Infective Endocraditis- Aortic Stenosis Flashcards
A 56 years old lady with Bicuspid Aortic Valve Is admitted for laparotomy.
A 56 years old lady with Bicuspid Aortic Valve Is admitted for laparotomy.
Q1: Why is Bicuspid Aortic Valve susceptible to IE?
because valve has 2 flaps only narrowing and obst stasis and bacteria can colonise and infect it.
Q3. Investigation identify Vegetations In infective Endocarditis?
2D ECHO
Q2: Pathogenesis of Infective Endocarditis in Bicuspid valve?
Narrowing of the valve – > stasis of blood – > bact. Colonisation and damage – > recurrent inflammation will cause progressive fibrosis, narrowing and stiffning – > further stenosis.
Q4: What are you looking for in 2D echo?
Valvular regurge /
Vent. Dilatation /
leaflet prolapse /
Pericardial effusion /
Annular prolapse.
Q5: What is the cause for sudden death in AS?
Acute MI / Aortic Diss.
Q7: Pathophysiology of Aortic Stenosis/How does AS lead to death?
Sclerosis Stenosis Vent Hypertrophy less elstiicity less coronary blood flow increase in myocardial work load and O2 consumption – > death.
Q6: Clinical picture of Aortic Stenosis?
Mild – > Asym.
Mod – > angina / Syncope / Dyspnea of exeretion
Sever – > HF complications and Symp may lead to sudden death.
Q9: What is the difference between Mechanical and Tissue Valve?
Mech; Good durability and less re-op / Easy to insert / Needs warfarin / Relative high risk of TE and bleeding
Tissue; Noiseless / Diff to insert / No warfarin and Relative low risk for bleeding and TE
Q10: what is the non-surgical option for Valve replacement?
TAVR
Q8: What are the surgical options to treat Aortic Stenosis?
Mechanical Valve Replacement / Tissue valve replacement / TAVR / Balloon valvoplasty
Q12: what is the commonest Bacteria cause infection of prosthetic valve?
HACEK group
Staph. Epid / Aureus
Q11: If metallic valve replacement was done and the patient developed Infective Endocarditis what will be your next step? Why?
Remove valve as it becomes septic focus, valve will be dehiscent
and Abx will not work as there’s no blood supply for the valve and also the biofilm around it.
Q13: If you find microscopic branching Hyphae on the removal of the valve, What is the cause? Types?
Fungal Inf.
By; Candida / Aspergillosis
Q14: A patient with Mechanical valve replacement after a while Started complaining of Arm weakness? Why?
Thromboembolism cerebrovascular Stroke (arm weakness)
Q15: Do you prescribe anti-coagulant post valve replacement?
Yes For 3 months
Q16: what is the common anti-coagulant used with outpatients?
Warfarin
Q. which pathway not affected by Warfarin?
Ext. Pathway
Q17: Mode of action of Warfarin?
Inhibition of Vit K dependent Coagulation Fx
Q19: Describe the common pathway of Clot formation ?
Prothrombin –(F10a)– > Thrombin
Fibrinogen –(Thrombin)–> Fibrin
Later on by F13a –> stabilization
Q. What does activate Factor 10?
Calcuim
Q20: Define Thrombus?
Solid material from that formed from blood coagulation products and it’s attached to the wall
Q21: What type of complication happen to non-displaced Thrombus ?
Infection / Dislodgment
Q22 what test you will do if you suspect that thrombus is infected?
Labs; CRP ESR and blood culture
Q23: What is CRP? What you look for in Blood Culture?
Acute phase reactant ptn produced by liver in response to acute inflammation.(Cytokines) stimulated by Inf. Inflam, trauma.
Looking for G+ve / G-ve / Anarobes
(Staph Aureus / Strept V. / Enetrococcus)
Q24: What is type of endocarditis that occur with adenocarcinoma ?
Libman Sac
Q25: what is the Antibiotic guide lines in patient with Aortic Stenosis?
Acc to NICE guidelines – only Abx in case of Highly infectious procedures
SIGN guidelines – No need for Abx at all
Q. Hand signs in IE
Janway lesions – Osler nodes -splinter Hge
Acshoff Nodules
Gran. Inflam, composed of fibrinoid necrosis surrounded by chronic inflammatory cells, including macrophages (Aschoff cells), lymphocytes, and plasma cells
