European Medical Professionals
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Questions and Answers

Which expert is from Kazakhstan?

  • Amina Rakisheva (correct)
  • Sigrun Halvorsen
  • Jolanta Čelutkienė
  • Maja Cikes

    • What is true about the declarations of interest submitted by the experts?

  • They were not submitted by all experts
  • They were published after the Guidelines
  • They were not compiled in a report
  • They were published in a separate document (correct)

    • Which expert is from Israel?

  • Marta Sitges
  • Gianluigi Savarese
  • Ales Linhart
  • Basil S. Lewis (correct)

    • How many experts are involved in the development of the Guidelines?

    <p>35</p> Signup and view all the answers

    Which expert is from Denmark?

    <p>Jens Cosedis Nielsen</p> Signup and view all the answers

    Which country has no experts involved in the development of the Guidelines?

    <p>Austria</p> Signup and view all the answers

    Which expert is from Canada?

    <p>Rhian M.Touyz</p> Signup and view all the answers

    What is the primary purpose of cardio-oncology services?

    <p>To address the cardiovascular needs of patients with cancer</p> Signup and view all the answers

    Which of the following is a type of cancer therapy-related cardiac dysfunction?

    <p>Anthracycline chemotherapy-related cardiac dysfunction</p> Signup and view all the answers

    What is the main goal of general principles of cardio-oncology?

    <p>To minimize cardiovascular toxicity in cancer therapy</p> Signup and view all the answers

    Which of the following is a cancer therapy-related cardiovascular toxicity definition?

    <p>Cardiac toxicity related to human epidermal receptor 2-targeted therapy</p> Signup and view all the answers

    What is the primary role of immune checkpoint inhibitors in cancer therapy?

    <p>To stimulate the immune system to attack cancer cells</p> Signup and view all the answers

    Which of the following is a type of cardiac dysfunction associated with chimeric antigen receptor T cell therapy?

    <p>Non-inflammatory heart failure</p> Signup and view all the answers

    What is the primary reason for the development of cancer therapy-related cardiac dysfunction definitions?

    <p>To standardize the diagnosis of cardiac dysfunction in cancer patients</p> Signup and view all the answers

    What is the main purpose of the section on cancer therapy-related cardiac dysfunction in the ESC Guidelines?

    <p>To present guidelines for the diagnosis and management of cancer therapy-related cardiac dysfunction</p> Signup and view all the answers

    What is the primary goal of the selection procedure for the Task Force members?

    <p>To ensure a representative mix of members from across the whole ESC region</p> Signup and view all the answers

    What is the purpose of the ESC Guidelines?

    <p>To provide guidance on the definitions, diagnosis, treatment, and prevention of cancer therapy-related CV toxicity</p> Signup and view all the answers

    What is the role of the ESC CPG?

    <p>To supervise and coordinate the preparation of new guidelines</p> Signup and view all the answers

    What is the source of financial support for the Task Force?

    <p>The ESC</p> Signup and view all the answers

    What is the purpose of the declaration of interest rules?

    <p>To ensure transparency and prevent potential biases in the development and review processes</p> Signup and view all the answers

    What is the purpose of the supplementary document?

    <p>To compile the declarations of interest of the Task Force members</p> Signup and view all the answers

    What is the focus of the guideline in terms of cancer treatment?

    <p>The guideline focuses on the cardiovascular health and wellness of patients after their cancer treatments</p> Signup and view all the answers

    What is the purpose of reviewing the declarations of interest of the Task Force members?

    <p>To ensure transparency and prevent potential biases in the development and review processes</p> Signup and view all the answers

    What is the website where the report is available?

    <p><a href="http://www.escardio.org/Guidelines">www.escardio.org/Guidelines</a></p> Signup and view all the answers

    What is the name of the journal that has supplementary data?

    <p>European Heart Journal</p> Signup and view all the answers

    What is the term for the abnormal heart rhythm?

    <p>Atrial fibrillation</p> Signup and view all the answers

    What is the term for the growth of new blood vessels that feed cancer cells?

    <p>Vascular endothelial growth factor inhibitors (VEGFi)</p> Signup and view all the answers

    What is the term for the heart condition caused by certain cancer therapies?

    <p>Cardiotoxicity</p> Signup and view all the answers

    What is the term for the abnormal accumulation of amyloid proteins in the heart?

    <p>Cardiac amyloidosis</p> Signup and view all the answers

    What is the term for the procedure that uses high-energy radiation to kill cancer cells?

