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Cardiology

Question
15 out of 18
 

Duke criteria is used in? (NEET 2014)



A Endocarditis

B CHF

C Arrhythmias

D Classification of antiarrhythmic drugs

Ans. A

Endocarditis

Diagnosis:

1. Blood cultures: 3 blood cultures sample should be taken

2. Blood tests: Normochromic, normocytic anaemia, neutrophil leucocytosis, high ESR/CRP.

3. Echocardiography Transthoracic Echo (TTE) may show vegetations, but only if >2mm.

Transesophasial Echo (TEE) is more sensitive, and better for visualizing mitral lesions and possible development aortic root abscess.

4. Diagnosis The Duke criteria for definitive diagnosis of endocarditis are given.

Table: The Duke Criteria for the Clinical Diagnosis of Infective Endocarditis

Major Criteria

1. Positive blood culture

2. Evidence of endocardial involvement Positive echocardiogram

Minor Criteria

1. Predisposition: predisposing heart condition or injection drug use

2. Fever ≥38.0°C (≥100.4°F)

3. Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions

4. Immunologic phenomena: glomerulonephritis, Osler's nodes, Roth's spots, rheumatoid factor

5. Microbiologic evidence: positive blood culture but not meeting major criterion as noted previously or serologic evidence of active infection with organism consistent with infective endocarditis

Criteria of How to diagnose: Definite infective endocarditis: 2 major or 1 major and 3 minor or all 5 minor criteria (if no major criterion is met).

Management

1. Antibiotics:

a. Empirical therapy:

i. Benzylpenicillin + gentamicin,

ii. If acute, add flucloxacillin

b. Definite therapy:If organism grows in blood culture.

i. Enterococci: amoxicillin gentamicin.

ii. Streptococci.' Benzylpenicillin for 2-4wks; then amoxicillin for 2wks.

iii. Staphylococci. flucloxacillin + gentamicin.

iv. Coxiella: doxycycline indefinitely + co-trimoxazole, or rifamp­icin or ciprofloxacin.

2. Consider surgery if: heart failure, valvular obstruction; repeated emboli; fungal endocarditis; persistent bacteriemia myocardial abscess; unstable infected prosthetic valve.

Prognosis30% mortality with staphylococci; 14% with bowel organisms; 6% with sensitive streptococci

Cardiology Flashcard List

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