CARDIOVASCULAR SYSTEMppt.pptx

They are believed to be caused by immune complex

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They are believed to be caused by immune complex deposition and are included as a minor criteria amongst Duke's criteria for clinical diagnosis of Infective Endocarditis.
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DUKE’S CRITERIA: MAJOR CRITERIA: 1. POSITIVE BLOOD CULTURE 2. INVOLVEMENT OF ENDOCARDIUM:- (ECHO BASED EVIDENCE-VEGETATIONS, ABSCESS, PERIVALVULAR DEHISCENCE OR NEW VALVULAR REGURGITATION) 189
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MINOR CRITERIA: 1. PREDISPOSITION (CARDIAC LESION, IV DRUG ABUSE) 2. FEVER > 38 C 3. VASCULAR OR IMMUNOLOGICAL SIGNS 4. POSITIVE BLOOD CULTURE – THAT DOES NOT MEET MAJOR CRITERIA 5. POSITIVE ECHO- THAT DOES NOT MEET MAJOR CRITERIA DIAGNOSIS: DIAGNOSIS CONFIRMED BY 2 MAJOR/1 MAJOR + 3 MINOR/ALL 5 MINOR CRITERIA. 190
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TREATMENT INJ. BENZYL PENICILLIN 20–40 LAKH UNITS IV 4 HOURLY FOR 4 WEEKS. PARENTERAL AMINOGLYCOSIDES (SM, GM, AMIKACIN) GIVEN IN APPROPRIATE DIVIDED DOSES FOR THE FIRST 2 WEEKS. APPROPRIATE ANTIBIOTIC CHANGES MAY BE MADE ON RECEIVING THE RESULTS OF BLOOD CULTURE. PROPHYLAXIS IN IE: CAPSULE AMOXYCILLIN 3 GM ORALLY, 1 HOUR BEFORE THE PROCEDURE AND 1.5 GM ORALLY 6 HOURS AFTER THE FIRST DOSE. 191
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INDICATIONS FOR SURGICAL MANAGEMENT a. FAILURE OF MEDICAL TREATMENT AS INDICATED BY PERSISTENT POSITIVE BLOOD CULTURE OR REFRACTORY FAILURE. B. MYOCARDIAL OR VALVE RING ABSCESS. C. AORTIC VALVE ENDOCARDITIS DEVELOPING HEART BLOCK. D. PROSTHETIC VALVE ENDOCARDITIS E. PRESENCE OF LARGE VEGETATION WITH POSSIBLE EMBOLISM F. FUNGAL ENDOCARDITIS. 192
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193 A
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511 194 Ans. is 'd' i.e., 3 culture separated by at least hour over 24hr [Ref Harrison 18th/e p. 1056].
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AS A PART OF THE INITIAL EVALUATION OF ALL PATIENTS WITH SUSPECTED ENDOCARDITIS THE FOLLOWING STUDIES SHOULD BE PERFORMED: IN THE ABSENCE OF PRIOR ANTIBIOTIC THERAPY THREE BLOOD CULTURE SETS SEPARATED FROM ONE ANOTHER BY AT LEAST 1 HOUR SHOULD BE OBTAINED FROM DIFFERENT VENIPUNCTURE SITES OVER 24 HOURS. 195
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196
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FUNGAL ENDOCARDITIS: MOST COMMONLY ASSOCIATED WITH CANDIDA AND ASPERGILLUS. MOST COMMONLY ASSOCITED WITH IV. DRUG ABUSE AND PROSTHETIC VALVES AND SUPPRESSED IMMUNITY . ANTIFUNGAL AGENTS DO NOT CURE ANTIFUNGAL CARDITIS. BOTH MEDICAL AND SURGICAL MANAGEMENT REQUIRED. 197
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198 Ans. is 'd' i.e., Good prognosis with treatment [Ref Color Atlas of Infective Endocarditis (Springer) 2007p.
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199 B
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CARDIAC TAMPONADE CARDIAC TAMPONADE IS CHARACTERIZED BY ACCUMULATION OF FLUID IN THE PERICARDIAL SAC DUE TO VARIOUS CAUSES. • THE ACCUMULATION OF PERICARDIAL FLUID LEADS TO ELEVATION OF THE PERICARDIAL PRESSURE. THE INCREASE IN INTRAPERICARDIAL PRESSURE LEADS TO REDUCED FILLING OF THE HEART. REMEMBER THAT THE TRUE FILLING PRESSURE OF THE HEART IS THE, MYOCARDIAL TRANSMURAL PRESSURE , WHICH IS: INTRACAVITARY PRESSURE - PERICARDIAL PRESSURE 200
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201
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IN CARDIAC TAMPONADE THE PERICARDIAL PRESSURE IS GREATER THAN THE INTRA CAVITARY PRESSURE.
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  • Winter '16
  • jean grey
  • Cardiology, Ans., Constrictive pericarditis

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