Cardio - Valvular Disease and Heart Failure

Question 1

What is infective endocarditis?

Answer 1

Inflammation of the endocardium, typically around the valves from when bacteria enter the blood and lead to vegetation formation in the endocardium

Question 2

What is the commonest cause of IE?

Answer 2

Staphylococcus

Question 3

What is vegetation?

Answer 3

Bacterial infection thats also forms a surrounding layer of fibrin/platelets

Question 4

What are the symptoms of IE?

Answer 4

Nausea
Malaise
Sweating
Unexplained weight loss

Question 5

What are the signs of IE?

Answer 5

Positive blood culture
New heart murmur 
Blood results show infective markers or anemia 
Echo: 
  - Vegetation 
  - Dehiscence of prosthetic valve
  - Abscess
  - Valve perforation 
Regurgitation of the affected valve

Question 6

What echo do we prefer for IE?

Answer 6

TOE>TTE

Question 7

What is the Duke’s criteria for IE?

Answer 7

Criteria used to determine the likelihood of someone having infective endocarditis

Question 8

What are the major criteria for IE? (4)

Answer 8

1. Persistently positive blood culture for typically organisms
2. ECHO findings
3. New valvular regurgitation murmur
4. Coxiella burnetti infection

Question 9

What are the minor criteria for IE? (5)

Answer 9

1. Temperature over 38C
2. Predisposing heart condition or IV drug use
3. Vascular (emboli to organs or brain)
4. Glomerulonephritis, Olders nodes, Roth spots
5. Positive blood cultures that do not meet specific criteria

Question 10

What classifies for definite IE?

Answer 10

• 2 major clinical criteria
• 1 major and 3 minor criteria
• 5 minor criteria

AND

positive gram stain or culture from surgery or autopsy

Question 11

What classifies for possible IE?

Answer 11

• 1 major and >1 minor criteria

- 3 minor criteria

Question 12

What rejects IE?

Answer 12

Failure to meet definite or possible criteria
Resolution with less than 4 days of antibiotics
No evidence of infection after surgery

Question 13

What is cardiac decompensation?

Answer 13

Heart failure when our heart fails to compensate for a fall in cardiac output.

Question 14

What signs of decompensation do we see in IE?

Answer 14

Shortness of breath
Leg/abdomen oedema 
Frequent cough 
Fatigue
Increase in jugular venous pressure
Lung crackles

Question 15

What other complications may we see in iE?

Answer 15

Vascular and embolic phenomena 
Immunologic phenomena 
Osler's nodes, Roth spots
Janeway lesions
Stroke
Splinter/conjuctival haemorrhages

Question 16

What parts of the heart are typically affected in IE?

Answer 16

The endocardium typically of the valves

Question 17

What valves are most commonly affected?

Answer 17

The aortic, followed by the mitral and then the right sided valves.

Question 18

How are valves affected?

Answer 18

Bacteria will commonly colonise areas where there is present underlying damage to the endothelium such as the valves, as they frequently experience turbulent blood flow. Therefore, bacteria form vegetations around the valves, and abnormal thickening thus preventing function. In turn, this causes regurgitation

Question 19

Why are IV drug users more at risk to IE?

Answer 19

IV drug users are more at risk to use an infected needle which will allow bacterial passage into the blood, but also they are typically immunosuppressed or may have congenital heart conditions making them predisposed to IE.