Medicine 1 > week 5 CVS > Flashcards

week 5 CVS Flashcards

(61 cards)

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1
Q

inflammation of the inner layer of the heart

A

endocarditis

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2
Q

infective endocarditis does not usually involve the heart valve

a. true
b. false

A

b. false

endocardium (inner layer of heart)

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3
Q

infective endocarditis usually stems from an infection in the blood stream

a. true
b. false

A

a. true

platelets, fibrin, micro-organisms cause inflammation of layer of the heart (Endocardium) - precipitate vegetations (made up of platelets, fibrin and micro-organisms)

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4
Q

What can you see in infective endocarditis on echocardiogram?

A

the vegetations (made of platelets, fibrin and micro-organisms)

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5
Q

conditions that predipose someone to infective endocarditis

A
  • prosthetic valves
  • cardiac devices
  • IV drug users
  • Congenital heart disease
  • rheumatic valve disease
  • Mitral valve prolaspe
  • immunosuppression
  • been in hospital a long time
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6
Q

common signs and symptoms of infective endocarditis

A

* FEVER (common)*
* chills/rigors
* poor appetite
* weight loss
*** HEART MURMUR **

less frequent - myalgia, back pain, confusion

embolic complications

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7
Q

Fever + new murmur with generalised infection are cornerstone of infective endocarditis

a. true
b. false

A

a. true

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8
Q

splinter haemorrages can be a sign of?

A

endocarditis

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9
Q

it is essiential to complete blood cultures before starting anti-biotics theraphy in endocarditis

a. true
b. false

A

a. true

3 x

30 mins apart

isolate the pathogen

*if you start before - likely culture will be negative

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10
Q

most of the time endocarditis is caused by?

A

* staphyloccous aeurus
* streptococci - virdans
* enterococci
* coagulase negative staphylococci

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11
Q

non-infective endocarditis causes

A

lupus - libman sacks endocarditis

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12
Q

most common cause of blood culture
-IE in endocarditis?

A

giving antibiotics early on

(often common bacteria which has been unidenitifable because givin antibiotics too early)

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13
Q

imaging used to detect endocarditis

A

trans thoracic echocardiogram - as soon as IE is suspected

trans-oesphageal echocardiogram

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14
Q

what might u see on echocardiogram for infective endocarditis

A
  • vegetation (infected mass) attached to the valve
  • abscess (perivalvular cavity with necrosis)
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15
Q

major diagnosis criteria for infective endocarditis

A
  1. Positive blood culture -> staph aureus, enterococcus, viridans streptococci
  2. Echocardiogram -> showing valvular vegetation
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16
Q

,minar diagnositc critera for infective endocarditis

A
  • temperature > 38C
  • Embolic phenomena
  • Predisposing cardiac lesion
  • IV drug use
  • Immunological phenomenoa
  • Postive culture
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17
Q

common micro-organisms in infective endocarditis

A
  1. *** staphylococcus aureus
  2. streptococci - virdans**
  3. enterococci
  4. coagulase negative staphylococci
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18
Q

if patient has a positive blood culture for common organisms and echocardiogram shows valvular vegitations?

A

2 main criteria for IE

-> definite IE

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19
Q

what anti-biotic to treat streptococci - which cause infective endocarditis

A

penicillin G - 4-6 weeks

or (amoxicillin)
with or with

vancomycin

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20
Q

what antibiotic to treat staphylococcus auereus, in endocarditis?

A

flucloxacillin

and

Vancomycin

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21
Q

anti-biotic therapy for prothetic valves in endocarditis always goes to at least 4 weeks

a.true
b. false

A

b. false - always goes to 6 weeks at least!

Add rifampicin and gentamicin

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22
Q

anti-biotic therapy for infective endocarditis in patients with prothetic valves

A

AT LEAST 6 weeks

add rifampicin and gentamicin (extra anti-biotics)

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23
Q

indications for cardiac surgery in patients with infective endocarditis

A
  1. Heart failure with vlave dysfunction
  2. **Uncontrolled infection **
  3. **Prevent embolism **- vegetation is persistently large (1+ emoblic episodes)
  • heart failure
  • persistent infection
  • prevention of embolism
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24
Q

