Podcast
Questions and Answers
Which of the following symptoms is most closely associated with heart failure?
Which of the following symptoms is most closely associated with heart failure?
- Palpitations due to arrhythmia
- Feeling faint from low blood pressure
- Chest pain due to ischaemia
- Breathlessness (correct)
What is the typical cause of chest pain related to heart disease?
What is the typical cause of chest pain related to heart disease?
- Arrhythmia
- Ischaemia (correct)
- Heart Failure
- Low blood pressure
Which physical sign would suggest heart failure in a clothed patient?
Which physical sign would suggest heart failure in a clothed patient?
- Breathlessness (correct)
- Peripheral cyanosis only
- High blood pressure only
- Low body temperature
What does 'pitting' peripheral oedema indicate in the context of cardiovascular assessment?
What does 'pitting' peripheral oedema indicate in the context of cardiovascular assessment?
What is the underlying cause of heart disease in cases of ischaemic heart disease?
What is the underlying cause of heart disease in cases of ischaemic heart disease?
Atherosclerosis and thrombosis can lead to which of the following consequences?
Atherosclerosis and thrombosis can lead to which of the following consequences?
What is the primary action of GTN spray in the management of angina?
What is the primary action of GTN spray in the management of angina?
Which of the following is considered a modifiable risk factor for heart disease?
Which of the following is considered a modifiable risk factor for heart disease?
What cardiac investigation is used to show changes during angina or MI, and heart rhythm?
What cardiac investigation is used to show changes during angina or MI, and heart rhythm?
Which cardiac investigation is used to detect the release of cardiac muscle proteins in acute coronary syndrome and MI?
Which cardiac investigation is used to detect the release of cardiac muscle proteins in acute coronary syndrome and MI?
What is the immediate treatment for ST-elevation MI (STEMI)?
What is the immediate treatment for ST-elevation MI (STEMI)?
Stenosis and regurgitation are the main problems associated with which of the following?
Stenosis and regurgitation are the main problems associated with which of the following?
Rheumatic fever typically occurs after which type of infection?
Rheumatic fever typically occurs after which type of infection?
Splinter haemorrhages in nails, finger clubbing, and fever are signs of which condition?
Splinter haemorrhages in nails, finger clubbing, and fever are signs of which condition?
Which treatment addresses symptoms of valvular heart disease?
Which treatment addresses symptoms of valvular heart disease?
Which of the following describes the need for anticoagulation?
Which of the following describes the need for anticoagulation?
What is the underlying issue in heart failure?
What is the underlying issue in heart failure?
Which symptoms are associated with heart failure?
Which symptoms are associated with heart failure?
What may inspiratory crackles at lung bases indicate?
What may inspiratory crackles at lung bases indicate?
Which of the following is a consequence of turbulent blood flow in the heart?
Which of the following is a consequence of turbulent blood flow in the heart?
What is indicated by dullness to percussion?
What is indicated by dullness to percussion?
A patient presents with breathlessness at rest and pulmonary oedema. Which type of heart failure is most likely?
A patient presents with breathlessness at rest and pulmonary oedema. Which type of heart failure is most likely?
In right-sided heart failure, which of the following findings would you most likely observe?
In right-sided heart failure, which of the following findings would you most likely observe?
Understanding the implications of Cardiac MRI findings is important; however, what are common contraindications for undergoing a Cardiac MRI?
Understanding the implications of Cardiac MRI findings is important; however, what are common contraindications for undergoing a Cardiac MRI?
A patient has a history of rheumatic fever. Which cardiac manifestation is most closely associated with this condition?
A patient has a history of rheumatic fever. Which cardiac manifestation is most closely associated with this condition?
Which of the following is the primary cause of chest pain in the context of heart disease?
Which of the following is the primary cause of chest pain in the context of heart disease?
What does the term 'arrhythmia' refer to in the context of cardiac symptoms?
What does the term 'arrhythmia' refer to in the context of cardiac symptoms?
Which of the following is a potential cause of a patient feeling faint, related to cardiovascular issues?
Which of the following is a potential cause of a patient feeling faint, related to cardiovascular issues?
What signs might a clinician observe in a clothed patient that could suggest a cardiovascular issue?
What signs might a clinician observe in a clothed patient that could suggest a cardiovascular issue?
What assessment finding correlates with potential heart failure?
What assessment finding correlates with potential heart failure?
What does the presence of additional heart sounds, specifically murmurs, typically indicate?
What does the presence of additional heart sounds, specifically murmurs, typically indicate?
What is indicated by observing 'inspiratory crackles at lung bases' during auscultation?
What is indicated by observing 'inspiratory crackles at lung bases' during auscultation?
What does 'dullness to percussion' typically suggest when assessing lung sounds?
What does 'dullness to percussion' typically suggest when assessing lung sounds?
Which pathological process underlies ischaemic heart disease?
Which pathological process underlies ischaemic heart disease?
What are the potential consequences of atherosclerosis and thrombosis in the coronary arteries?
What are the potential consequences of atherosclerosis and thrombosis in the coronary arteries?
A patient is prescribed GTN spray. What is the route of administration?
A patient is prescribed GTN spray. What is the route of administration?
Which medication is commonly used as a regular anti-anginal drug?
Which medication is commonly used as a regular anti-anginal drug?
Among the following, which is a modifiable risk factor for heart disease?
Among the following, which is a modifiable risk factor for heart disease?
Which of the following is a risk factor for heart disease that cannot be modified?
Which of the following is a risk factor for heart disease that cannot be modified?
Which cardiac investigation provides real-time images of the heart's structure, movement of valves/muscle and blood flow?
Which cardiac investigation provides real-time images of the heart's structure, movement of valves/muscle and blood flow?
What does a 'stress test' assess in the context of cardiac investigations?
What does a 'stress test' assess in the context of cardiac investigations?
What does the term 'STEMI' stand for in the context of myocardial infarction?
What does the term 'STEMI' stand for in the context of myocardial infarction?
What is the immediate intervention for a patient presenting with ST-elevation Myocardial Infarction (STEMI)?
What is the immediate intervention for a patient presenting with ST-elevation Myocardial Infarction (STEMI)?
What are the two main problems associated with valvular heart disease?
What are the two main problems associated with valvular heart disease?
How long after a streptococcal upper respiratory tract infection (URTI) does Rheumatic Fever typically occur?
How long after a streptococcal upper respiratory tract infection (URTI) does Rheumatic Fever typically occur?
Which of the following is associated with Rheumatic Fever?
Which of the following is associated with Rheumatic Fever?
What is a 'flitting' polyarthritis?
What is a 'flitting' polyarthritis?
What is the primary aim of treatments for valvular heart disease?
What is the primary aim of treatments for valvular heart disease?
Following a valve replacement, which type of valve typically necessitates long-term anticoagulation therapy?
Following a valve replacement, which type of valve typically necessitates long-term anticoagulation therapy?
A 78-year-old patient presents to the clinic complaining of recent onset breathlessness and fatigue, and has pitting oedema. Based on the Rotterdam study, which of the following age groups has the highest prevalence of heart failure?
A 78-year-old patient presents to the clinic complaining of recent onset breathlessness and fatigue, and has pitting oedema. Based on the Rotterdam study, which of the following age groups has the highest prevalence of heart failure?
Which of the following is a common cause of right-sided heart failure due to pulmonary hypertension in chronic lung disease?
Which of the following is a common cause of right-sided heart failure due to pulmonary hypertension in chronic lung disease?
Which compensatory mechanism is activated in response to reduced cardiac output to retain salt and water?
Which compensatory mechanism is activated in response to reduced cardiac output to retain salt and water?
Which of the following is a non-cardiac cause of heart failure syndrome related to excessive demand?
Which of the following is a non-cardiac cause of heart failure syndrome related to excessive demand?
A patient presents with breathlessness due to pulmonary oedema and pulmonary venous congestion. Which of the following conditions is most likely?
A patient presents with breathlessness due to pulmonary oedema and pulmonary venous congestion. Which of the following conditions is most likely?
Which class of medications includes drugs ending in '-opril' and is used in the pharmacological correction of heart failure?
Which class of medications includes drugs ending in '-opril' and is used in the pharmacological correction of heart failure?
A patient is found to have a cardiac arrhythmia with a rate faster than 100 bpm and normal P waves on their ECG. Which arrhythmia is most likely?
A patient is found to have a cardiac arrhythmia with a rate faster than 100 bpm and normal P waves on their ECG. Which arrhythmia is most likely?
Which of the following rhythm disturbances is characterised by uncoordinated atrial contractions, leading to a rapid, irregular ventricular rate, predisposing the patient to being anticoagulated?
Which of the following rhythm disturbances is characterised by uncoordinated atrial contractions, leading to a rapid, irregular ventricular rate, predisposing the patient to being anticoagulated?
A young, athletic individual is found to have a heart rate of 55 bpm during a routine check-up. Which of the following is the most likely explanation?
A young, athletic individual is found to have a heart rate of 55 bpm during a routine check-up. Which of the following is the most likely explanation?
A patient reports occasional sensations of 'missed' or 'extra' heartbeats. Which type of intermittent rhythm disturbance is most likely?
A patient reports occasional sensations of 'missed' or 'extra' heartbeats. Which type of intermittent rhythm disturbance is most likely?
Which of the following rhythm disturbances is characterised by the absence of electrical activity and contraction?
Which of the following rhythm disturbances is characterised by the absence of electrical activity and contraction?
Which therapeutic intervention is indicated as an emergency treatment for ventricular fibrillation?
Which therapeutic intervention is indicated as an emergency treatment for ventricular fibrillation?
Which treatment is most appropriate for a patient with bradycardia?
Which treatment is most appropriate for a patient with bradycardia?
For which of the following arrhythmias might an implantable defibrillator be an appropriate treatment option?
For which of the following arrhythmias might an implantable defibrillator be an appropriate treatment option?
A patient with atrial fibrillation is prescribed warfarin. What is the primary goal of this medication?
A patient with atrial fibrillation is prescribed warfarin. What is the primary goal of this medication?
Which of the following would be least helpful as part of the initial investigations into heart failure?
Which of the following would be least helpful as part of the initial investigations into heart failure?
A patient with a history of chronic obstructive pulmonary disease (COPD) develops right-sided heart failure. Which of the following pharmacological interventions specifically targets the underlying mechanism related to their COPD?
A patient with a history of chronic obstructive pulmonary disease (COPD) develops right-sided heart failure. Which of the following pharmacological interventions specifically targets the underlying mechanism related to their COPD?
A patient is diagnosed with heart failure and prescribed spironolactone. What is the primary mechanism of action of this medication in the context of heart failure management?
