Other Forms of Heart Disease

Question 1

What is the most common cause of infective endocarditis in IV drug users?

Answer 1

staph aureus (overall it’s staph and strep)

Question 2

What are the major complications of endocarditis?

Answer 2

emboli (systemic or cerebral) and valvular incompetence leading to CHF

Question 3

What patients are at high risk of developing infective endocarditis?

Answer 3

cogenital heart disease, rheumatic heart dz, prosthetic valves, degenerative valve dz (calcified aortic valve), previous endocarditis, cardiac transplant pts who develop valvulopathy

Question 4

What procedures put high risk endocarditis patients at risk for infection?

Answer 4

major dental procedures, invasive procedures involving infected tissue, respiratory procedures (also IV drug use)

Question 5

What does the presentation for infective endocarditis look like?

Answer 5

fever, dyspnea, myalgias, arthralgias, GI complaints

Question 6

What are some cutaneous manifestations in infective endocarditis?

Answer 6

petechiae, splinter hemorrhages, osler’s nodes (painful), janeway lesions (not painful)

Question 7

What should be done to work up infective endocarditis?

Answer 7

blood cultures and echo (especially transesophageal)

Question 8

What is the initial treatment for infective endocarditis?

Answer 8

penicillin/nafcillin/vancomycin + gentamicin

(vanc + gent is probably best)–eventally might need valve replacement

Question 9

What is the prophylatic drug for high risk endocarditis pts?

Answer 9

amoxicillin 2 gm or ceftriaxone 1 gm–but because of MRSA prevalance sometimes use vancomycin

Question 10

What is the major complication of pericarditis?

Answer 10

effusion leading to tamponade

Question 11

What are the signs and symptoms of acute pericarditis?

Answer 11

sharp, pleuritic chest pain (they usually lean forward because it feels better), friction rub, low fever, tachycardia

Question 12

What is the primary diagnostic modality for acute pericarditis?

Answer 12

EKG-diffuse ST elevation (concave upwards), depressed PR in the same leads with ST elevation

Question 13

What should be ordered to evaluate for acute pericarditis with effusion?

Answer 13

echo or CT if there is no echo available

Question 14

What does EKG with large pericardial effusion causing tamponade look like?

Answer 14

low voltage, tachycardia, electrical alternans (QRS changes in size from beat to beat)

Question 15

What is Beck’s triad for tamponade?

Answer 15

hypotension, JVD, muffled heart sounds

Question 16

How do you treat pericarditis?

Answer 16

high dose ASA or NSAIDs for 1-3 weeks (if its infections use antibiotics) also the addition of colchicine helps

Question 17

What is the treatment for a large pericardial effusion with tamponade?

Answer 17

pericardiocentesis

Question 18

What kind of murmur is mitral valve prolapse?

Answer 18

mid-systolic click

Question 19

What does VSD cause?

Answer 19

pulmonary hypertension

Question 20

What is the treatment for ventricular fibrillation?

Answer 20

immediate cardioversion

Question 21

What is the most common cause of v fib?

Answer 21

myocardial ischemia

Question 22

What is sick sinus syndrome?

Answer 22

the SA node goes too fast or too slow (aka tachy-brady sydrome)

Question 23

What are the symptoms with sick sinus syndrome?

Answer 23

syncope, palpitations, SOB

Question 24

What is the treatment for sick sinus syndrome?

Answer 24

pacemaker

Question 25

What does right bundle branch block look like on EKG and is it serious?

Answer 25

rabbit ears –not really serious

Question 26

What does LBBB look like on EKG and is it serious?

Answer 26

deep S wave in V1 and wide big R wave V6–yes, it’s serious