indications for cardiac surgery in patients with infective endocarditis

A
  1. Heart failure with vlave dysfunction
  2. **Uncontrolled infection **
  3. **Prevent embolism **- vegetation is persistently large (1+ emoblic episodes)
  • heart failure
  • persistent infection
  • prevention of embolism
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25
Group B beta-hemolytic streptococcal infection is associated with rheumatic Heart disease a. true b. false
b. false group A beta haemolytic streptococcal
26
Age group most prone to rheumatic fever
5-15 year olds boys > girls
27
symptoms of rheumatic fever
* carditis * painful joints * pericarditis/valvulitis
28
cause of rheumatic heart disease
chronic immunological response to the infection
29
patients with rhuematic heart disease are prone to developing atrial fibriliation a. true b. false
a. true
30
Rheumatic heart disease typically effects the left-side valves with greater affinity a. true b. false
a. true mitral stenosis +/- regurgitation aortic stenosis or regurgitation (less common)
31
Rheumatic heart disease typically effects the left-side valves with greater affinity a. true b. false
a. true mitral stenosis +/- regurgitation aortic stenosis or regurgitation (less common)
32
common features of echocardiogram in rheumatic heart disease - for valves?
1. thickening 2. calcification 3. restrictive movement
33
prophylaxis for overt acute rheumatic fever
penicillin prophylaxis
34
treatment for etablished RHD
treat for HF - > - Diuretics - Vasodilators (ACEi) - AF -> betablockers/digoxin / + anti-coagulation (warfarin)
35
treatment for rheumatic fever
Antibiotics -> oral penicillin V Anti-inflammatories -> NSAIDs first line Treat complications / Secondary prophylaxis? to prevent RHD! - Echo screening? - Audible murmurs
36
what are the only anti-coagulants you can use in rheumatic heart disease
Warfarin
37
Balloon mitral valvuplasty
*percutaneous - do not need to open heart - done from femoral artery * symptomatic mitral stenosis -> balloon opens the valve * younger patients
38
what is a thrombus made of?
**fibrin + platelets** RBC
39
virchows tirad
3 main causes of thrombus 1.stasis 2. hypercoagulability 3. endothelial damage
40
what colour is thrombus in venous system compared to arterial
venous -> red (RBC and fibrin) arterial -> white (platelets and fibrin)
41
acquired disorder that can lead to hypercoagulability
* pregnancy * cancer * sepsis
42
movement of blood clot along a vessel
thrombo-embolism
43
signs and symptoms of DVT
Asymmetrical - pitting oedema - Erythema (warm) skin - calf swelling - localised pain in calf - Swollen veins, sore to touch. - Red skin around darkened area - prominant collaterl veins
44
diagnosis of DVT
* pretest probability - WELLS Score * blood test - D-dimer * Doppler Ultrasound -GOLD STANDARD
45
WELLS score > 2
DVT likely
46
What is a D-dimer
D-dimer is the breakdown product of cross-linked fibrin produced during fibrinolysis when clot formed - body is trying to break it down (continuously turning over D-dimer during blood clot) if clot should be positive
47
D-dimer is highly sensitive and highly specific a. true b. false
b. false is sensitive but NON-SPECIFIC - lots of reasons for activation of clotting casade - sepsis, bleeding , cancer, recent surgery
48
symptoms of PE
Pleuritic chest pain SOB – dyspnoea Haemoptysis Tachycardia Pleural rub on auscultation - pulmonary infarction - local area of infarction ECG - right heart strain
49
diagnosing Pulmonary embolism
Pretest probability – **WELLS SCORE ** Blood test –** D-Dimer (if low)** Imaging – if D-dimer is positive or high pretest probability score. - **CT pulmonary angiogram - Isotope ventilation/perusion scan**
50
diagnostic imaging for PE
CT pulmonary angiogram
51
diagnostic imaging for PE
CT pulmonary angiogram
52
WELLS score is used as a test for DVT and PE a. true b. false
a/ true
53
There needs to be 2 negative tests to exclude DVT or PE a. true b. false
a. true
54
if there is no known risk /cause of PE/DVT found out they need to be on treatment for longer a. true b. false
a. true because dont know what causd it if stop treatment after 3 months have higher risk of it reoccuring anti-coagulate for longer term!!!
55
treatment for PE
anti-coagulation - provoked (known cause) - 3 months - unprovoked - lifelong? ***DOACs ***- factor Xa inhibitors - rivaroxaban direct thrombin inhibitor - dabigatran
56
when give thrombolysis (altepase) for PE
(if collapsed, haemodynamic compromise, shocked) massive PE risk of dying is very high
57
describe arterial leg ulcers
- PALE, painful and punched out. - - They usually occur in the setting of peripheral vascular disease, which this patient is likely to have given the risk factors and claudication pain. Pain while sitting down suggests critical ischaemia.
58
Neuropathic ulcers usually occur over pressure areas such as the sole of the foot and are associated with a sensory neuropathy a. true b.false
a. true
59
Which clotting factors does warfarin act on?
Warfarin - clotting factors affected mnemonic - 1972 (10, 9, 7, 2)
60
Ivabradine
Ivabradine is a medication that is used in heart failure to reduce the heart rate. It acts on the If ion current in the sinoatrial node.
61
Ivabradine - acts on the If ion current in the sinoatrial node a. true b,false
a. true
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