Subject 5 - Infective endocarditis
(4 hours)
Place
Training Room, Dapartment of Cardiology.
Purpose
To know:
• The main clinical signs of infectious endocarditis with the analysis of the etiology and
pathogenesis of the disease, physical changes, modern principles of treatment of this disease.
Professional orientation of students
Still recorded high mortality in patients with infective endocarditis (IE). The increase of IE in the
structure of the causes of formation of acquired heart disease requires constant improvement of
diagnostic methods.Highly important is the identification of the causative factors for specific
therapy and for prognosis.
The basic level of knowledge and skills
№ Discipline
1. Anatomy
To be able to know
Anatomical structure of the heart
2. Histology
Functional activity of cardiomyocytes
3. Biochemistry
Fundamentals of the metabolism of
proteins, indicators of fibrinolysis,
coagulation
Etiology and pathogenesis of disorders
of the heart, kidneys, spleen
4. Pathophysiology
1.
Propedevtika
internal diseases
To be able to do
Semiotics of disorders of the circulatory To evaluate clinical and laboratory
organs
findings
Plan for practical lesson
№
Elements of practical employments
Time(minutes)
1.
Verification of present's students
5
2.
Entrance control and his analysis
15
3. * Distributing patients for Supervision ( card or clinical tasks )
10
4. * Review patients or study of educational hospital chart
40
5.
Discussion of findings, formulation of previous diagnosis, determination of
methods of additional inspection of patient, interpretation of their results,
formulation of final diagnosis and plan of treatment
50
6.
Exercises with clinical formulations for solving clinical situation tasks
20
7.
Output control of knowledge and its evaluation
15
8.
Results and final assessment of knowledge and skills of students and tasks to
self- preparation for the next lesson
5
Note: * - in the case of patients absence in clinical, practice can be made in the form of
preparation and decision of situational tasks.
The list of theoretical issues addressed in class
1 . What is the term "infective endocarditis".
2. Etiology, pathogenesis, primary and secondary infective endocarditis.
3. Classification of IE.
4 . Clinical manifestations of this disease.
5 . Diagnostic criteria (for Schlant RC 1994 and Duke).
6. Change of biochemical and immunological parameters for endocarditis, voznikshimna against
autoimmune diseases (SLE, and others.).
7. Principles of treatment of IE.
8 . Criteria for curing and recurrence of IE.
9 . Complications and outcomes of IE.
Methods of practical classes *
(* On the first lesson the teacher carries out safety training (if any condition), which is
celebrated in the magazine signed by student teacher).
After reviewing the present teacher carries out a written entrance control basic knowledge.
Then the instructor carries out the distribution of students for Supervision of patients and
determine their problem.
№ Task
1.
Instructions a student
To
provide In a survey reveal:
curation
of 1.Symptoms of valvular heart disease
patient diagnosed (clinical and additional)
with IE
2. The presence of inflammatory signs of
infection
3. Typical of IE changes at
echocardiography, x-ray, laboratory data
Note teacher for students
P Pay special attention to:
• duration of the identified
complaints and objective data
• course of the disease, the
quality of treatment at the
previous stages of treatment
• timing of the appearance of
changes in the
echocardiography
Teachers work according to the plan of studies, spend the weekend at the end of the control
knowledge. Before the end of class the teacher sums up the results of his studies on the
assessment of each student and announce the topic of the next session.
Illustrative material
1. Tables and slides classification, pathogenesis of IE.
2. Videotape with ehokardiografichnimi Heart Study in IE.
3. Sets the X-ray, ECG analysis.
4. A set of test cases and case studies with the standards of answers.
Forms and methods of self-control
Test items:
1 . Male 26 years old, a drug addict, is being treated in the cardiology department with
diagnosis "infectious endocarditis." Sick 3 months, 3 times changed
antibiotic therapy. Currently, low-grade fever persists,
there were signs of left ventricular failure, failure detected
III level of the aortic valve. Decisive in the treatment of the patient at this stage
They are:
A. aortic valve replacement
B. Changing antimicrobials
C. Connection xenobiotic spleen
D. cardiotonic therapy
E. immunomodulatory therapy
2. Patient S., 70 years old. 2 weeks before admission, the temperature increases to 38 ° C. With
the diagnosis of pneumonia was sent to the hospital. On examination: pale skin, tachycardia. In
the lower parts of the lungs - finely wheezing. In the V point - short protodiastolic f noise. BP
140/40 mmHg , The lower edge of the spleen is palpated. Hb - 40 units. Eritrea. - 2.5 x 10 12 / L
Lake. - 12x10 9 / L, erythrocyte sedimentation rate -35 mm / hour. ECG - ST depression in V
5,6. In urine - proteinuria. What are the most likely diagnosis:
A. Bacterial endocarditis
B. Rheumatic heart disease
C. Acute myocarditis
D. chronic myelogenous leukemia
E. Acute pericarditis
3. In patients following tooth extraction increased body temperature to 40 ° C, there was
fever, which is accompanied by considerable sweating. Objectively: skin pale and hemorrhages
on the conjunctiva, labile pulse, 100 beats weak filling. / Min. , Blood pressure - 140/60 mm Hg
The diameter of the heart 15 cm, changeable diastolic murmur over the aorta. In the blood:
leukocytosis, ESR - 28 mm / h, a positive sample formolova. On US - thickening and blurring
aortic valve regurgitation I st. What is the most likely diagnosis?
A. Bacterial endocarditis
Hepatitis B.
C. rheumatic fever
D. aspiration pneumonia
E. Respiratory - a viral disease
Case Studies
1 . The patient 24 years complains of fever up to 38.5 C during the
three weeks, epistaxis, dyspnea when walking, general weakness. In history Rheumatism. Objectively: skin pale, small petechiae, "dance carotid." Over the aorta and so on.
Botkin - Erba - systolic and protodiastolic noise. The liver protruded from the costal arch by 3
cm, the spleen - 2 cm. What is able to develop in a patient? Have a plan of inspection of patient,
determine what tests will confirm your diagnosis and what to rule out other diseases. Assign
therapy.