A patient is diagnosed with heart failure and prescribed spironolactone. What is the primary mechanism of action of this medication in the context of heart failure management?
A patient experiencing ventricular tachycardia is being managed by an implantable cardioverter-defibrillator (ICD). Under what circumstances would the ICD deliver a high-energy shock?
A patient experiencing ventricular tachycardia is being managed by an implantable cardioverter-defibrillator (ICD). Under what circumstances would the ICD deliver a high-energy shock?
A patient with atrial fibrillation is started on digoxin for rate control. What aspect of cardiac function does digoxin primarily affect to achieve this therapeutic goal?
A patient with atrial fibrillation is started on digoxin for rate control. What aspect of cardiac function does digoxin primarily affect to achieve this therapeutic goal?
A patient with heart failure is scheduled for an elective electrophysiological study and possible catheter ablation. What is the main purpose of catheter ablation in managing certain types of arrhythmias?
A patient with heart failure is scheduled for an elective electrophysiological study and possible catheter ablation. What is the main purpose of catheter ablation in managing certain types of arrhythmias?
In the management of atrial fibrillation, what is the rationale for using rate-controlling drugs such as beta-blockers or digoxin?
In the management of atrial fibrillation, what is the rationale for using rate-controlling drugs such as beta-blockers or digoxin?
A patient presents with recurrent episodes of syncope due to atrio-ventricular (AV) block. What is the most definitive long-term treatment option for this condition?
A patient presents with recurrent episodes of syncope due to atrio-ventricular (AV) block. What is the most definitive long-term treatment option for this condition?
A patient with a known history of ventricular tachycardia is undergoing a surgical procedure. What is the critical concern regarding the use of electrocautery equipment during the surgery?
A patient with a known history of ventricular tachycardia is undergoing a surgical procedure. What is the critical concern regarding the use of electrocautery equipment during the surgery?
A patient receiving amiodarone for long-term management of atrial fibrillation develops new-onset pulmonary fibrosis. What is the most appropriate course of action?
A patient receiving amiodarone for long-term management of atrial fibrillation develops new-onset pulmonary fibrosis. What is the most appropriate course of action?
What is a key characteristic of 'Cor Pulmonale'?
What is a key characteristic of 'Cor Pulmonale'?
Which of the following is a common symptom of heart failure related to fluid retention?
Which of the following is a common symptom of heart failure related to fluid retention?
Which of the following blood tests is typically part of the initial investigations for heart failure?
Which of the following blood tests is typically part of the initial investigations for heart failure?
The activation of the renin-angiotensin-aldosterone system in heart failure leads to which physiological response?
The activation of the renin-angiotensin-aldosterone system in heart failure leads to which physiological response?
Which class of medications is characterised by drug names ending in '-sartan' and used in heart failure management?
Which class of medications is characterised by drug names ending in '-sartan' and used in heart failure management?
A patient presents with a heart rate exceeding 100 bpm. An ECG shows normal P waves. Which arrhythmia is most likely?
A patient presents with a heart rate exceeding 100 bpm. An ECG shows normal P waves. Which arrhythmia is most likely?
What is a primary characteristic of atrial fibrillation (AF) that often necessitates anticoagulation therapy?
What is a primary characteristic of atrial fibrillation (AF) that often necessitates anticoagulation therapy?
A young, well-trained athlete is found to have a heart rate of 55 bpm. What is the most likely underlying cause?
A young, well-trained athlete is found to have a heart rate of 55 bpm. What is the most likely underlying cause?
What is the typical patient description of extrasystoles?
What is the typical patient description of extrasystoles?
Which arrhythmia is characterised by a complete absence of electrical activity and cardiac muscle contraction?
Which arrhythmia is characterised by a complete absence of electrical activity and cardiac muscle contraction?
What is the immediate treatment of choice for a patient in confirmed ventricular fibrillation (VF)?
What is the immediate treatment of choice for a patient in confirmed ventricular fibrillation (VF)?
For which condition would a pacemaker be the most appropriate treatment?
For which condition would a pacemaker be the most appropriate treatment?
Which of the following arrhythmias might be appropriately managed with an implantable cardioverter-defibrillator (ICD)?
Which of the following arrhythmias might be appropriately managed with an implantable cardioverter-defibrillator (ICD)?
A patient with atrial fibrillation(AF) is prescribed warfarin. What is the major goal of warfarin therapy?
A patient with atrial fibrillation(AF) is prescribed warfarin. What is the major goal of warfarin therapy?
A patient is being investigated for breathlessness. Which test from the following list is least helpful in the diagnosis of heart failure?
A patient is being investigated for breathlessness. Which test from the following list is least helpful in the diagnosis of heart failure?
A patient with COPD develops right-sided heart failure. Which treatment targets the underlying mechanism related to their COPD?
A patient with COPD develops right-sided heart failure. Which treatment targets the underlying mechanism related to their COPD?
A diagnosed heart failure patient is prescribed spironolactone. What is its primary action in the context of heart failure management?
A diagnosed heart failure patient is prescribed spironolactone. What is its primary action in the context of heart failure management?
An ICD delivers a high-energy shock after detecting ventricular tachycardia. What triggers the ICD to deliver this shock?
An ICD delivers a high-energy shock after detecting ventricular tachycardia. What triggers the ICD to deliver this shock?
A patient with atrial fibrillation is started on digoxin. What is the primary mechanism by which digoxin achieves rate control?
A patient with atrial fibrillation is started on digoxin. What is the primary mechanism by which digoxin achieves rate control?
What is the main purpose of catheter ablation as a treatment for certain types of arrhythmias?
What is the main purpose of catheter ablation as a treatment for certain types of arrhythmias?
What is the rationale for using rate-controlling drugs in atrial fibrillation?
What is the rationale for using rate-controlling drugs in atrial fibrillation?
What is the definitive long-term treatment for recurrent syncope due to complete heart block?
What is the definitive long-term treatment for recurrent syncope due to complete heart block?
A patient with ventricular tachycardia is undergoing surgery. Why is there a concern regarding the use of electrocautery equipment?
A patient with ventricular tachycardia is undergoing surgery. Why is there a concern regarding the use of electrocautery equipment?
A patient on amiodarone develops new-onset pulmonary fibrosis. What is the immediate next step to take?
A patient on amiodarone develops new-onset pulmonary fibrosis. What is the immediate next step to take?
Imagine a scenario where the sino-atrial (SA) node is firing at a rate of 72 beats per minute (bpm), but the atrioventricular (AV) node only conducts every other impulse. What would be the resulting ventricular heart rate?
Imagine a scenario where the sino-atrial (SA) node is firing at a rate of 72 beats per minute (bpm), but the atrioventricular (AV) node only conducts every other impulse. What would be the resulting ventricular heart rate?
According to SDCEP guidelines regarding anticoagulation, what is generally recommended for patients taking DOACs?
According to SDCEP guidelines regarding anticoagulation, what is generally recommended for patients taking DOACs?
For patients on warfarin therapy undergoing minor procedures, what INR level is generally considered acceptable to proceed, alongside local haemostatic measures?
For patients on warfarin therapy undergoing minor procedures, what INR level is generally considered acceptable to proceed, alongside local haemostatic measures?
According to the previous standard, what blood pressure reading typically indicates hypertension?
According to the previous standard, what blood pressure reading typically indicates hypertension?
When measuring blood pressure in a clinic, what is the recommended approach for ensuring accuracy?
When measuring blood pressure in a clinic, what is the recommended approach for ensuring accuracy?
What is the 'white coat effect' in the context of blood pressure measurement?
What is the 'white coat effect' in the context of blood pressure measurement?
What proportion of hypertension cases are classified as 'essential' hypertension?
What proportion of hypertension cases are classified as 'essential' hypertension?
Which of the following is considered an environmental factor contributing to essential hypertension?
Which of the following is considered an environmental factor contributing to essential hypertension?
Secondary hypertension is suspected in what percentage of hypertension cases?
Secondary hypertension is suspected in what percentage of hypertension cases?
In which of the following scenarios should clinicians particularly investigate the possibility of secondary hypertension?
In which of the following scenarios should clinicians particularly investigate the possibility of secondary hypertension?
Which of the following is the most common cause of secondary hypertension?
Which of the following is the most common cause of secondary hypertension?
Which of the following endocrine disorders is a known cause of secondary hypertension?
Which of the following endocrine disorders is a known cause of secondary hypertension?
A patient presents with central obesity, striae, and hypertension. Which endocrine disorder should be suspected?
A patient presents with central obesity, striae, and hypertension. Which endocrine disorder should be suspected?
A patient presents with postural hypotension, headaches, and hypertension. Which of the following conditions may be suspected?
A patient presents with postural hypotension, headaches, and hypertension. Which of the following conditions may be suspected?
Which of the following is a potential cardiovascular effect of sustained elevated blood pressure?
Which of the following is a potential cardiovascular effect of sustained elevated blood pressure?
Which ocular change can occur as a consequence of chronic hypertension?
Which ocular change can occur as a consequence of chronic hypertension?
Which of the following is a potential consequence of uncontrolled hypertension affecting the brain?
Which of the following is a potential consequence of uncontrolled hypertension affecting the brain?
Which common oral side effect is associated with the use of nifedipine or amlodipine?
Which common oral side effect is associated with the use of nifedipine or amlodipine?
Which of the following cardiovascular drugs is known to cause lichenoid drug reactions?
Which of the following cardiovascular drugs is known to cause lichenoid drug reactions?
What is the most frequent symptom observed in infective endocarditis (IE)?
What is the most frequent symptom observed in infective endocarditis (IE)?
In approximately what percentage of infective endocarditis cases does the infection affect the left side of the heart?
In approximately what percentage of infective endocarditis cases does the infection affect the left side of the heart?
Which heart valve is most commonly affected in right-sided endocarditis among intravenous drug abusers?
Which heart valve is most commonly affected in right-sided endocarditis among intravenous drug abusers?
Which microorganism is most often the cause of acute infective endocarditis affecting both normal and abnormal valves?
Which microorganism is most often the cause of acute infective endocarditis affecting both normal and abnormal valves?
What is the approximate mortality rate associated with right-sided endocarditis in intravenous drug abusers?
What is the approximate mortality rate associated with right-sided endocarditis in intravenous drug abusers?
In native valve bacterial endocarditis, what is the most common bacterial cause according to the pie chart?
In native valve bacterial endocarditis, what is the most common bacterial cause according to the pie chart?
What is the primary strategy for managing a patient with endocarditis complicated by abscess formation in the heart, congestive heart failure and neurological dysfunction?
What is the primary strategy for managing a patient with endocarditis complicated by abscess formation in the heart, congestive heart failure and neurological dysfunction?
