last topics

Question 1

Infective endocarditis risk factors

Answer 1

Risk factors:
- Prosthetic valves, foregoing bodies, acquired valvular disease, mural thrombus, HCM, conditions predisposed to infection

Most commonly seen in pt with MVP with MR or AS

Question 2

Symptoms in infective endocarditis

Answer 2

fever, chills
fatigue
arthalgia, myalgia
night sweats
paleness
weight loss
hematuria
splenomegaly

New heart murmur: regurgitation
Embolic event
sepsis
microhematirua
fever of unknown origin in case of: new AV block, new HF, peripheral abscess, previous IE, intracardiac material

Question 3

Special signs in endocarditis

Answer 3

Janeway lesion: erythematous, hemorrhagic/pustular lesion on palms/soles

Osler-node: tender, subcut nodules in pulp of digits or thenar (immune complex depositions)

Roth’s spots: conjuctive petechiae. Retinal haemorrhage with white center

Question 4

Diagnostics of endocarditis

Answer 4

Duke criteria
Positive blood culture
Echo - vegetation, perivalvular abscess, new valvular regurgitation.

minor crit:
- janeway, fever. osler roths spots, glomerulonephritis

Question 5

Congenital heart disease in adults

Answer 5

1. Patent ductus arteriosus
2. Aortic coarctation
3. Tetralogy of ballot
4. Transposition of the great arteries
5. Pulmonary stenosis
6. Ebsteins anomality of the tricuspid valve

Question 6

Arterial septal defects

Answer 6

1. Ostium secundum arterial septal defect
2. patent foramen ovale
3. Ostium primum arterial septal defect
4. Sinus venosus defect
5. Common or single atrium

Question 7

ventricular septal defects

Answer 7

Most common congenital abnormality.
Ass with downs syndrome
Many close spont
L ->R

Question 8

Drug treatment of HT

Answer 8

Monotherapy

• CCB (elderly)
• ACEi( young) /ARB
• BB (pregnant)

Combination
- ACEi + CCB + Thiazide diuretics

Diuretics and BB ↓ mortality

Question 9

Types of anticoagulants

Answer 9

Heparin - bind ATIII, mesure aPTT (n: 30-50s)
LMWH - only fX
Direct thrombin inhibitors (e.g dabigatrin)
Direct oral factor Xa inhibitors
Warfarin (Vit K dep factors: VII, IX, X, thrombin)

Question 10

Thrombolytic agents

Answer 10

TPA

Streptokinase

Question 11

Antiplatelet drugs

Answer 11

Aspirin
- Block COX
Glycoprotein IIB/IIIa
- Block platelet cross-linking
Clopidogrel
- Prevent ADP mediated aggregation
Dipyridamole
- inhibit PDE; inhibit platelet aggregation, and creates vasodilation
- also inhibit uptake of adenosine