    <p>Radiotherapy</p> Signup and view all the answers

    What is the email address to request permission to translate or reproduce the ESC Guidelines?

    <p><a href="mailto:[email protected]">[email protected]</a></p> Signup and view all the answers

    What does the ESC represent?

    <p>European Society of Cardiology's official position on a given topic</p> Signup and view all the answers

    What is the purpose of quality criteria for the development of guidelines?

    <p>To make all decisions transparent to the user</p> Signup and view all the answers

    What is the classification of a treatment or procedure that is beneficial, useful, or effective?

    <p>Class I</p> Signup and view all the answers

    What is S′?

    <p>Systolic velocity of tricuspid annulus obtained by Doppler tissue imaging</p> Signup and view all the answers

    What is SCORE2?

    <p>Systematic Coronary Risk Estimation 2</p> Signup and view all the answers

    What is the purpose of the ESC Guidelines?

    <p>To represent the official position of the ESC on a given topic</p> Signup and view all the answers

    What is SCORE2-OP?

    <p>Systematic Coronary Risk Estimation 2—Older Persons</p> Signup and view all the answers

    What is the classification of a treatment or procedure with conflicting evidence and/or a divergence of opinion?

    <p>Class II</p> Signup and view all the answers

    In which patients is antibiotic prophylaxis recommended after surgical repair?

    <p>Only for the first 6 months after the procedure</p> Signup and view all the answers

    What is the classification of the recommendation for antibiotic prophylaxis in patients with previous IE?

    <p>I B</p> Signup and view all the answers

    What is the recommendation for pre-operative screening in elective cardiac surgery or transcatheter valve implantation?

    <p>Pre-operative screening for nasal carriage of S. aureus is recommended</p> Signup and view all the answers

    What is the recommendation for antibiotic prophylaxis in patients with ventricular assist devices?

    <p>Antibiotic prophylaxis is recommended</p> Signup and view all the answers

    What is the recommendation for antibiotic prophylaxis in patients with transcatheter implanted aortic and pulmonary valvular prostheses?

    <p>Antibiotic prophylaxis is recommended</p> Signup and view all the answers

    What is the recommendation for antibiotic prophylaxis in patients at low risk of IE?

    <p>Antibiotic prophylaxis is not recommended</p> Signup and view all the answers

    What is the recommendation for antibiotic prophylaxis in patients with surgically implanted prosthetic valves?

    <p>Antibiotic prophylaxis is recommended</p> Signup and view all the answers

    What is the recommendation for antibiotic prophylaxis in patients undergoing oro-dental procedures at increased risk of IE?

    <p>Antibiotic prophylaxis is recommended</p> Signup and view all the answers

    What is recommended as the first-line imaging modality in suspected infective endocarditis?

    <p>Transthoracic echocardiography (TTE)</p> Signup and view all the answers

    In which situation is repeating TTE and/or TOE recommended?

    <p>When clinical suspicion of IE remains high after initial negative or inconclusive examination</p> Signup and view all the answers

    What is the recommended duration of antibiotic treatment for native valve endocarditis due to oral streptococci and Streptococcus gallolyticus group?

    <p>4 weeks</p> Signup and view all the answers

    In which situation is cardiac CTA recommended?

    <p>In patients with suspected perivalvular or paraprothetic complications</p> Signup and view all the answers

    What is recommended for patients with complicated infective endocarditis?

    <p>Diagnosis and management at an early stage in a Heart Valve Centre with immediate surgical facilities</p> Signup and view all the answers

    When is intra-operative echocardiography recommended?

    <p>In all cases of IE requiring surgery</p> Signup and view all the answers

    What is not recommended?

    <p>Systemic skin or nasal decolonization without screening for S. aureus</p> Signup and view all the answers

    When is TOE recommended in patients with clinical suspicion of IE?

    <p>In all patients with clinical suspicion of IE and a negative or non-diagnostic TTE</p> Signup and view all the answers

    What is recommended for patients with suspected IE and a negative or non-diagnostic TTE?

    <p>Repeat TTE and/or TOE within 5-7 days</p> Signup and view all the answers

    What is recommended when the patient is stable before switching from intravenous to oral antibiotic therapy?

    <p>Repeat TTE and/or TOE</p> Signup and view all the answers

    What is the recommended dosage of gentamicin for adult patients with normal renal function in the treatment of non-complicated NVE due to oral streptococci and S.gallolyticus?

