Paeds cardio Flashcards
what are the 3 main pathogens that cause infective endocarditis
1) Strep viridian’s (dental surgery)
2) staph A
3) enterococci (GI or GU surgery)
what are the triad of causes that would suggest IE?
1) platelet aggregation/adhesion
2) endothelial damage
3) microbiological adherence
it is the turbulent blood flow that causes stress forces. Bacteraemia must occur.
what are some clinical signs of infective endocarditis?
1) Murmur (systolic - aortic stenosis)
2) Janeway lesions, osler nodes, splinter haemorrhage
3) SPLENOMEGALY
4) emboli could cause -
- stoke (cerebral emboli) –> hemiplegia, seizure etc
- pulmonary emboli
- glomerulonephritis
can also be non-acute - fatigue, weight loss, leathery, myalgia
investigations for IE?
ECHO for vegetation blood culture for microbiology haematuria ESR leukocytes
reasons for surgical intervention for IE?
1) vegetation -
- growing despite medicine
- over 1 embolic event in 2 weeks
- highly mobile vegetables
2) valvular incompetence
- heart failure
- valvular rupture or leak
- aortic or mitral valve dysfunction with ventricular failure
3) perivalvular cause-
- heart block
- valvular dehiscence or rupture
- abbess formation
what antibiotic management would you use for IE?
1) sensitive strep - IV penicillin or ceftriaxone (4 weeks)
2) methicillin resistant staph aureus - vancomycin 6 weeks + gentamicin 5 days
3) HACEK - vancomycin + gentamycin (6 weeks)
What illness does rheumatic fever usually precede?
1) strep throat/scarlet fever
2) pharyngitis
for 2-4 weeks. The bacterial infection is from group A beta-haemolytic streptococcus (Streptococcus pyogenes)
what are the risk factors for rheumatic fever?
1) girls
2) poor
3) tropical country
what is the pathophysiology of rheumatic fever?
GAS or strep pyogenes is that they release stretolysin O and S. The rheumatic strands of this will secrete M proteins, for which the body releases anti M proteins. These have detrimental impacts on the heart, brain and joints.
Clinical features of Rheumatic fever?
1) strep throat/scarlet fever (white tongue –> strawberry tongue or white spots on tonsils, sore throat, rash on body, flush on face, swollen glands)
2) Mitral valve murmur in severe acute rheumatic fever
3) Diagnostic criteria are based on 2 major or 1 major and 2 minor problems as well as identifying positive blood cultures (strep pyogenes or Anti streptolysin O) -
Major -
- carditis
- erythema marginatum (look like waterspots)
- syndham’s chorea
- polyarthritis (5 joints at the same time)
- subcutaneous nodules)
differential diagnosis for rheumatic fever
1) septic arthritis - only effects one joint, positive futures from that joint
2) reactive arthritis - in response to conjunctivitis or urethritis, males
3) infective endocarditis - echo, positive for strep viridian’s/staph A or enterococci + oslner, Janeway, splinter, hepatomegaly
4) myocarditis - st elevation/saddle, troponin, creatinine kinase
what is the management for rheumatic fever?
1) benzylpeneckllin (give this 3/4 weekly for prophylactic measure)
2) NSAIDS or aspirin
3) emergency valve replacement
what is tetralogy of fallot?
- VSD
- Right ventricular hypertrophy
- overriding aorta
- pulmonary stenosis
what murmur would you hear in IE?
Aortic stenosis, first heart sound
what murmur would you hear in Rheumatic Fever?
mitral valve murmur @ apex
