ToL EM cardiology Flashcards
What is the most common valve involved in acute bacterial endocarditis?
Mitral valve
What organisms are most commonly involved in acute bacterial endocarditis?
HACEK organisms (haemophilus, actinobacillus, cardiobacterium, eikenella, kingella)
Staph aureus
Viridans streptococci
What diagnostic studies should be preformed on a patient in whom you suspect acute bacterial endocarditis?
Blood cultures (before abx initiation)
EKG
Echo
CBC
What criteria can be used to diagnose acute bacterial endocarditis?
Duke criteria
How many duke criteria must be positive to diagnose acute bacterial endocarditis?
2 major OR 1 major + 3 minor OR 5 minor
What are the major duke criteria?
Bacteremia (2 positive blood cultures) Endocardial involvement (positive echo showing vegetations, or new valvular regurg)
What are the 6 minor duke criteria?
- Predisposing condition (IVDE, indwelling cath)
- Fever
- Vascular/embolic phenomena (janeway lesions, ICH)
- Immunologic phenomena (oseler nodes, roth spots, + RF, acute glomerulonephritis)
- 1 positive blood culture
- Positive echo not meeting major criteria (worsening murmur)
What is the suggested empiric therapy and duration for acute bacterial endocarditis of a native valve in a non-IVDU?
Penicillin/ampicillin + gentamycin x 4-6 weeks
What is the suggested empiric therapy and duration for acute bacterial endocarditis of a native valve in an IVDU patient?
Vancomycin x4-6 weeks
What is the treatment for acute bacterial endocarditis in a patient with a prosthetic valve?
vancomycin + gentamycin + rifampin
What is the #1 risk factor for angina?
Smoking
What EKG findings are consistent with stable angina?
No changes at rest.
1mm ST depression during episode
What follow up testing should a patient undergo after being diagnosed with stable angina?
Exercise stress test
What is the first line therapy for chronic angina?
B-blockers
What is prinzmetal angina?
vasospastic angina
What medication is contraindicated in treatment of prinzmetal angina?
propanolol
What is the treatment for prinzmetal angina?
nitrates and CCB
An irregularly irregular rhythm with no discernable P waves is consistent with what dysrhythmia?
A fib
What are the components of the CHA2DS2VASc score?
CHF = 1 HTN = 1 Age >74 = 2 DM = 1 Stroke/TIA = 2 Vascular disease = 2 Age 65-74 = 1 Female = 1
A CHADSVASc score of ___ or greater should be anticoagulated
2
What rhythm is characterized by a PR interval >.2 without any dropped beats?
1st degree AV block
PR intervals that become longer and longer until a beat is dropped is what type of rhythm?
Wenckebach (Mobitz I) (Second degree AV block, type 1)
What are the characteristic EKG findings of a mobitz II (second degree AV block, type II)?
Consistently long PR interval, with some dropped beats.
How would you describe the EKG findings of a 3rd degree AV block (complete heart block)?
P waves and QRS complexes have no correlation to eachother.
A wide QRS with R and R’ waves in leads v4-v6 is characteristic of?
Left heart block
Which leads are R and R’ waves seen in in a right heart block?
V1-V3
What should be the first attempted treatment for a stable patient in SVT?
valsalva