According to SDCEP guidelines, what is the general recommendation for patients taking DOACs who require a minor procedure?
According to SDCEP guidelines, what is the general recommendation for patients taking DOACs who require a minor procedure?
For patients on warfarin therapy undergoing minor procedures, what INR level is generally considered acceptable to proceed, assuming local haemostatic measures are also used?
For patients on warfarin therapy undergoing minor procedures, what INR level is generally considered acceptable to proceed, assuming local haemostatic measures are also used?
According to the previous standard, what blood pressure reading would typically indicate hypertension?
According to the previous standard, what blood pressure reading would typically indicate hypertension?
In native valve bacterial endocarditis, which bacterial genus accounts for approximately 50% of cases?
In native valve bacterial endocarditis, which bacterial genus accounts for approximately 50% of cases?
What is the primary strategy for managing a patient with endocarditis complicated by vegetation formation, congestive heart failure and neurological dysfunction?
What is the primary strategy for managing a patient with endocarditis complicated by vegetation formation, congestive heart failure and neurological dysfunction?
Which cardiac feature is commonly associated with infective endocarditis (IE)?
Which cardiac feature is commonly associated with infective endocarditis (IE)?
What is an embolic event related to infective endocarditis?
What is an embolic event related to infective endocarditis?
Which of the following signs is associated with Osler's nodes?
Which of the following signs is associated with Osler's nodes?
What is a key diagnostic criterion for infective endocarditis (IE)?
What is a key diagnostic criterion for infective endocarditis (IE)?
According to the modified Duke criteria, what combination of findings would classify a patient as having 'definite' infective endocarditis (IE)?
According to the modified Duke criteria, what combination of findings would classify a patient as having 'definite' infective endocarditis (IE)?
What guides the selection of antimicrobial treatment for infective endocarditis (IE)?
What guides the selection of antimicrobial treatment for infective endocarditis (IE)?
Which of the following best describes why antibiotic prophylaxis is considered in the context of dental procedures and infective endocarditis (IE)?
Which of the following best describes why antibiotic prophylaxis is considered in the context of dental procedures and infective endocarditis (IE)?
According to the NICE guidelines, is antibiotic prophylaxis routinely recommended for individuals undergoing dental procedures to prevent infective endocarditis?
According to the NICE guidelines, is antibiotic prophylaxis routinely recommended for individuals undergoing dental procedures to prevent infective endocarditis?
Which patient group is considered at high risk of developing infective endocarditis (IE) according to SDCEP guidelines?
Which patient group is considered at high risk of developing infective endocarditis (IE) according to SDCEP guidelines?
According to SDCEP guidelines, a patient with a history of rheumatic fever would be classified as which risk category for infective endocarditis (IE)?
According to SDCEP guidelines, a patient with a history of rheumatic fever would be classified as which risk category for infective endocarditis (IE)?
A patient undergoing dental treatment is at 'high risk' of IE. What does SDCEP recommend a dental practitioner focus on?
A patient undergoing dental treatment is at 'high risk' of IE. What does SDCEP recommend a dental practitioner focus on?
A 62-year-old patient presents with a new heart murmur, fever, and fatigue. Which of the following conditions should be highly suspected?
A 62-year-old patient presents with a new heart murmur, fever, and fatigue. Which of the following conditions should be highly suspected?
A patient with suspected infective endocarditis has absent pulses in their left leg. What is the most likely explanation?
A patient with suspected infective endocarditis has absent pulses in their left leg. What is the most likely explanation?
A patient presents with small, non-tender hemorrhagic lesions on the palms of their hands and soles of their feet. These lesions are most likely:
A patient presents with small, non-tender hemorrhagic lesions on the palms of their hands and soles of their feet. These lesions are most likely:
A clinician suspects infective endocarditis in a patient. Initial investigations should include:
A clinician suspects infective endocarditis in a patient. Initial investigations should include:
During a general examination of a patient, which physical sign might suggest infective endocarditis?
During a general examination of a patient, which physical sign might suggest infective endocarditis?
A patient is diagnosed with IE. Blood cultures come back negative. What percentage of IE are blood cultures typically negative in?
A patient is diagnosed with IE. Blood cultures come back negative. What percentage of IE are blood cultures typically negative in?
Which of the following is considered a MAJOR criterion in the Duke Criteria for IE?
Which of the following is considered a MAJOR criterion in the Duke Criteria for IE?
According to the SDCEP guidelines, which website should a healthcare professional visit for more information?
According to the SDCEP guidelines, which website should a healthcare professional visit for more information?
Which of the following factors influencing oral health is directly addressed in the SDCEP guidelines concerning infective endocarditis (IE)?
Which of the following factors influencing oral health is directly addressed in the SDCEP guidelines concerning infective endocarditis (IE)?
A patient with suspected IE develops sudden unilateral blindness. What is the likely underlying mechanism?
A patient with suspected IE develops sudden unilateral blindness. What is the likely underlying mechanism?
A patient presents with glomerulonephritis and is suspected of having a condition associated with immune complexes. What key signs would further lead to a diagnosis?
A patient presents with glomerulonephritis and is suspected of having a condition associated with immune complexes. What key signs would further lead to a diagnosis?
In the context of managing a patient with infective endocarditis (IE), why is identifying the specific causative microorganism through blood cultures critically important?
In the context of managing a patient with infective endocarditis (IE), why is identifying the specific causative microorganism through blood cultures critically important?
A patient with prosthetic valve replacement develops a fever, new murmur and splinter hemorrhages. Blood cultures grow Streptococcus viridans. An echocardiogram shows a perivalvular abscess. Despite appropriate IV antibiotic therapy, the patient develops worsening heart failure. What is the most appropriate next step in management?
A patient with prosthetic valve replacement develops a fever, new murmur and splinter hemorrhages. Blood cultures grow Streptococcus viridans. An echocardiogram shows a perivalvular abscess. Despite appropriate IV antibiotic therapy, the patient develops worsening heart failure. What is the most appropriate next step in management?
A 23-year-old intravenous drug user presents with fever, shortness of breath, and chest pain. On examination, you note a new murmur. What initial step is most critical in the management of this patient?
A 23-year-old intravenous drug user presents with fever, shortness of breath, and chest pain. On examination, you note a new murmur. What initial step is most critical in the management of this patient?
Which cardiac manifestation is commonly associated with infective endocarditis (IE)?
Which cardiac manifestation is commonly associated with infective endocarditis (IE)?
What is a potential embolic consequence of infective endocarditis affecting the left side of the heart?
What is a potential embolic consequence of infective endocarditis affecting the left side of the heart?
Osler's nodes are characterised by which of the following?
Osler's nodes are characterised by which of the following?
Which combination of findings meets the criteria for 'definite' infective endocarditis (IE) according to the modified Duke criteria?
Which combination of findings meets the criteria for 'definite' infective endocarditis (IE) according to the modified Duke criteria?
What is the primary determinant in selecting antimicrobial treatment for infective endocarditis (IE)?
What is the primary determinant in selecting antimicrobial treatment for infective endocarditis (IE)?
Generally speaking, why is antibiotic prophylaxis considered in some dental procedures for high-risk patients?
Generally speaking, why is antibiotic prophylaxis considered in some dental procedures for high-risk patients?
According to NICE guidelines, what is the current recommendation regarding antibiotic prophylaxis for dental procedures to prevent infective endocarditis (IE)?
According to NICE guidelines, what is the current recommendation regarding antibiotic prophylaxis for dental procedures to prevent infective endocarditis (IE)?
According to SDCEP guidelines, which patient group is considered at high risk of developing infective endocarditis (IE)?
According to SDCEP guidelines, which patient group is considered at high risk of developing infective endocarditis (IE)?
According to SDCEP guidelines, how would a patient with a history of rheumatic fever be classified in terms of IE risk?
According to SDCEP guidelines, how would a patient with a history of rheumatic fever be classified in terms of IE risk?
According to SDCEP, what primary area should dental practitioners concentrate on when treating a patient at 'high risk' of IE?
According to SDCEP, what primary area should dental practitioners concentrate on when treating a patient at 'high risk' of IE?
A patient is diagnosed with IE. Blood cultures come back negative. In what percentage of IE cases are blood cultures typically negative?
A patient is diagnosed with IE. Blood cultures come back negative. In what percentage of IE cases are blood cultures typically negative?
According to the SDCEP guidelines, which website can a healthcare professional visit for further information related to IE?
According to the SDCEP guidelines, which website can a healthcare professional visit for further information related to IE?
A patient presents with glomerulonephritis and is suspected of having a condition associated with immune complexes. What key signs would further lead to a diagnosis of infective endocarditis?
A patient presents with glomerulonephritis and is suspected of having a condition associated with immune complexes. What key signs would further lead to a diagnosis of infective endocarditis?
According to the information, what activity presents a greater risk of infective endocarditis (IE) than a single dental procedure?
According to the information, what activity presents a greater risk of infective endocarditis (IE) than a single dental procedure?
Other than benefits and risks, what should healthcare professionals offer people clear and consistent advice about regarding infective endocarditis?
Other than benefits and risks, what should healthcare professionals offer people clear and consistent advice about regarding infective endocarditis?
For bacteraemia producing dental procedures, antibiotic prophylaxis is:
For bacteraemia producing dental procedures, antibiotic prophylaxis is:
What is the potential negative outcome of antibiotic prophylaxis against infective endocarditis (IE) for dental procedures based on the information?
What is the potential negative outcome of antibiotic prophylaxis against infective endocarditis (IE) for dental procedures based on the information?
What point is made about awareness of cardiovascular disorders, in relation to clinical practice?
What point is made about awareness of cardiovascular disorders, in relation to clinical practice?
What should practitioners do when in doubt about managing a patient at risk of IE?
What should practitioners do when in doubt about managing a patient at risk of IE?
What factor decreases confidence in prescribing antibiotics for prophylaxis?
What factor decreases confidence in prescribing antibiotics for prophylaxis?
Besides good oral health, what other invasive procedure should healthcare professionals give advice about?
Besides good oral health, what other invasive procedure should healthcare professionals give advice about?
There are certain 'subtleties' to the debate about prescribing antibiotic prophylaxis - what does this suggest?
There are certain 'subtleties' to the debate about prescribing antibiotic prophylaxis - what does this suggest?
If the SA node is firing normally, but the AV node only lets every third impulse through completely at random, what conduction ratio is this?
If the SA node is firing normally, but the AV node only lets every third impulse through completely at random, what conduction ratio is this?
Why is antibiotic prophylaxis not routinely indicated for bacteraemia-producing dental procedures?
Why is antibiotic prophylaxis not routinely indicated for bacteraemia-producing dental procedures?