    <p>3 mg/kg/day i.v. or i.m. in 1 dose</p> Signup and view all the answers

    What is the recommended duration of treatment with penicillin G, amoxicillin, or ceftriaxone for patients with NVE due to oral streptococci and S.gallolyticus who are allergic to beta-lactams?

    <p>4 weeks</p> Signup and view all the answers

    What is the recommended dosage of ceftriaxone for paediatric patients with NVE due to oral streptococci and S.gallolyticus?

    <p>100 mg/kg/day i.v. in 1 dose</p> Signup and view all the answers

    What is the recommended duration of treatment with (flu)cloxacillin or cefazolin for patients with PVE due to methicillin-susceptible staphylococci?

    <p>6 weeks</p> Signup and view all the answers

    What is the recommended dosage of vancomycin for adult patients with NVE due to oral streptococci and S.gallolyticus who are allergic to beta-lactams?

    <p>30 mg/kg/day i.v. in 2 doses</p> Signup and view all the answers

    What is the recommended route of administration for gentamicin in patients with NVE due to oral streptococci and S.gallolyticus?

    <p>Intramuscularly</p> Signup and view all the answers

    What is the recommended dosage of amoxicillin for adult patients with NVE due to oral streptococci and S.gallolyticus?

    <p>200 mg/kg/day i.v. in 6 doses</p> Signup and view all the answers

    What is the recommended duration of treatment with penicillin G, amoxicillin, or ceftriaxone for patients with PVE due to oral streptococci and S.gallolyticus?

    <p>6 weeks</p> Signup and view all the answers

    What is the recommended dosage of rifampin for adult patients with PVE due to methicillin-susceptible staphylococci?

    <p>900 mg/day i.v. or orally in 3 equally divided doses</p> Signup and view all the answers

    What is the recommended dosage of penicillin G for adult patients with NVE due to oral streptococci and S.gallolyticus?

    <p>24 million U/day i.v. in 6 doses</p> Signup and view all the answers

    What is the recommended dose of ampicillin for adults with native valve endocarditis or prosthetic valve endocarditis due to high-level aminoglycoside-resistant Enterococcus spp.?

    <p>12 g/day i.v. in 4-6 doses</p> Signup and view all the answers

    What is the recommended dose of gentamicin for paediatrics with IE due to beta-lactam-resistant Enterococcus spp.?

    <p>3 mg/kg/day i.v. or i.m. in 1 dose</p> Signup and view all the answers

    What is the recommended dose of daptomycin for adults with IE due to vancomycin-resistant Enterococcus spp.?

    <p>10-12 mg/kg/day i.v. in 1 dose</p> Signup and view all the answers

    When is emergency surgery recommended in aortic or mitral native valve endocarditis or prosthetic valve endocarditis?

    <p>With severe acute regurgitation or obstruction causing symptoms of heart failure</p> Signup and view all the answers

    What is recommended in IE with vegetation ≥10 mm and other indications for surgery?

    <p>Urgent surgery</p> Signup and view all the answers

    What is recommended for large aneurysms in patients with IE?

    <p>Neurosurgery or endovascular therapy</p> Signup and view all the answers

    What is recommended in patients with IE and suspected infective cerebral aneurysms?

    <p>Brain CT or MRA</p> Signup and view all the answers

    What is the contraindication for outpatient parenteral antibiotic treatment of infective endocarditis?

    <p>Liver cirrhosis (Child–Pugh B or C)</p> Signup and view all the answers

    What is the recommended dose of ceftaroline for adults with IE due to vancomycin-resistant Enterococcus spp.?

    <p>1800 mg/day i.v. in 3 doses</p> Signup and view all the answers

    What is the recommended dose of fosfomycin for paediatrics with IE due to vancomycin-resistant Enterococcus spp.?

    <p>2-3 g/day i.v. in 1 dose</p> Signup and view all the answers

    What is the recommended dosage of cefazolin for paediatric patients with NVE due to methicillin-susceptible staphylococci who are allergic to penicillin?

    <p>300-600 mg/kg/day in 3-4 doses</p> Signup and view all the answers

    What is the recommended dosage of gentamicin for adult patients with PVE due to methicillin-resistant staphylococci?

    <p>3 mg/kg/day i.v. or i.m. in 1 (preferred) or 2 doses</p> Signup and view all the answers

    What is the recommended dosage of vancomycin for paediatric patients with NVE due to methicillin-resistant staphylococci?

    <p>30 mg/kg/day i.v. in 2-3 equally divided doses</p> Signup and view all the answers

    What is the recommended combination of antibiotics for patients with NVE due to non-HLAR Enterococcus spp.?

