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Cardiovascular Medicine Midterm > ID of CV > Flashcards

ID of CV Flashcards

1
Q

In a patient with subacute infective endocarditis, what lab and imaging should include in the work up?

A

Blood cultures x4 and TTE

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2
Q

Staphylococcus epidermidis is implicated for subacute endocarditis. what tests would confirm staphylococus epidermidis?

A
  • blood culture revealing G+ cocci in clusters
  • catalase positive
  • coagulase negative
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3
Q

ABX prophylaxis is indicated for a patient who has had infective endocarditis or are at risk of endocarditis. what abx are used for patients who are allergic to penicillin?

A

Oral cephalexin hr before procedure

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4
Q

What is the best empiric treatment for a patient with acute infective endocarditis?

A

Vancomysin and ceftriaxone

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5
Q

In a patient with endocarditis, would their estimated sedimentation rate be elevated or decreased?

A

elevated

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6
Q

what microorganism is associated dental procedure related endocarditis?

A

Streptococcus viridans

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7
Q

Fever, decreased breath sounds, heart murmur at right sternal border (decrescendo-distolic), IV drug user, frequent STI, elelvated sedimentation rate, high WBCs, positive PPD, nodular infiltrates bilaterally on xray, all indicate _

A

R-sided infectious endocarditis (via IV drug use)

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8
Q

The nodular infiltrates thats seen in lung fields in an pt with endocarditis is usually due to _

A

septic emboli via tricuspid valve

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9
Q

The most likely organism of R-sided infectious endocarditis is _

A

Staph aureus

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10
Q

Differentiate between acute and subacute endocarditis

A
  1. Subacute = L side, slow onset, systemic symptoms, S. viridans, HACEK, enterococus are common causative agents.
  2. Acute = R sided thus affects Tri > Bi > aorta > pulm. fast onset, HIGH fever,SOB, pleuritic chest pain symptoms. S. aureus common cause
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11
Q

What are predispositions to infective endocarditis?

A
  1. Prosthetic valves
  2. implantable devices
  3. Parenteral nutrition tube
  4. Congenital heart disease(BAV, VSD, PDA, C of A)
  5. Previous endocarditis
  6. Structural heart disease
  7. Valvular heart disease rheumatic, MVP, aortic valve)
  8. Hemodialysis
  9. HIV
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12
Q

New murmur or changing murmur almost always indicates _

A

endocarditis

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13
Q

Dental procedures –> _sided endocarditis and the likely organism involved is _

A

Left.

Strep viridans

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14
Q

What are the major jone’s criteria for acute rheumatic fever?

A
  1. Carditis
  2. polyarthritis
  3. sydenham’s chorea
  4. Erythema marginatum
  5. Subcutaneous nodules
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15
Q

What the minor jones criteria for acute rheumatic fever?

A
  1. Fever
  2. arthralgia
  3. previous rheumatic fever or heart disease
  4. acute phase reactants
  5. prolonged P-R interval on EKG
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16
Q

When is prophylactic antibiotics for endocarditis indicated?

A
  • prosthetic valve, previous endocarditis, Heart transplant, congenital defects
  • going for dental procedure, tonsillectomy, adenoidectomy, or surgery on infected skin
17
Q

What is the standard prophylactic medication? what if pt is allergic to penicillin?

A

Amoxicillin (oral), ampicillin, cefazolin, or ceftriaxone (if unable to take oral)

If allergic to penicillin or ampicilin then clindamycin, cephalexin, azithromycin or clarithromycin

If allergic to penicillin/ampicillin and unable to take oral med then caphalexin, ceftrixone or clindamycin

18
Q

what are the most common gram negative endocarditis (besides in IV drug users)

A

HACEK organisms (Haemophilus, actinobacillus, cardiobaterium, eikenella, kingella)

19
Q

What are the common treatments for gram positive endocarditis?

A 
Strep = penicillin G
Staph = Nafcillin
20
Q

what are the 3 main causes of myocarditis?

A
  • Coxsackie B viruses
  • Trypanosomas (Chagas disease)
  • Borrelia (lyme disease)
21
Q

Pt presents with retrosternal chest pain that radiates to neck and L shoulder, cough and difficulty swallowing, night sweats, positive PPD, elevated CBC. what is the likely diagnosis?

A
  • acute pericarditis secondary to TB
22
Q

The most common infectious cause of pericarditis?

A
  • Coxsakie viruses (Also Echovirus and flu)
23
Q

In a patient with subacute endocarditis, what lab findings would support the diagnosis?

A
  1. Hematuria
  2. Proteinuria
  3. Blood culture + for coxiella, and others
  4. Increased ESR
  5. retinal hemorrhages
24
Q

What’s needed to have met to diagnose IE according to Duke criteria?

A

One of the following

  1. 2 major criteria
  2. 1 major with 3 minor criteria
  3. 5 minor criteria
25
Q

What’s considered a major criteria according to the Duke’s criteria for diagnosis of infective endocarditis?

A
  1. Positive blood culture with an infecting microorganism

2. Evidence of endocardial involvement via ECHO or signs or new valvular regurg

26
Q

What’s considered a minor criteria according to the Duke’s criteria for diagnosis of infective endocarditis?

A
  1. Predisposition to IE such IV drug user, prosthetic valve etc
  2. Fever
  3. Vascular phenomena: emboli, infarcts, aneurysm, hemorrhage, janeway lesion
  4. Immunologic phenomenon: glomerulonephritis, osler nodes, roth spots rhematoid factor
  5. Microbiologic evidence: positive blood culture or serology titer that do not meet major criteria
27
Q

a 28 year old male with recent URI presents with substernal chest pain that radiates to B/L shoulders. the pain is central in nature with associated diaphoresis and ever. Cardiac auscultation reveals a friction rub. what is the most likely diagnosis? and what is the classification of the causative agent?

A

Acute Pericarditis due to a viral infection, most likely coxsakie B virus, a member of picornavirus which is classified as +ssRNA naked icosahedral virus

28
Q

Pleuritic chest pain can be relieved in what position?

A

Sitting upright and leaning forward

29
Q

What is the treatment for acute pericarditis?

A

high dose ASA (steroids) and colchicine

30
Q

What lab values can be monitored to ensure treatment effectiveness in a patient with acute pericarditis?

A

CRP (C-reactive protein)

31
Q

Aside from viral, what are some other causes of pericarditis?

A
  • Chronic kidney failure with uremia
  • Neoplastic processes (hodgkin, mets, lymphomas)
  • Dressler - most MI
  • SLE
  • Drug induced (PCN, clozpine, minoxidil)
  • Radiation
  • S/P invasive cardiac procedure
32
Q

Inflammatory pericardial syndrome is diagnosed with at least 2 of which 4 criteria?

A
  1. Pericarditic chest pain
  2. Pericardial rubs
  3. New widespread ST elevation or PR depression
  4. pericardial effusion

Others: CRP, ESR, WBC, CT, CMR

Cardiovascular Medicine Midterm (6 decks)

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