What activity presents a greater risk of infective endocarditis than a single dental procedure?
What activity presents a greater risk of infective endocarditis than a single dental procedure?
In the context of preventing infective endocarditis, what consistent and clear advice should healthcare professionals offer?
In the context of preventing infective endocarditis, what consistent and clear advice should healthcare professionals offer?
A dentist is unsure about managing a patient at risk of infective endocarditis. What should they do?
A dentist is unsure about managing a patient at risk of infective endocarditis. What should they do?
Why does the current SDCEP guidance suggest that antibiotic prophylaxis is not routinely indicated for bacteraemia-producing dental procedures?
Why does the current SDCEP guidance suggest that antibiotic prophylaxis is not routinely indicated for bacteraemia-producing dental procedures?
Aside from good oral health, what other invasive procedure should patients receive advice about in relation to infective endocarditis (IE)?
Aside from good oral health, what other invasive procedure should patients receive advice about in relation to infective endocarditis (IE)?
How does a working knowledge of cardiovascular disorders and potential complications influence clinical dental practice?
How does a working knowledge of cardiovascular disorders and potential complications influence clinical dental practice?
What is the primary implication of the statement that 'there are subtleties to the debate' about prescribing antibiotic prophylaxis?
What is the primary implication of the statement that 'there are subtleties to the debate' about prescribing antibiotic prophylaxis?
Which of the following scenarios would most likely create decreased confidence in prescribing antibiotics for prophylaxis?
Which of the following scenarios would most likely create decreased confidence in prescribing antibiotics for prophylaxis?
Regarding the statement, 'Endocarditis is a disease with which dental practitioners need to be familiar', what represents the MOST important responsibility for a practitioner?
Regarding the statement, 'Endocarditis is a disease with which dental practitioners need to be familiar', what represents the MOST important responsibility for a practitioner?
In a clothed patient, which of the following signs could indicate a cardiovascular issue?
In a clothed patient, which of the following signs could indicate a cardiovascular issue?
What is a symptom of heart disease unrelated to ischaemia?
What is a symptom of heart disease unrelated to ischaemia?
What are typical symptoms of heart failure?
What are typical symptoms of heart failure?
A patient reports experiencing heart palpitations. What cardiovascular issue does this suggest?
A patient reports experiencing heart palpitations. What cardiovascular issue does this suggest?
What does a raised Jugular Venous Pressure (JVP) typically indicate?
What does a raised Jugular Venous Pressure (JVP) typically indicate?
What pathological processes underlie ischaemic heart disease?
What pathological processes underlie ischaemic heart disease?
Which medication class is commonly used to provide immediate relief during an angina attack?
Which medication class is commonly used to provide immediate relief during an angina attack?
What is the primary purpose of performing a coronary angiogram?
What is the primary purpose of performing a coronary angiogram?
What is the goal when administering aspirin to a patient during a myocardial infarction?
What is the goal when administering aspirin to a patient during a myocardial infarction?
Within the context of valvular heart disease, what two primary issues arise?
Within the context of valvular heart disease, what two primary issues arise?
How long after a streptococcal infection does rheumatic fever typically develop?
How long after a streptococcal infection does rheumatic fever typically develop?
What is the significance of 'flitting' polyarthritis in the diagnosis of Rheumatic Fever?
What is the significance of 'flitting' polyarthritis in the diagnosis of Rheumatic Fever?
What is the main objective regarding treatments for valvular heart disease?
What is the main objective regarding treatments for valvular heart disease?
Post valve replacement, what consideration is most important?
Post valve replacement, what consideration is most important?
What are the common causes of right-sided heart failure?
What are the common causes of right-sided heart failure?
Which physiological response is triggered during heart failure to retain fluid, and also to increase blood pressure and cardiac output?
Which physiological response is triggered during heart failure to retain fluid, and also to increase blood pressure and cardiac output?
Which of the following is a non-cardiac cause of heart failure related to excessive demand on the heart?
Which of the following is a non-cardiac cause of heart failure related to excessive demand on the heart?
A patient has normal P waves and a heart rate above 100 bpm. Which arrhythmia is likely?
A patient has normal P waves and a heart rate above 100 bpm. Which arrhythmia is likely?
What is the primary goal of administering warfarin to a patient with atrial fibrillation?
What is the primary goal of administering warfarin to a patient with atrial fibrillation?
What is a typical finding in healthy, young athletes?
What is a typical finding in healthy, young athletes?
A patient reports symptoms that align to extrasystoles. How might they describe this?
A patient reports symptoms that align to extrasystoles. How might they describe this?
Which arrhythmia is marked by the absence of electrical activity and contraction?
Which arrhythmia is marked by the absence of electrical activity and contraction?
What intervention should be immediately performed in a patient with ventricular fibrillation?
What intervention should be immediately performed in a patient with ventricular fibrillation?
What intervention should be immediately performed in a patient with bradycardia?
What intervention should be immediately performed in a patient with bradycardia?
For which arrhythmia might an implantable defibrillator be the most appropriate therapy?
For which arrhythmia might an implantable defibrillator be the most appropriate therapy?
When using electrocautery equipment during surgery, what is the main concern for a patient with an implantable cardioverter-defibrillator?
When using electrocautery equipment during surgery, what is the main concern for a patient with an implantable cardioverter-defibrillator?
A patient receiving amiodarone for atrial fibrillation develops pulmonary fibrosis. What step follows?
A patient receiving amiodarone for atrial fibrillation develops pulmonary fibrosis. What step follows?
A patient previously had a blood pressure reading of 160/100 mmHg. According to the previous standard, what would this indicate?
A patient previously had a blood pressure reading of 160/100 mmHg. According to the previous standard, what would this indicate?
What methods should be used to measure accurate blood pressure in a clinic?
What methods should be used to measure accurate blood pressure in a clinic?
What is the definition of the 'white coat effect' in blood pressure measurements?
What is the definition of the 'white coat effect' in blood pressure measurements?
In what proportion of hypertension cases is the cause classified as 'essential' hypertension?
In what proportion of hypertension cases is the cause classified as 'essential' hypertension?
Which of the following is an environmental factor that has been linked to development of hypertension?
Which of the following is an environmental factor that has been linked to development of hypertension?
What percentage of cases are classified as secondary hypertension?
What percentage of cases are classified as secondary hypertension?
In which scenario should clinicians be suspicious that the patient may be experiencing secondary hypertension?
In which scenario should clinicians be suspicious that the patient may be experiencing secondary hypertension?
A patient exhibits central obesity, presence of striae, and hypertension. Which endocrine disorder should the clinician suspect?
A patient exhibits central obesity, presence of striae, and hypertension. Which endocrine disorder should the clinician suspect?
A patient exhibits postural hypotension, headaches, and hypertension. Which of the following conditions may be suspected?
A patient exhibits postural hypotension, headaches, and hypertension. Which of the following conditions may be suspected?
What is a possible cardiovascular effect of sustained elevated blood pressure?
What is a possible cardiovascular effect of sustained elevated blood pressure?
What eye changes might occur as a consequence of chronic hypertension?
What eye changes might occur as a consequence of chronic hypertension?
What is a common oral side effect that can coincide with the use of amlodipine?
What is a common oral side effect that can coincide with the use of amlodipine?
Which cardiovascular drug is known to cause lichenoid drug reaction?
Which cardiovascular drug is known to cause lichenoid drug reaction?
What is a patient's most frequent symptom if they are diagnosed with infective endocarditis (IE)?
What is a patient's most frequent symptom if they are diagnosed with infective endocarditis (IE)?
Most of infective endocarditis cases affect which side of the heart?
Most of infective endocarditis cases affect which side of the heart?
Which valve is most commonly affected in right-sided endocarditis among intravenous drug abusers?
Which valve is most commonly affected in right-sided endocarditis among intravenous drug abusers?
According to SDCEP, what should dental practitioners focus on as part of an appointment for patients at 'high risk' of infective endocarditis?
According to SDCEP, what should dental practitioners focus on as part of an appointment for patients at 'high risk' of infective endocarditis?
In the context of cardiovascular signs, what is suggested by the presence of pallor?
In the context of cardiovascular signs, what is suggested by the presence of pallor?
A patient has a diagnosis of heart disease. Their main complaint is ankle swelling. Which of the following is the most appropriate course of action?
A patient has a diagnosis of heart disease. Their main complaint is ankle swelling. Which of the following is the most appropriate course of action?
During auscultation of a patient's chest, a clinician notes a 'wheezing' sound. In what circumstance could this be related to heart disease?
During auscultation of a patient's chest, a clinician notes a 'wheezing' sound. In what circumstance could this be related to heart disease?
A patient presents with heart disease symptoms, and central cyanosis is observed. What does central cyanosis indicate?
A patient presents with heart disease symptoms, and central cyanosis is observed. What does central cyanosis indicate?
Which of the following best describes the underlying mechanism of angina pectoris?
Which of the following best describes the underlying mechanism of angina pectoris?
What is the primary reason for using nitrates in the management of angina?
What is the primary reason for using nitrates in the management of angina?
A patient is diagnosed with Acute Coronary Syndrome. What initial blood marker is most indicative of myocardial damage?
A patient is diagnosed with Acute Coronary Syndrome. What initial blood marker is most indicative of myocardial damage?
What is the usual pathway for managing ST-Elevation Myocardial Infarction (STEMI)?
What is the usual pathway for managing ST-Elevation Myocardial Infarction (STEMI)?
Why does stenosis of a heart valve lead to increased cardiac workload?
Why does stenosis of a heart valve lead to increased cardiac workload?
What is the primary reason for needing anticoagulation with a mechanical heart valve?
What is the primary reason for needing anticoagulation with a mechanical heart valve?
According to prevalence from the Rotterdam Study, which age range exhibits highest rate of heart failure?
According to prevalence from the Rotterdam Study, which age range exhibits highest rate of heart failure?
How does chronic lung disease leads to pulmonary hypertension and right-sided heart failure?
How does chronic lung disease leads to pulmonary hypertension and right-sided heart failure?
What is the physiological effect of the renin-angiotensin-aldosterone system (RAAS) activation in heart failure?
What is the physiological effect of the renin-angiotensin-aldosterone system (RAAS) activation in heart failure?
Which sign is commonly observed in a patient experiencing right-sided heart failure?
Which sign is commonly observed in a patient experiencing right-sided heart failure?
Based on slide 23, which of the following is an example of a non-cardiac cause of heart failure related to fluid overload?
Based on slide 23, which of the following is an example of a non-cardiac cause of heart failure related to fluid overload?
Which class of drugs used in heart failure affects the RAAS system and ends in '-sartan'?
Which class of drugs used in heart failure affects the RAAS system and ends in '-sartan'?
