Pediatric Heart Disease
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| Regular healthy person gets endocarditis. What is the organism and what is the treatment? | Staph aureus. [(Nafcillin OR Oxacillin) + 5d gent] x 4-6 weeks
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| Person with pre-existing heart disease gets endocarditis. What is the organism and what is the treatment? | Strep viridans. Tx with PCN G x 4 wks OR PCN (or CTX) + gent x 2 wks
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| What tx to give person with endocarditis with cardiac prosthetic device infected with S. aureus? | Vanc + gent (+/- rifampin) x 4-6wks
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| Person gets endocarditis after dental procedure. What is the organism and what is the treatment? | Strep viridans. Tx with PCN G x 4 wks OR PCN (or CTX) + gent x 2 wks
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| Pt s/p bowel or GU manipulation gets endocarditis. What is the organism and what is the treatment? What if the pt is PCN allergic? | Enterococci (Grp D Strep). Tx with ampicillin + gent x 4-6 wks. If PCN allergic: vanc + gent x 4-6 wks
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| IVDU pt gets endocarditis. What are the organisms it could be? | Can be Pseudomonas or Serratia.
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| Pt s/p open heart surg gets endocarditis. What is the organism? | Fungi
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| Pt with indwelling IV catheter gets endocarditis. What is the organism? | Staph - coag neg.
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| Person with MRSA endocarditis. What is Tx? | Vanc +/- TMP/SMX x 4-6wks
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| Person with Staph Epi endocarditis. What is Tx? | Vanc +/- rifampin x 6wks
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| What are HACEK organisms? | slow-growing G- org that are part of nl flora
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| Person with HACEK endocarditis. What is Tx? Does tx change if they have a prosthetic heart valve? | CTX x 4 wks. If prosthetic, then same but x 6 wks.
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| Name the HACEK organisms. | Hemophilus spp, Actinobacillus, Actinomycetemcomitans, Cardiobacterium hominus, Eikenella corrodens, Kingella kingae
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| Prophylaxis for endocarditis in oral/esophageal/resp procedures | Amox if PO, if NPO then ampicillin. If PCN allergic: Clinda OR Cephalosporin (CTX) OR Macrolide (Azithromycin)
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| Pts with high risk of developing endocarditis. What do you prophylax with? What to use if PCN allergic? | Pts with prosthetic valves, prior endocarditis, complex cong heart disease, pulm shunts. Tx with ampicillin and gentamicin. If PCN allergic: vanc AND gent
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| Pts with moderate risk of developing endocarditis. What do you prophylax with? | Congenital heart disease, acquired valvular disease, aortic stenosis, MVP with regurg or thick valves. Amox OR ampicillin. If PCN allergic: Vanc
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| Need endocarditis prophylaxis? MVP with no regurg or thick valves | no
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| Need endocarditis prophylaxis? tonsillectomy | yes
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| Need endocarditis prophylaxis? repair of ASD/VSD/PDA | no
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| Need endocarditis prophylaxis? Rigid bronch | yes
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| Need endocarditis prophylaxis? Coronary artery bypass | no
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| Diagnosis Criteria for Acute Rheumatic Fever | JONES. MAJOR: J - Joints (migratory polyarthritis), O (O-antigen, carditis), N (subQ nodules), E (erythema marginatum), S (Sydenham chorea). MINOR: arthralgia (can't use if have arthritis), fever, increased ESR < CRP, EKG with long PR.
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| How many criteria needed to make ARF diagnosis? | Must have evidence of prior Strep infection. PLUS Chorea by itself OR 2 major OR 1 major and 2 minor OR 5 minor. Can't use arthralgia if already have major arthritis.
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| Treatment for ARF | penicillin or erythromycin to get rid of bug, ASA as anti-inflammatory (tx arthritis and carditis), but if have CHF with carditis, give prednisone.
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