no causative micro-organism can be grown usual the usual blood culture method; can be due to previous antibiotic administration.

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What are the 5 stages of action potential?

0 - rapid depolarisationi 
1 - early repolarisation 
2 - plateau phase 
3 - repolarisation 
4 - resting membrane potential

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What % is reduced ejection fraction?

less than/equal to 40%

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causative organism of rheumatic fever

Group A beta haemolytic streptococci

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list minor criteria for rheumatic fever (5)

fever
raised CRP/ESR
arthralgia
prolonger PR interval
previous rheumatic fever

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list major criteria for rheumatic fever (5)

Carditis
Arthritis
Subcutaneous nodules
Erythema marginatum
Sydenham’s syndrome

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fever & new murmur is ___ until proven otherwise

infective endocarditis

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what is infective endocarditis

infection involving the endocardial surfaces of the heart, involving valvular structures, chordae tendinae, sites of septal defects or mural endocardium

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what are vegetations along edge of valve in infective endocarditis (3)

fibrin
platelets
infective organism

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risk factors for IE (5)

prosthetic valve
previous episodes
congenital heart defects
IVDU
HOCM

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most common causative organism of IE

staphylococcus aureus

most common causative organism of IE in patients following prostethic valve surgery

staphylococcus epidermis

IE organism associated with colorectal cancer

streptococcus bovis

iE organisms found in the mouth assoc with poor dental hygiene or following a dental procedure

strep mitis

- strep sanguinis

blood cultures needed in IE

3 sets taken within 24 hours

IE echo findings

- vegetations if > 2 mm - underlying valvular disease - valvular regurgitation - abscess

Dukes major criteria (2)

1) Positive blood cultures | 2) Endocardium involved

Dukes minor criteria (5)

1) Predisposition (e.g. cardiac lesion, IVDU) 2) Fever (> 38.0 deg) 3) Vascular/immunological signs 4) Positive blood cultures that do not meet major criteria 5) positive echo that does not meet major criteria

minor dukes criteria vascular phenomena

Vascular phenomena such as; - major arterial emboli - septic pulmonary infarcts - mycotic aneurysm - intracranial haemorrhage - conjunctival haemorrhage - janeway lesions

minor dukes immunological phenomena

Immunological phenomena - osler nodes - glomerulonephritis - roth spots - rheumatoid factor

Treatment of infective endocarditis

Ceftriaxone or Cef & gent

Viral causes of acute pericarditis (4)

- Coxsackie - EBV - Mumps - Varicella - HIV

management of acute pericarditis

Analgesia - e.g. Ibuprofen consider colchicine

Accumulation of pericardial fluid raised intrapericardial pressure --> poor ventricular filling + fall in cardiac output

Cardiac tamponade

3 causes of cardiac tamponade

- acute pericarditis - aortic dissection - haemodialysis

Becks triad - diagnosis of cardiac tamponade (3)

- muffled heart sounds - falling BP - rising JVP

2 commonest causes of HF

- acute coronary disease | - HTN

structural & congenital causes of HF

structural: valvular pathologies congenital: ASD, VSD, inherited cardiomyopathies

rate related causes of HF

- AF uncontrolled - thyrotoxicosis - anaemia - heart block

pulmonary causes of HF

- COPD - pulmonary fibrosis - recurrent PE - primary pulmonary HTN

autoimmune disease causes of HF

- amyloidosis | - sarcoidosis

when should digoxin therapy be considered

non paroxysmal AF & they are sedentry

4 causes of mitral regurg

1) rheumatic heart disease 2) ischaemic heart disease - papillary muscle rupture 3) valvular vegetations - patients with endocarditis 4) physiological mitral valve regurg due to dilated left atrium

what maintains the long plateau in an action potential

calcium influx through L-type channel

electrolyte involved in depolarisation

sodium influx

electrolyte in repolarisation

potassium

effect of adrenaline on frank starling graph

push to the left

what should be performed prior to cardioverion in patient with AF & why?

- echocardiogram | - identify thromboembolism

Rivaroxiban mechanism

Factor Xa inhibitor

drug used to reduce anxiety & dyspnoea in HF exacerbation

morphine