In the context of cardiac arrhythmias, what distinguishes sinus tachycardia from other tachycardias?
In the context of cardiac arrhythmias, what distinguishes sinus tachycardia from other tachycardias?
A patient has irregularly irregular pulse, increasing the risk of stroke. What is the underlying mechanism for prescribing anticoagulation?
A patient has irregularly irregular pulse, increasing the risk of stroke. What is the underlying mechanism for prescribing anticoagulation?
A young, athletic individual has bradycardia. What could be a physiological explanation?
A young, athletic individual has bradycardia. What could be a physiological explanation?
A patient is given a diagnosis of extrasystoles. How would this be described?
A patient is given a diagnosis of extrasystoles. How would this be described?
What is the underlying issue for cardiac arrest due to ventricular fibrillation?
What is the underlying issue for cardiac arrest due to ventricular fibrillation?
Which of the following is a treatment for ventricular fibrillation?
Which of the following is a treatment for ventricular fibrillation?
A patient requires a pacemaker. What is the most likely type of arrhythmia?
A patient requires a pacemaker. What is the most likely type of arrhythmia?
What is the purpose of implantable cardioverter-defibrillators (ICDs)?
What is the purpose of implantable cardioverter-defibrillators (ICDs)?
How does warfarin reduce the risk of stroke in atrial fibrillation?
How does warfarin reduce the risk of stroke in atrial fibrillation?
Which blood pressure reading constitutes hypertension, according to the previous standard?
Which blood pressure reading constitutes hypertension, according to the previous standard?
What step is recommended when measuring blood pressure to ensure accuracy?
What step is recommended when measuring blood pressure to ensure accuracy?
What is the 'white coat effect' in blood pressure measurement?
What is the 'white coat effect' in blood pressure measurement?
What percentage of hypertension cases are classified as 'essential' hypertension?
What percentage of hypertension cases are classified as 'essential' hypertension?
Which environmental factor significantly contributes to essential hypertension?
Which environmental factor significantly contributes to essential hypertension?
Under what conditions should secondary hypertension be highly suspected and investigated?
Under what conditions should secondary hypertension be highly suspected and investigated?
What is renal artery stenosis?
What is renal artery stenosis?
Conn's syndrome can cause secondary hypertension. What is the underlying issue of Conn's syndrome?
Conn's syndrome can cause secondary hypertension. What is the underlying issue of Conn's syndrome?
A patient presents with central obesity, striae, and hypertension. Which endocrine disorder should always be suspected in such cases?
A patient presents with central obesity, striae, and hypertension. Which endocrine disorder should always be suspected in such cases?
A patient shows postural hypotension, headaches, and hypertension. What condition is suspected?
A patient shows postural hypotension, headaches, and hypertension. What condition is suspected?
Which cardiovascular effect can chronic untreated hypertension cause?
Which cardiovascular effect can chronic untreated hypertension cause?
What ocular change can occur because of long-standing hypertension?
What ocular change can occur because of long-standing hypertension?
Uncontrolled chronic hypertension carries several risks - what can happen to the brain vessels?
Uncontrolled chronic hypertension carries several risks - what can happen to the brain vessels?
What common side effect is associated with calcium channel blockers such as nifedipine or amlodipine?
What common side effect is associated with calcium channel blockers such as nifedipine or amlodipine?
Which cardiovascular drug could trigger lichenoid drug reactions?
Which cardiovascular drug could trigger lichenoid drug reactions?
What is the most frequent symptom in infective endocarditis (IE)?
What is the most frequent symptom in infective endocarditis (IE)?
Native valve bacterial endocarditis is caused by which bacterial genus in approximately 50% of cases?
Native valve bacterial endocarditis is caused by which bacterial genus in approximately 50% of cases?
According to SDCEP guidelines, what action is required for a patient taking DOACs who requires low-risk treatment?
According to SDCEP guidelines, what action is required for a patient taking DOACs who requires low-risk treatment?
What invasive procedure should patients be given clear advice about, besides good oral health?
What invasive procedure should patients be given clear advice about, besides good oral health?
What should practitioners do if they are unsure?
What should practitioners do if they are unsure?
Which is the most definitive factor influencing decision making in clinical dental practice regarding cardiovascular disorders and potential complications?
Which is the most definitive factor influencing decision making in clinical dental practice regarding cardiovascular disorders and potential complications?
What is the most common cause of breathlessness related to the heart?
What is the most common cause of breathlessness related to the heart?
Which of the following is a sign of heart failure observable in a clothed patient?
Which of the following is a sign of heart failure observable in a clothed patient?
What pathological processes directly contribute to ischaemic heart disease?
What pathological processes directly contribute to ischaemic heart disease?
Which cardiac investigation provides a real-time moving image of the heart?
Which cardiac investigation provides a real-time moving image of the heart?
Why is a patient with Atrial Fibrillation (AF) often prescribed anticoagulation medication such as Warfarin?
Why is a patient with Atrial Fibrillation (AF) often prescribed anticoagulation medication such as Warfarin?
A patient with known cardiovascular disease presents with significant postural hypotension and episodic headaches. Which of the following underlying secondary causes of hypertension should be suspected?
A patient with known cardiovascular disease presents with significant postural hypotension and episodic headaches. Which of the following underlying secondary causes of hypertension should be suspected?
A young, otherwise healthy, male patient has a blood pressure reading of 150/95 mmHg during a routine check-up. According to current guidelines, what is the MOST important next step in managing this patient?
A young, otherwise healthy, male patient has a blood pressure reading of 150/95 mmHg during a routine check-up. According to current guidelines, what is the MOST important next step in managing this patient?
Which factor decreases confidence in prescribing antibiotics for dental prophylaxis specifically?
Which factor decreases confidence in prescribing antibiotics for dental prophylaxis specifically?
A patient presents with glomerulonephritis. In the context of infective endocarditis (IE) and immune complexes, what additional clinical findings would most strongly suggest a diagnosis of IE as the underlying cause of the renal condition?
A patient presents with glomerulonephritis. In the context of infective endocarditis (IE) and immune complexes, what additional clinical findings would most strongly suggest a diagnosis of IE as the underlying cause of the renal condition?
Why might an implantable cardioverter-defibrillator (ICD) be surgically implanted?
Why might an implantable cardioverter-defibrillator (ICD) be surgically implanted?
What cardiac issue is most frequently attributed to ischaemia?
What cardiac issue is most frequently attributed to ischaemia?
Other than respiratory issues, what is another cause of breathlessness?
Other than respiratory issues, what is another cause of breathlessness?
Which of the following signs in a clothed patient may indicate a cardiovascular problem?
Which of the following signs in a clothed patient may indicate a cardiovascular problem?
Inspiratory crackles can indicate pulmonary oedema; however, what do reduced breath sounds and dullness to percussion indicate?
Inspiratory crackles can indicate pulmonary oedema; however, what do reduced breath sounds and dullness to percussion indicate?
What are the consequences of ischaemic heart disease?
What are the consequences of ischaemic heart disease?
What is the route of GTN spray administration?
What is the route of GTN spray administration?
Which of the following is an example of a regular anti-anginal drug?
Which of the following is an example of a regular anti-anginal drug?
Which of the following is a non-modifiable risk factor for heart disease?
Which of the following is a non-modifiable risk factor for heart disease?
Which of the following statements best describes the use of chest X-rays in cardiac investigations?
Which of the following statements best describes the use of chest X-rays in cardiac investigations?
Which invasive cardiac investigation is used to help guide intervention?
Which invasive cardiac investigation is used to help guide intervention?
What heart structures are affected in valvular heart disease?
What heart structures are affected in valvular heart disease?
What heart conditions are associated with Rheumatic Fever?
What heart conditions are associated with Rheumatic Fever?
What sign indicates endocarditis?
What sign indicates endocarditis?
What type of valve replacement requires more durable anticoagulation?
What type of valve replacement requires more durable anticoagulation?
What are the main components of heart failure?
What are the main components of heart failure?
According to the Rotterdam study, which age group has the highest prevalence of heart failure?
According to the Rotterdam study, which age group has the highest prevalence of heart failure?
In right-sided heart failure, what physical exam finding would you MOST likely observe?
In right-sided heart failure, what physical exam finding would you MOST likely observe?
Which of the following is an example of non-cardiac cause of heart failure?
Which of the following is an example of non-cardiac cause of heart failure?
Which medications are categorised by drug names ending in “-opril?”
Which medications are categorised by drug names ending in “-opril?”
Which is the most common type of rhythm disturbance?
Which is the most common type of rhythm disturbance?
A young athlete is found to have a heart rate of 55 bpm. Why?
A young athlete is found to have a heart rate of 55 bpm. Why?
Which of the following statements is true regarding ventricular fibrillation?
Which of the following statements is true regarding ventricular fibrillation?
Which cardiac event is not ‘shockable’?
Which cardiac event is not ‘shockable’?
Which therapeutic intervention is MOST appropriate for a patient with bradycardia?
Which therapeutic intervention is MOST appropriate for a patient with bradycardia?
When is anticoagulation needed?
When is anticoagulation needed?
Activating the renin-angiotensin-aldosterone system to retain salt and water, is a compensatory mechanism for which cardiovascular issue?
Activating the renin-angiotensin-aldosterone system to retain salt and water, is a compensatory mechanism for which cardiovascular issue?
What blood pressure reading previously typically indicated hypertension?
What blood pressure reading previously typically indicated hypertension?
What technique might be applied when taking blood pressure, to provide accurate measurements?
What technique might be applied when taking blood pressure, to provide accurate measurements?
Around what percentage of hypertension cases are deemed ‘essential’ hypertension?
Around what percentage of hypertension cases are deemed ‘essential’ hypertension?
Which sign is associated with Cushing’s Syndrome?
Which sign is associated with Cushing’s Syndrome?
What can sustained elevated blood pressure lead to?
What can sustained elevated blood pressure lead to?
Which ocular effect can occur as a consequence of chronic hypertension?
Which ocular effect can occur as a consequence of chronic hypertension?
Gingival hyperplasia is a common oral side effect of which of the following cardiovascular drugs?
Gingival hyperplasia is a common oral side effect of which of the following cardiovascular drugs?
Which sign is most frequently observed in infective endocarditis?
Which sign is most frequently observed in infective endocarditis?
Where does infective endocarditis (IE) most commonly affect in the heart?
Where does infective endocarditis (IE) most commonly affect in the heart?
Which microorganism is MOST often the cause of acute infective endocarditis?
Which microorganism is MOST often the cause of acute infective endocarditis?
If infective endocarditis becomes complicated by abscess formation, which of the following is the most appropriate treatment option?
