Cardiovascular 2

Question 1

What is endocarditis?

Answer 1

-Inflammation of the endocardial or vulvular surface
-Mostly of infectious nature

Question 2

What is the cause of infective endocarditis?

Answer 2

Bacterial:
-Staphylococci
-Streptococci
-Enterococci

Rarely fungi & chlamydia microorganisms

Question 3

Non-infective endocarditis cause:

Answer 3

-Systemic autoimmune conditions
-Some cancer

Question 4

Characteristic of **aseptic (non-infective) endocarditis?

Answer 4

Sterile thrombosis on one or more heart valves

Question 5

Risk factors of infective endocarditis:

Answer 5

-Valvular abnormality
-Intravenous drug abuse
-Intravenous chemotherapy
-Bacteria introduced by dental surgery
-Diabetes

Question 6

Endocarditis pathophysiology:

Answer 6

-Colonisation of the valve by bacteria.
-Damaged endocardium and bacterial presence activate blood clotting, leading to formation of thrombi (made of fibrin & platelets)
-thrombi–} ‘vegetation’ (cauliflower shape, contain bacteria)

Question 7

Endocarditis commonly affect, which valves? Which side of heart?

Answer 7

Left side of heart, Mitral and Aortic valve

Question 8

Types of infective endocarditis:

Answer 8

-Acute bacterial (ABE)
-Subacuate bacterial endocarditis (SBE)

Question 9

Features of acute bacterial (ABE)?

Answer 9

-quick onset
-leads to valvular incompetence
-may lead to heart failure

Question 10

Murmur

Answer 10

Noise made by backflow of blood

Question 11

Vegetations can break and dislocate in the arterial system. Clinical consequences include:

Answer 11

-Small bleeding in skin, under nails, conjuctivae
-Renal I fraction
-Stroke
-glomerulonephritis

Question 12

Infective Endocarditis diagnosis methods:

Answer 12

• Blood culture
  -Echocardiography for valvular damage
• Transoesophageal echocardiography (TOE) sensitive to detecting vegetation

Question 13

What are 2 classes of valvular dysfunction?

Answer 13

1. Valvular stenosis - fail to fully open. |^ workload
2. Valvular incompetence - fail to close completely causing backwards flow (regurgitation)

Question 14

What is Mitral incompetence?

Answer 14

Inability of mitral valve to fully close during ventricular contraction (systole) allowing for leakage into left atrium.

Question 15

Lateral atrium(LA) dilation can lead to atrial fibrillation (AF) and loss of atrial systolic contractility. What happens?

Answer 15

In AF, LA muscle contractions are chaotic, uncoordinated and absent.
- producing irregular heart rate

Question 16

Aortic stenosis:

Answer 16

Narrowing of aortic valve (tricuspid)
1. Acquired stenosis due to calcification
2. Congenital bicuspid valve
- Hypertrophied left ventricle
- Accompanied systolic murmur

Question 17

Aortic incompetence:

Answer 17

Blood flow backward in ventricular diastole (from aorta back to LV).
- LV increase stroke volume, adequate to maintain cardiac output untill late stage
- LV dilatation & hypertrophy
- Palpitations
- Accompanied diastolic murmur

Question 18

Valvular investigation methods:

Answer 18

1. Chest X-ray - doesn’t demonstrate valvular abnormality
2. ECG shows LV hypertrophy and strain
3. Echocardiography - measure size of heart chambers, wall thickness, ejection fraction and detect abnormal blood flow