🫀🫁Cardio & Resp🫀🫁 - Valvular Disease & Heart Failure Flashcards
What is infective endocarditis?
An infection of the endocardium or vascular endothelium of the heart
ENDO (inner lining), CARD (heart) ITIS (inflammation)
What does infective endocarditis affect?
Typically affects the heart valves
The result of bacteria entering the blood stream and forming ”a vegetation” in the endocardium
Streptococci are the most common (20-40% of cases)
What is a “vegetation”, in the context of infective endocarditis?
A bacterial infection surrounded by a layer of platelets and fibrin
What are the common symptoms that someone with infective endocarditis may present with?
Fever
Malaise
Sweats
Unexplained weight loss
What signs can be present upon examination of someone with infective endocarditis?
There may be a new heart murmur on examination
Blood tests show anaemia and raised markers of infection
Echocardiogram can show a vegetation, abscess, valve perforation and/or new dehiscence of prosthetic valve (often also regurgitation of the affected valve)
What investigations should be performed on someone with suspected endocarditis?
Blood tests
Blood cultures
Echocardiogram
What would you look to see in blood tests of someone with suspected infective endocarditis?
Anaemia
Raised infection markers
What would you see in an echocardiogram of someone with infective endocarditis?
Vegetation, abscess, valve perforation and/or new dehiscence of prosthetic valve - often regurgitation in affected valve
Which type of echocardiogram should be performed on someone with endocarditis?
Transoesophageal echo - higher sensitivity compared to transthoracic
What is the definition of heart decompensation?
Inability of the heart to maintain adequate circulation
What features of heart decompensation would you look out for?
Cardiac decompensation
Shortness of breath, frequent coughing
Swelling of legs and abdomen
Fatigue
What are the clinical signs of heart decompensation?
Raised jugular venous pressure (JVP) - specifically right sided heart failure
Lung crackles
Oedema
Why is raised JVP specific to right sided heart failure?
It reflects elevated pressure in the right atrium and central venous system due to impaired venous return or inefficient cardiac output into the lungs
(can originate with left sided too, if pressure in lungs builds to a point where it causes right-sided heart failure)
What are the other complications of heart decompensation?
Vascular and embolic phenomena (stroke, Janeway lesions, splinter/conjunctival haemorrhages)
Immunological phenomena (Osler’s nodes, Roth spots)
What are Janeway lesions?
A rare symptom of acute bacterial endocarditis that appear as flat, painless, red or bluish-red spots on the palms and soles of the feet
What are Osler’s nodes?
A sign of infective endocarditis
Tender, purple-pink nodules with a pale centre, typically 1–1.5 mm in diameter
Usually found on the distal fingers and toes, but can also appear on the lateral digits, hypothenar, and thenar muscles
(Thought to be caused by small emboli from cardiac vegetation)
What are Roth spots?
Small areas of bleeding in the retina of the eye that appear as red spots with pale or white centres
What part of the heart does infective endocarditis affect?
Infective endocarditis affects the endocardium, especially the valves of the heart
Aortic valve is affected most frequently (aortic > mitral > right-sided valves)
Why doe vegetations usually occur at valves?
More common for bacteria to attach to the endocardium if underlying damage is present, and this occurs more frequently at sites of turbulent blood flow such as the valves of the heart
What is rheumatic fever?
Temporary inflammatory condition caused by Group A streptococci infection
The organism affects connective tissue including in the heart and elsewhere in the body
What is rheumatic heart disease?
Rheumatic heart disease is a permanent condition as a sequala of previous rheumatic fever causing permanent damage to the heart valves
How long after a rheumatic fever episode does rheumatic heart disease arise?
There is a long time lag between the rheumatic fever episode and the sequala of rheumatic heart disease
Over 7 years and can be up to 30years
What is the most common valvular dysfunction caused by rheumatic heart disease?
Mitral stenosis
Acute rheumatic fever can affect aortic valve causing regurgitation (20%)
Can also cause tricuspid valve regurgitation (10%)
What are the symptoms of mitral stenosis?
Haemoptysis (coughing up blood)
Fatigue
Shortness of breath
Paroxysmal nocturnal dyspnoea
Palpitations
What are the clinical signs of mitral stenosis?
Fluid overload, such as peripheral oedema, malar flush, hoarse voice
Loud S2
RV heave
Why are palpitations important in mitral stenosis?
Palpitations are important as a common complication is atrial fibrillation secondary to atrial dilatation from chronic mitral stenosis
How does mitral stenosis lead to a hoarse voice?
Compression of left recurrent laryngeal nerve by dilated left atrium
What are the major Jones’ criteria for rheumatic heart disease?
Major criteria
-Carditis
-Arthritis
-Chorea
-Erythema Marginatum
-Subcutaneous nodules
What are the minor Jones’ criteria for rheumatic heart disease?
Minor criteria
-Polyarthralgia
-Fever >38.5deg celcius
-Elevated acute phase reacts (CRP or ESR)
-Prolonged PR interval on ECG
What are the diagnostic requirements for rheumatic heart disease using Jones’ criteria?
2 major criteria
1 major and 2 minor criteria
3 minor criteria
What are the pathognomic features of rheumatic heart valves?
Leaflet or chordal thickening
Prolapse of leaflets
Excessive leaflet tip motion during systole
What are the management options of mitral stenosis?
Valve commissurotomy – percutaneous or surgical
Valve replacement
Management of complications (e.g. heart failure and atrial fibrillation (vitamin K antagonist))