    <p>Ampicillin or amoxicillin with ceftriaxone for 6 weeks</p> Signup and view all the answers

    What is the recommended dosage of rifampin for adult patients with PVE due to methicillin-resistant staphylococci?

    <p>900 mg/day i.v. or orally in 2-3 doses</p> Signup and view all the answers

    What is the recommended dosage of ampicillin for paediatric patients with NVE due to non-HLAR Enterococcus spp.?

    <p>300 mg/kg/day i.v. in 4-6 equally divided doses</p> Signup and view all the answers

    What is the recommended duration of gentamicin treatment for adult patients with PVE due to methicillin-resistant staphylococci?

    <p>2 weeks</p> Signup and view all the answers

    What is the recommended dosage of ceftriaxone for paediatric patients with NVE due to non-HLAR Enterococcus spp.?

    <p>100 mg/kg i.v. in 2 doses</p> Signup and view all the answers

    What is recommended for patients with spondylodiscitis and vertebral osteomyelitis complicating IE?

    <p>MRI or PET/CT</p> Signup and view all the answers

    What is recommended for patients requiring heart surgery who are high risk of CAD, in the absence of aortic valve vegetations?

    <p>Invasive coronary angiography</p> Signup and view all the answers

    What is the recommended dosage of vancomycin for adult patients with PVE due to methicillin-resistant staphylococci?

    <p>30-60 mg/kg/day i.v. in 2-3 doses</p> Signup and view all the answers

    After a transient ischaemic attack, what is recommended?

    <p>Perform cardiac surgery without delay</p> Signup and view all the answers

    What is the recommended duration of rifampin treatment for adult patients with PVE due to methicillin-resistant staphylococci?

    <p>at least 6 weeks</p> Signup and view all the answers

    What is recommended for patients following PWID-related IE?

    <p>Addiction treatment</p> Signup and view all the answers

    What is recommended for early PVE (within 6 months of valve surgery)?

    <p>Surgery with new valve replacement and complete debridement</p> Signup and view all the answers

    What is recommended for CIED implantation?

    <p>Antibiotic prophylaxis covering S. aureus</p> Signup and view all the answers

    What is recommended in patients with right-sided IE who are receiving appropriate antibiotic therapy?

    <p>Surgery in patients with right ventricular dysfunction</p> Signup and view all the answers

    What is not recommended in patients with IE?

    <p>Thrombolytic therapy</p> Signup and view all the answers

    What is recommended for patients with spondylodiscitis and/or septic arthritis?

    <p>TTE/TOE</p> Signup and view all the answers

    What is recommended for CIED reimplantation after extraction for CIED-related IE?

    <p>At a site distant from the previous generator, as late as possible</p> Signup and view all the answers

    Study Notes

    Experts Involved in Guideline Development

    • A list of experts from various countries contributed to the development of the guidelines
    • Each expert submitted declarations of interest, which were compiled in a report and published in a supplementary document

    European Society of Cardiology (ESC) Guidelines

    • The guidelines are published for personal and educational use only
    • No commercial use is authorized without written permission from the ESC
    • Permission can be obtained by submitting a written request to Oxford University Press

    Content of the Guidelines

    • The guidelines provide guidance on cancer therapy-related cardiac dysfunction
    • Topics covered include:
      • Anthracycline chemotherapy-related cardiac dysfunction
      • Human epidermal receptor 2-targeted therapy-related cardiac dysfunction
      • Immune checkpoint inhibitor-associated myocarditis and non-inflammatory heart failure
      • Chimeric antigen receptor T cell and tumour-related cardiac dysfunction
      • Cardio-oncology services
      • Cardiovascular toxicity definitions
      • Cancer therapy-related cardiovascular toxicity

    Classes of Recommendations

    • Class I: Evidence and/or general agreement that a given treatment or procedure is beneficial, useful, effective
    • Class II: Conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the given treatment or procedure

    Task Force Selection

    • The Task Force was selected by the ESC to represent professionals involved in the medical care of patients with cancer
    • The selection procedure aimed to ensure a representative mix of members from across the ESC region and relevant ESC Subspecialty Communities.

    Financial Support

    • The Task Force received its entire financial support from the ESC without any involvement from the healthcare industry.

    Purpose of the Guidelines

    • The guidelines aim to improve quality of care and clinical outcomes for patients with cancer
    • The guidelines provide guidance on the definitions, diagnosis, treatment, and prevention of cancer therapy-related cardiovascular toxicity (CTR-CVT), and the management of cardiovascular disease (CVD) caused directly or indirectly by cancer.