If infective endocarditis becomes complicated by abscess formation, which of the following is the most appropriate treatment option?
Why are blood cultures so integral in the management of IE patients??
Why are blood cultures so integral in the management of IE patients??
What is the definitive criteria according to Duke for IE?
What is the definitive criteria according to Duke for IE?
Antibiotic prophylaxis is not routinely indicated for bacteraemia-producing dental procedures - what is the overriding SDCEP consensus?
Antibiotic prophylaxis is not routinely indicated for bacteraemia-producing dental procedures - what is the overriding SDCEP consensus?
Apart from being familiar with IE, what is the dental practitioner's MOST important and ethical responsibility?
Apart from being familiar with IE, what is the dental practitioner's MOST important and ethical responsibility?
In the context of cardiovascular health, what is the underlying cause of ankle swelling?
In the context of cardiovascular health, what is the underlying cause of ankle swelling?
What is the recommended first step for a patient experiencing angina?
What is the recommended first step for a patient experiencing angina?
Which statement best describes the underlying cause of most cases of 'essential' hypertension?
Which statement best describes the underlying cause of most cases of 'essential' hypertension?
What is the most common cause of secondary hypertension?
What is the most common cause of secondary hypertension?
A patient presents with central obesity, hypertension, and purple striae on their abdomen. Which of the following is the most likely underlying cause?
A patient presents with central obesity, hypertension, and purple striae on their abdomen. Which of the following is the most likely underlying cause?
A cardiovascular patient develops gingival hyperplasia. Which medication is most likely responsible?
A cardiovascular patient develops gingival hyperplasia. Which medication is most likely responsible?
A patient with cardiovascular disease develops oral ulceration. Which of the following medications is the most likely cause?
A patient with cardiovascular disease develops oral ulceration. Which of the following medications is the most likely cause?
Which cardiovascular drug is associated with lichenoid drug reactions?
Which cardiovascular drug is associated with lichenoid drug reactions?
What percentage of infective endocarditis cases affect the left side of the heart?
What percentage of infective endocarditis cases affect the left side of the heart?
What is the most common causative organism in acute infective endocarditis, particularly affecting both normal and abnormal valves?
What is the most common causative organism in acute infective endocarditis, particularly affecting both normal and abnormal valves?
What is the approximate mortality rate associated with right-sided infective endocarditis in intravenous drug abusers?
What is the approximate mortality rate associated with right-sided infective endocarditis in intravenous drug abusers?
According to the pie chart showing native valve bacterial endocarditis, which genus accounts for approximately 50% of cases?
According to the pie chart showing native valve bacterial endocarditis, which genus accounts for approximately 50% of cases?
In managing a patient with endocarditis complicated by vegetation formation, congestive heart failure, and neurological dysfunction, what treatment strategy is likely to be used?
In managing a patient with endocarditis complicated by vegetation formation, congestive heart failure, and neurological dysfunction, what treatment strategy is likely to be used?
Which of the following answers best describes the nature of Osler's nodes?
Which of the following answers best describes the nature of Osler's nodes?
What are Janeway lesions characterised by?
What are Janeway lesions characterised by?
According to modified Duke criteria, which findings would classify a patient as having 'definite' infective endocarditis?
According to modified Duke criteria, which findings would classify a patient as having 'definite' infective endocarditis?
What is the most important factor in determining the proper antimicrobial treatment for infective endocarditis?
What is the most important factor in determining the proper antimicrobial treatment for infective endocarditis?
According to the NICE guidelines, is antibiotic prophylaxis routinely recommended for dental procedures to prevent IE?
According to the NICE guidelines, is antibiotic prophylaxis routinely recommended for dental procedures to prevent IE?
According to SDCEP guidelines, which patient group is considered at the highest risk of developing infective endocarditis (IE)?
According to SDCEP guidelines, which patient group is considered at the highest risk of developing infective endocarditis (IE)?
During the dental treatment of a patient at 'high risk' of infective endocarditis (IE), what is the most important area a practitioner should focus on, according to current SDCEP guidelines?
During the dental treatment of a patient at 'high risk' of infective endocarditis (IE), what is the most important area a practitioner should focus on, according to current SDCEP guidelines?
A patient with suspected infective endocarditis presents with sudden unilateral blindness. What is the likely underlying mechanism?
A patient with suspected infective endocarditis presents with sudden unilateral blindness. What is the likely underlying mechanism?
According to arguments 'against' prophylaxis, what presents MORE of a risk than a single dental procedure?
According to arguments 'against' prophylaxis, what presents MORE of a risk than a single dental procedure?
What is the potential negative outcome of antibiotic prophylaxis against IE?
What is the potential negative outcome of antibiotic prophylaxis against IE?
What is the most appropriate action for practitioners who are unsure about managing a patient at risk of IE?
What is the most appropriate action for practitioners who are unsure about managing a patient at risk of IE?
What activity would be MORE of a risk of IE than receiving a dental procedure?
What activity would be MORE of a risk of IE than receiving a dental procedure?
What BEST represents the most important general responsibility for dental practitioners regarding endocarditis, according to the statement, 'Endocarditis is a disease with which dental practitioners need to be familiar'?
What BEST represents the most important general responsibility for dental practitioners regarding endocarditis, according to the statement, 'Endocarditis is a disease with which dental practitioners need to be familiar'?
What is the main concern that is associated with hypertension?
What is the main concern that is associated with hypertension?
Which of the following medications, identified in cardiac disease pharmacological correction, ends in '-sartan'?
Which of the following medications, identified in cardiac disease pharmacological correction, ends in '-sartan'?
Which of the following medications, identified in cardiac disease pharmacological correction, ends in '-olol'?
Which of the following medications, identified in cardiac disease pharmacological correction, ends in '-olol'?
Which blood type is associated with a slightly increased increased risk of cardiovascular disease?
Which blood type is associated with a slightly increased increased risk of cardiovascular disease?
The Rotterdam's studies showed that which are ranges had the highest prevalence of heart failure?
The Rotterdam's studies showed that which are ranges had the highest prevalence of heart failure?
What term is used to describe the phenomenon where a patient's blood pressure is elevated in a clinical setting, but normal in other environments?
What term is used to describe the phenomenon where a patient's blood pressure is elevated in a clinical setting, but normal in other environments?
In the context of infective endocarditis, what is indicated by "absent pulses" during a general examination?
In the context of infective endocarditis, what is indicated by "absent pulses" during a general examination?
In the context of infective endocarditis, what does the term Vegetation refer to?
In the context of infective endocarditis, what does the term Vegetation refer to?
What is the key advice to give to patients undergoing invasive procedures such as body piercing or tattooing?
What is the key advice to give to patients undergoing invasive procedures such as body piercing or tattooing?
What is the significance of normal P-waves on an ECG in the context of tachycardia?
What is the significance of normal P-waves on an ECG in the context of tachycardia?
What is the correct ECG reading to use to determine ventricular tachycardia? (bpm = beats per minute)
What is the correct ECG reading to use to determine ventricular tachycardia? (bpm = beats per minute)
Which of the following would most likely suggest a cardiac issue when inspecting the signs in a clothed patient?
Which of the following would most likely suggest a cardiac issue when inspecting the signs in a clothed patient?
A 68 year old patient presents with breathlessness and fatigue. They have been recorded as being a past smoker, with a BMI averaging 30. What aspect identified in 'Risk Factors' indicates that they are in the older demographic?
A 68 year old patient presents with breathlessness and fatigue. They have been recorded as being a past smoker, with a BMI averaging 30. What aspect identified in 'Risk Factors' indicates that they are in the older demographic?
In the Glasgow Coma Scale (GCS), what does 'E' stand for?
In the Glasgow Coma Scale (GCS), what does 'E' stand for?
According to the content, what may be the result where there is turbulent blood flow in Heart Sounds?
According to the content, what may be the result where there is turbulent blood flow in Heart Sounds?
In the content, what does dullness to percussion represent in Lung Sounds?
In the content, what does dullness to percussion represent in Lung Sounds?
Which of the following symptoms is most likely associated with a cardiac arrhythmia?
Which of the following symptoms is most likely associated with a cardiac arrhythmia?
Which cardiac condition is most commonly linked to atherosclerosis and thrombosis?
Which cardiac condition is most commonly linked to atherosclerosis and thrombosis?
Which common medication prescribed for angina is administered sublingually for rapid relief?
Which common medication prescribed for angina is administered sublingually for rapid relief?
Which blood test is crucial for detecting myocardial damage and is indicative of acute coronary syndrome or myocardial infarction?
Which blood test is crucial for detecting myocardial damage and is indicative of acute coronary syndrome or myocardial infarction?
Which valvular defect is characterised by the incomplete closure of the valve, resulting in backward flow of blood?
Which valvular defect is characterised by the incomplete closure of the valve, resulting in backward flow of blood?
Which heart valve is primarily affected in right-sided endocarditis among intravenous drug abusers?
Which heart valve is primarily affected in right-sided endocarditis among intravenous drug abusers?
A patient presents with a constellation of symptoms including central obesity, striae, hypertension caused by a tumour which secretes ACTH. Which condition on the list is most likely?
A patient presents with a constellation of symptoms including central obesity, striae, hypertension caused by a tumour which secretes ACTH. Which condition on the list is most likely?
According to the information provided, what activity presents a greater risk of infective endocarditis (IE) than a single dental procedure?
According to the information provided, what activity presents a greater risk of infective endocarditis (IE) than a single dental procedure?
A patient with a known history of ventricular tachycardia is scheduled for a surgical procedure using electrocautery equipment. What should the clinical team do?
A patient with a known history of ventricular tachycardia is scheduled for a surgical procedure using electrocautery equipment. What should the clinical team do?
A cardiologist observes an irregularly irregular pulse in a patient. What arrhythmia does this suggest and why does this necessitate anticoagulation?
A cardiologist observes an irregularly irregular pulse in a patient. What arrhythmia does this suggest and why does this necessitate anticoagulation?
Flashcards
Chest Pain
Chest Pain
Usually due to ischaemia; a common symptom of heart disease.
Breathlessness
Breathlessness
Often indicates heart failure, but respiratory issues should also be considered.
Ankle Swelling
Ankle Swelling
Can be a sign of heart failure.
