🫀🫁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