    Infective Endocarditis Prevention and Treatment

    Recommendations for Antibiotic Prophylaxis

    • Antibiotic prophylaxis is recommended in patients with previous infective endocarditis (IE), surgically implanted prosthetic valves, and transcatheter implanted aortic and pulmonary valvular prostheses.
    • Antibiotic prophylaxis is recommended in patients with untreated cyanotic congenital heart disease (CHD) and patients treated with surgery or transcatheter procedures with post-operative palliative shunts, conduits, or other prostheses.
    • Antibiotic prophylaxis is not recommended in other patients at low risk of IE.

    Recommendations for IE Prevention in High-Risk Patients

    • Antibiotic prophylaxis is recommended in high-risk patients undergoing dental extractions, oral surgery, and procedures requiring manipulation of the gingival or periapical region of the teeth.

    Recommendations for IE Prevention in Cardiac Procedures

    • Pre-operative screening for nasal carriage of S. aureus is recommended before elective cardiac surgery or transcatheter valve implantation to treat carriers.
    • Peri-operative antibiotic prophylaxis is recommended before placement of a cardiac implanted electronic device (CIED).
    • Optimal pre-procedural aseptic measures of the site of implantation are recommended to prevent CIED infections.

    Diagnosis and Management of IE

    • Transthoracic echocardiography (TTE) is recommended as the first-line imaging modality in suspected IE.
    • Transoesophageal echocardiography (TOE) is recommended in patients with clinical suspicion of IE and a negative or non-diagnostic TTE.

    Antibiotic Treatment of IE Due to Oral Streptococci and Streptococcus gallolyticus Group

    • Penicillin-susceptible oral streptococci and S. gallolyticus group:
      • 4-week duration in native valve endocarditis (NVE) or 6-week duration in prosthetic valve endocarditis (PVE).
      • Penicillin G, amoxicillin, or ceftriaxone are recommended for 4 (in NVE) or 6 weeks (in PVE).

    Antibiotic Treatment of IE Due to Staphylococcus spp.

    • Methicillin-susceptible staphylococci:
      • 4–6 weeks of (flu)cloxacillin or cefazolin in NVE.
      • 6 weeks of (flu)cloxacillin or cefazolin with rifampin and gentamicin in PVE.
    • Methicillin-resistant staphylococci:
      • 4–6 weeks of vancomycin in NVE.
      • 6 weeks of vancomycin with rifampin and gentamicin in PVE.

    Antibiotic Treatment of IE Due to Enterococcus spp.

    • Beta-lactam and gentamicin-susceptible strains:
      • 6 weeks of ampicillin or amoxicillin with ceftriaxone and gentamicin in NVE.
      • 6 weeks of ampicillin or amoxicillin with ceftriaxone and gentamicin in PVE.
    • High-level aminoglycoside resistance:
      • 6 weeks of ampicillin or amoxicillin and ceftriaxone in NVE and PVE.
    • Beta-lactam-resistant Enterococcus spp. (E. faecium):
      • 6 weeks of vancomycin with gentamicin in NVE and PVE.
    • Vancomycin-resistant Enterococcus spp.:
      • 6 weeks of daptomycin with beta-lactams (ampicillin, ertapenem, or ceftaroline) or fosfomycin in NVE and PVE.### CIED Reimplantation
    • CIED reimplantation should be performed at a site distant from the previous generator, as late as possible, after signs and symptoms of infection have abated, and once blood cultures are negative for at least 72 hours (or 2 weeks if vegetations were visualized).
    • Removal of CIED is not recommended after a single positive blood culture with no other clinical evidence of infection.

    Surgical Treatment of Right-Sided Infective Endocarditis

    • Surgery is recommended for patients with right-sided IE receiving antibiotic therapy in the following scenarios:
      • Right ventricular dysfunction secondary to acute severe tricuspid regurgitation non-responsive to diuretics.
      • Persistent vegetation with respiratory insufficiency requiring ventilatory support after recurrent pulmonary emboli.
      • Large residual tricuspid vegetations (>20 mm) after recurrent septic pulmonary emboli.
      • Patients with simultaneous involvement of left-heart structures.

    Antithrombotic Therapy in Infective Endocarditis

    • Interruption of antiplatelet or anticoagulant therapy is recommended in the presence of major bleeding (including intracranial haemorrhage).
    • Thrombolytic therapy is not recommended in patients with IE.

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