Palpitations
Palpitations
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Feeling Faint
Feeling Faint
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Pulse
Pulse
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Jugular Venous Pressure (JVP)
Jugular Venous Pressure (JVP)
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Peripheral Oedema
Peripheral Oedema
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Normal Heart Sounds
Normal Heart Sounds
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Additional Heart Sounds
Additional Heart Sounds
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Additional Lung Sounds
Additional Lung Sounds
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Reduced Breath Sounds
Reduced Breath Sounds
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Ischaemic Heart Disease
Ischaemic Heart Disease
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Underlying Processes
Underlying Processes
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Consequences
Consequences
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Acute Coronary Syndrome
Acute Coronary Syndrome
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Management of Angina
Management of Angina
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ECG
ECG
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Chest X-ray
Chest X-ray
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Echocardiogram
Echocardiogram
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Troponin Levels
Troponin Levels
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ST-elevation MI (STEMI)
ST-elevation MI (STEMI)
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Non-ST-elevation (NSTEMI)
Non-ST-elevation (NSTEMI)
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Main Valvular Problems
Main Valvular Problems
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Rheumatic Fever
Rheumatic Fever
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General Appearance
General Appearance
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Stress Test
Stress Test
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Coronary Angiogram
Coronary Angiogram
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Management of MI
Management of MI
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Heart Valves
Heart Valves
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Heart Failure
Heart Failure
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Types of Heart Failure
Types of Heart Failure
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Modifiable Risk Factors
Modifiable Risk Factors
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Non Modifiable Risk Factors
Non Modifiable Risk Factors
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Signs of endocarditis
Signs of endocarditis
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Treatments
Treatments
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Cor Pulmonale
Cor Pulmonale
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High Output Heart Failure
High Output Heart Failure
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Renin-Angiotensin-Aldosterone System
Renin-Angiotensin-Aldosterone System
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Sartans
Sartans
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Sinus Tachycardia
Sinus Tachycardia
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Atrial Fibrillation
Atrial Fibrillation
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Ventricular Tachycardia
Ventricular Tachycardia
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Bradycardia
Bradycardia
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Extrasystoles
Extrasystoles
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Ventricular Fibrillation
Ventricular Fibrillation
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Asystole
Asystole
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DC Cardioversion
DC Cardioversion
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Catheter Ablation
Catheter Ablation
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Pacemaker
Pacemaker
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Implantable Defibrillator
Implantable Defibrillator
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Rate Controlling Drugs
Rate Controlling Drugs
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Anticoagulation
Anticoagulation
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Commonest Causes of Heart Failure
Commonest Causes of Heart Failure
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Aldosterone Antagonists
Aldosterone Antagonists
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Vasodilators
Vasodilators
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Loop Diuretics
Loop Diuretics
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Hypertension
Hypertension
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Valvular Heart Disease
Valvular Heart Disease
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Breathlessness in Heart Failure
Breathlessness in Heart Failure
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Fluid Retention in Heart Failure
Fluid Retention in Heart Failure
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Fatigue in Heart Failure
Fatigue in Heart Failure
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CXR in Heart Investigations
CXR in Heart Investigations
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ECG in Heart Investigations
ECG in Heart Investigations
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U&E
U&E
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FBC
FBC
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Thyroid Function Tests
Thyroid Function Tests
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Compensatory Mechanisms
Compensatory Mechanisms
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ACE Inhibitors
ACE Inhibitors
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Beta Blockers
Beta Blockers
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Sino-atrial node
Sino-atrial node
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Atrio-ventricular Node
Atrio-ventricular Node
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His-Purkinje System
His-Purkinje System
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Warfarin management
Warfarin management
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DOACs
DOACs
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Hypertension: BP Level
Hypertension: BP Level
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Measuring Blood Pressure
Measuring Blood Pressure
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'Essential' Hypertension
'Essential' Hypertension
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Secondary Hypertension
Secondary Hypertension
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Secondary Hypertension Causes
Secondary Hypertension Causes
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Cushing's Syndrome
Cushing's Syndrome
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Elevated BP Effects
Elevated BP Effects
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Hypertensive Encephalopathy
Hypertensive Encephalopathy
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Hypertension: Effects on Eyes
Hypertension: Effects on Eyes
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Nicorandil Side Effect
Nicorandil Side Effect
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Atenolol Side Effect
Atenolol Side Effect
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Nifedipine/Amlodipine Side Effect
Nifedipine/Amlodipine Side Effect
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Infective Endocarditis (IE)
Infective Endocarditis (IE)
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IE: Affected Heart Side
IE: Affected Heart Side
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Acute IE cause
Acute IE cause
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IE: Risk Factors
IE: Risk Factors
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Native Valve IE microbes
Native Valve IE microbes
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IE 'Toxic Features'
IE 'Toxic Features'
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Warfarin rule in anticoagulation
Warfarin rule in anticoagulation
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Phaeochromocytoma
Phaeochromocytoma
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Elevated BP effects on the heart
Elevated BP effects on the heart
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Glomerulonephritis
Glomerulonephritis
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Tricuspid valve related to IV drug abuse
Tricuspid valve related to IV drug abuse
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IE Mortality Rate
IE Mortality Rate
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Fungal endocarditis prognosis
Fungal endocarditis prognosis
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Bacterial endocarditis
Bacterial endocarditis
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Prosthetic Heart Valves
Prosthetic Heart Valves
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Hypertension Level
Hypertension Level
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Ambulatory BP monitoring
Ambulatory BP monitoring
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Most common cause of bacterial endocarditis
Most common cause of bacterial endocarditis
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Renal artery stenosis
Renal artery stenosis
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Arrhythmias (Cardiac Feature)
Arrhythmias (Cardiac Feature)
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Deteriorating Valve Function
Deteriorating Valve Function
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Changing Murmurs
Changing Murmurs
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Heart Failure (Cardiac)
Heart Failure (Cardiac)
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Limb Septic Emboli
Limb Septic Emboli
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Cerebral Septic Emboli
Cerebral Septic Emboli
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Cardiac Septic Emboli
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Glomerulonephritis Symptoms
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Osler's Nodes
Osler's Nodes
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Splinter Hemorrhages
Splinter Hemorrhages
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Janeway Lesions
Janeway Lesions
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Diagnosis of IE
Diagnosis of IE
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IE Treatment
IE Treatment
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Antimicrobial Treatment
Antimicrobial Treatment
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Antibiotic Prophylaxis
Antibiotic Prophylaxis
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IE General examination
IE General examination
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Major Criteria
Major Criteria
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Minor criteria
Minor criteria
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IE Definite Diagnosis
IE Definite Diagnosis
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IE Possible Diagnosis
IE Possible Diagnosis
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Rationale for Antibiotic Prophylaxis
Rationale for Antibiotic Prophylaxis
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Increased IE Risk
Increased IE Risk
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Scope of NICE Guideline
Scope of NICE Guideline
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IE Moderate Risk
IE Moderate Risk
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SDCEP Guidelines Topic
SDCEP Guidelines Topic
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IE Cardiac Features?
IE Cardiac Features?
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Septic Emboli Destinations?
Septic Emboli Destinations?
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Immune Complexes in IE?
Immune Complexes in IE?
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IE Diagnosis Components?
IE Diagnosis Components?
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General Examination Findings of IE?
General Examination Findings of IE?
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Blood Cultures in IE?
Blood Cultures in IE?
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Definite IE Diagnosis?
Definite IE Diagnosis?
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IE Antibiotic Prophylaxis?
IE Antibiotic Prophylaxis?
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Increased Risk of IE?
Increased Risk of IE?
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Moderate Risk of IE?
Moderate Risk of IE?
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IE and Interventions
IE and Interventions
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Tooth brushing vs Dental Work
Tooth brushing vs Dental Work
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Antibiotic Prophylaxis Effectiveness
Antibiotic Prophylaxis Effectiveness
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Cost-Effectiveness of Antibiotic Prophylaxis
Cost-Effectiveness of Antibiotic Prophylaxis
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Patient education
Patient education
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Importance of Cardiovascular Knowledge
Importance of Cardiovascular Knowledge
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Dental Practitioners and Endocarditis
Dental Practitioners and Endocarditis
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Antibiotic Use Post-Dental Work
Antibiotic Use Post-Dental Work
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Patient Prevention Advice
Patient Prevention Advice
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Endocarditis Awareness
Endocarditis Awareness
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Daily oral hygiene vs IE risk
Daily oral hygiene vs IE risk
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Chest Pain - Ischaemia
Chest Pain - Ischaemia
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Orthopnea
Orthopnea
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Pitting Oedema Mechanism
Pitting Oedema Mechanism
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What is acute coronary syndrome?
What is acute coronary syndrome?
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Nicorandil
Nicorandil
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Echocardiogram (Doppler)
Echocardiogram (Doppler)
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What is IE?
What is IE?
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Acute IE causative organism
Acute IE causative organism
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Infective Endocarditis: High Risk Factors
Infective Endocarditis: High Risk Factors
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Infective Endocarditis: Moderate Risk Factors
Infective Endocarditis: Moderate Risk Factors
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IE: Diagnosis factors
IE: Diagnosis factors
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IE: General Examinations (Eyes)
IE: General Examinations (Eyes)
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IE: Minor Criteria - Immunologic Phenomenon
IE: Minor Criteria - Immunologic Phenomenon
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IE: Antibiotic Treatment
IE: Antibiotic Treatment
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What is the result of having prosthetic heart valves?
What is the result of having prosthetic heart valves?
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Infective Endocarditis: Risk of Intervention and Development Result
Infective Endocarditis: Risk of Intervention and Development Result
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IE: Patient Advice Aspects
IE: Patient Advice Aspects
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How do you shorten an angina attack?
How do you shorten an angina attack?
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What is pulmonary oedema?
What is pulmonary oedema?
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Atherosclerosis and thrombosis
Atherosclerosis and thrombosis
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NSTEMI
NSTEMI
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What is the Mitral valve?
What is the Mitral valve?
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Arrhythmias Lead To...?
Arrhythmias Lead To...?
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Non Cardiac Causes To Heart Failure?
Non Cardiac Causes To Heart Failure?
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Pharmaceutical for Heart Failure?
Pharmaceutical for Heart Failure?
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Paroxysmal Nocturnal Dyspnea (PND)
Paroxysmal Nocturnal Dyspnea (PND)
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Modifiable Risk Management
Modifiable Risk Management
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ECG usage
ECG usage
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Tissue Valve
Tissue Valve
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Acute Heart Failure
Acute Heart Failure
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Combined Heart Failure
Combined Heart Failure
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Arrhythmia Therapy
Arrhythmia Therapy
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Electrical Activity Present?
Electrical Activity Present?
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Most Common Rhythm Disturbance
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Anti-Arrhythmia
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Arteriosclerosis
Arteriosclerosis
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Mechanical Valve
Mechanical Valve
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Hypertension ? Causes
Hypertension ? Causes
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Blood Cultures
Blood Cultures
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Right sided
Right sided
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Specific forms
Specific forms
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Types ?
Types ?
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Study Notes
- Signs/Symptoms of Heart Disease
Overview of Heart Disease Signs and Symptoms
- Chest pain is typically due to ischaemia.
- Breathlessness is often associated with heart failure, keep respiratory issues in mind.
- Ankle swelling is an indicator of heart failure.
- Palpitations suggest arrhythmia.
- Feeling faint may be due to low blood pressure or arrhythmia.
Identifying Signs in a Clothed Patient
- General appearance can reveal breathlessness, pallor, sweating, or cyanosis (central, peripheral).
- Assess pulse for rate, rhythm, and volume.
- Check blood pressure.
- Jugular Venous Pressure (JVP) may be raised in heart failure.
- Peripheral oedema, identified by 'pitting' upon pressure, may be present.
Other Signs of Heart Disease
-
Heart sounds should be normal, indicating the closure of the mitral and aortic valves.
-
Additional heart sounds, such as murmurs, are due to turbulent blood flow.
-
Lung sounds should be normal vesicular breath sounds.
-
Additional lung sounds like inspiratory crackles at lung bases indicate pulmonary oedema.
-
Reduced breath sounds and dullness to percussion suggest pleural effusion or consolidation.
-
Ischaemic Heart Disease
Ischaemic Heart Disease Explained
- Coronary artery disease is the primary cause.
- Atherosclerosis (narrowing) and thrombosis (blockage) are underlying pathological processes.
- Consequences include angina (narrowing) and myocardial infarction [MI] (blockage).
- Acute Coronary Syndrome encompasses unstable angina and MI.
Management of Angina
- Management involves stopping activity and resting.
- GTN spray administered sublingually shortens attacks.
- Regular anti-anginal drugs include beta blockers like bisoprolol, nitrates like isosorbide mononitrate, and calcium channel blockers like amlodipine.
- Nicorandil, a potassium channel activator, is another treatment option.
- Percutaneous coronary intervention (PCI) and Coronary artery bypass graft (CABG) are also used.
Risk Factors
-
Modifiable Risk Factors -These include smoking, alcohol consumption, Hyperlipidaemia and Hypertension
-
Also diabetes/overweight, increased clotting, and poor lifestyle choices such as poor diet or lack of exercise.
-
Non-Modifiable
-
These include age, male gender, racial group, and being a post-menopausal woman.
Cardiac Investigations
- ECGs detect changes during angina or MI, and heart rhythm abnormalities.
- Chest X-rays reveal heart enlargement and pulmonary oedema.
- Echocardiograms (ultrasound with doppler flow study) show structure, movement of valves and heart muscle, and blood flow.
- Stress tests, such as stress echo or myocardial perfusion scan, identify reversible ischaemia.
- Cardiac MRI and Coronary angiograms (invasive, guides intervention such as stent placement).
- Troponin levels, measured via blood test, indicate release of cardiac muscle proteins in acute coronary syndrome - and indicate MI.
Management of MI
- It is a medical emergency, paramedics perform ECG and triage to a specialist centre.
- Inform if given aspirin 300mg (chewed).
- In ST-elevation MI (STEMI), immediate coronary intervention and stent placement plus medical treatment is needed.
- non-ST-elevation MI (NSTEMI) is approached through anti-thrombotics, beta blockers, and nitrates.
Valvular Heart Disease
- Valves are mitral, aortic, tricuspid, and pulmonary. The main problems are narrowing (stenosis), leaking, potentially leading to regurgitation
Rheumatic Fever
- Can occur 2-3 weeks after a streptococcal URTI.
- It impacts the heart, causing Rheumatic Heart Disease, Endocarditis, Myocarditis (Aschoff bodies) and Pericarditis
- Can cause Arteritis in the arteries, 'Flitting' polyarthritis in the joints, and Skin rashes and Subcutaneous nodules in the skin
Treatments for Heart Disease
- This involves treating symptoms with anti-arrhythmics and diuretics for heart failure.
- Surgical valve options are repair or replacement, with tissue valves having limited lifespans and mechanical valves requiring anticoagulation.
- Minimally invasive procedures can be used eg transcatheter aortic valve intervention (TAVI) for AS
Heart Failure
- Heart Failure Definition
- Heart has failed to deliver enough blood for the needs of the body.
- It's clinical syndrome with multiple causes, including breathlessness, fatigue and oedema.
- Types of Heart Failure
- Can Acute or Chronic. Acute can lead to pulmonary oedema.
- Can be right-sided or left-sided, often both are congested.
Causes of Heart Failure
- Common Causes Ischaemic heart disease and Hypertension. Valvular heart disease
- Chronic Obstructive Pulmonary Disease
- cor pulmonale, can cause right sided heart failure.
- Non-Cardiac Causes
- Excessive demand in high output heart failure due to Arterio-venous shunts / Anaemia or Hyperthyroidism Fluid overload from other causes: IV therapy or Renal injury (failure)
- Symptoms
- Breathlessness, Fluid Retention or Fatigue
- Investigations
- Requires a CXR or ECG
- Management Mechanisms
- Reduced cardiac output and blood pressure resembles dehydration or haemorrhage.
- Activate the renin-angiotensin-aldosterone system to retain salt and water
- Activate sympathetic nervous system to vasoconstrict and stimulate heart
- Treatments
- ACE inhibitors --opril
- Angiotensin II receptor blockers ---sartan
- Aldosterone antagonists e.g. spironolactone
- Loop diuretics to treat symptoms due to fluid overload
- Beta blockers ----olol
- Vasodilators – hydralazine, nitrates
Cardiac Rhythm Disturbances
- Normal Cardiac Electrical system
- Sino-atrial node
- Atrial Tissue
- Atrio-ventricular node
- Ventricular conducting tissue - His-Purkinje system
- ECG - electrocardiogram (image in text)
Rhythm Disturbances
- Tachycardias, Sinus Tachycardia
- Sinus Tachycardia is > 100 bpm, this is a normal response to exercise or emotion. . Hyperthyroidism, hypovolaemia, fever, heart failure can lead to this. Normal p-waves on ECG occur
- Atrial Fibrillation
- The most common rhythm disturbance
- Leads to being anticoagulated
- Results in a rapid rate, irregular ventricular rate and can cause an irregular pulse.
- Ventricular Tachycardia
- Rate usually faster than 140 bpm, often associated with ischaemic heart disease and can be caused by drugs
- Bradycardias are < 60 bpm
- Sinus bradycardia maybe be normal in athletes.
- With beta blockers may cause blackouts or dizzy spells
- Extrasystoles - a most common type
- Disturbance requires a sensation of missed or extra beats but usually has no clinical significance
- Ventricular Fibrillation
- Requires an AED to reverse. There is no cardiac output so cardiac arrest occurs and it causes death.
- Asystole - not 'shockable'
- There is an absence of electrical activity and contraction. Causes sudden cardiac arrest and death.
- Treatments for Arrhythmias
- Anti-arrhythmic drugs – beta blockers, amiodarone
- DC cardioversion
- Cardiac arrest
- Catheter ablation
- Pacemakers for bradycardia
- Implantable defibrillators for VT or VF, must always check for electrical interference from electro-cautery equipment.
- Rate-controlling drugs – beta blockers/digoxin and/or Anticoagulation - warfarin or DOAC.
Blood Pressure and Hypertension
Hypertensions BP levels
- Above 140/90 is previously standard
- Now tend to treat according to level of BP and overall cardiovascular risk
- Measuring Blood pressure - . Use a recommended device while seated and take at least 2 measurements and average 2 readings. Variability causes "white coat effect"
- Hypertension Aetiology
- 'Essential' Hypertension: 90% cases.
- Causes: environmental, obesity, salt intake, lack of excersise and mutliple genetic influences
- Hypertension - Secondary. 10% are relatively rare cases
- if BP very high, Renal function problems or patient symptoms could causes a clue
- Secondary Hypertension -
- Common causes are renal
- renal artery stenosis and older patient with vascular disease
- Endocrine causes: Conn's syndrome or Cushing's syndrome
- Intrinsic renal disease e.g. glomerulonephritis
- Centrally obese patient with Cuhsing's syndrome or adrenal adenoma has ? Electrolytes show low K
What Effects can Elevated BP Have?
Increases risk of CHD with peripherial disease
- Aneurysm. Cerebral circulation causing stroke Oral Issues -
- Bendroflumethiazide causes - Atenolol, Lichenoid and oral ulcerations Infective Endocarditis Information
- IE affects the left aide with Bacterial growth
- Acute cases are caused by Staphylococcus aureus
- Prosthetic Heart Valves can present early, or late
- Endocarditis in intravenous drug abuse is usually presents acutely
Risk Factors
- These include drug abuse, Abortion, Prosthetic valve and Cardiac and urinary catheterisation
- Procedures Include -Dental and urological
- Incidences around for Cardiac Deaths
- Is between 1.7-6.2 cases Europe / USA, increasing in UK. Mortality rate is higher over 65s
- Infections are common Native Valvue
- Caused by Oral streptococci
- Diagnosis through Features/Blood work
IE 'Toxic' Features
- These include Pyrexia, Sweats or Splenomegaly
- Leads to arrythmias with heart failure
- can be emolic to Limbs, Cardiac functions
- Glumerulonephritis occurs causing loin pain and haematuria
- Fingers / Toes - Osler's nodes can be tender and painful for hours
- A diagnosis is defined through criteria, which can show Antibodies to streptococcal polysaccharide and raised Antistreptolylin O titres (ASOT)
- Signs can include splinter haemorrhages in nails, finger clubbing, fever
Treatment
- Must use a suitable treatment dictated by from culture
- Antibiotic Prophylaxis for Dentists. Recent update with high / medium risk Increases risk of IE with SDCEP Previous IE
- Any form of prosthetic heart valve and cyanotic diseases
- SDCEP. www.sdcep.org.uk
- Has a template letter for cardiologists.
Arguments Against Prophylaxis
Reasons Against Prophylaxis
- There is no consistent association between an interventional procedure and the development of IE
- Regular tooth brushing presents a greater risk of IE than a single dental procedure
- Antibiotic prophylaxis clinical effectiveness is unproven.
- Antibiotic prophylaxis against IE for dental procedures is not cost effective and may lead to a net loss of life
Patient Advice
- Healthcare professionals should offer clear and consistent advice about prevention which includes the Benefits and risks, the importance of maintaining good oral health, the symptoms that may indicate IE and when to seek advice, and the risks of undergoing invasive procedures such as body piercing or tattooing
Summary
- A working knowledge of cardiovascular disorders and their implications/potential implications is important for safe clinical practice
- Endocarditis is a disease with which dental practitioners need to be familiar
- Antibiotic prophylaxis isn't routinely indicated for bacteremia producing dental procededs.
- there are subtleties to the debate, so liase if in doubt also.
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