cardiovascular valve disorders mod 6 Flashcards
ride a tricycle before a bicycle
right side:
pulmonary valve: systole open
tricuspid: diastole open
left side:
mitral valve/bicuspid: diastole open
aortic: systolic open
a: wear and tear
b: calcification
c: pannus - build up on leaflets
d: endocarditis - inflammation valves
e: thrombus on leaflets
valve abnormalities
stenosis: Very tight and hard for the blood to get through
* *aortic valve mainly
regurgitation: Very loose and the blood flows backward with increased pressures
* *mitral valve mainly
** heart muscle hypertrophy due to incomplete closure and opening, increases pressure
aortic stenosis triad
sometimes no s/s
chest pain
lightheaded
SOB
exertion exacerbation
infective endocarditis
vegetation of valves - infection, can break off and occlude vessels
Risk Factors
Prosthetic valve
Pacemaker-associated
*****intravenous drug use (IVDA)
IVDA Causative organisms Streptococcus viridans (S. viridans) Staphylococcus aureus (S. aureus) Staphylococcus epidermidis (S. epidermidis).
tricuspid valve*
vegetation
infected mass on valve
mitral regurgitation
fatigue
SOB
buck up in left ventricle
usually surgery to replace
s/s infective endocarditis
**long term IV ABX course
Fever Chills Anorexia Weight loss Myalgias: pain in muscles Arthralgias; joint pain Heart murmur
Signs of ischemia or infarction of the extremities, spleen, kidney, bowel, or brain may be the initial clinical manifestations of IE.
Septic emboli can lodge in a cerebral artery or arteriole and cause an ischemic stroke. Neurological symptoms from embolic stroke occur in up to 40% of patients with IE. Patients may also present with meningitis, seizures, encephalopathy, or abscesses of the brain.
septic emboli in IE?
bicuspid/mitral - peripheral
tricuspid - lungs
infected blood clots
Microorganisms travel into the heart, adhere to damaged endothelial tissue, and attract WBCs and platelets, which release cytokines and coagulation factors.
Stimulation of the coagulation cascade results in fibrin deposition and, eventually, development of a vegetation.
Carried by the bloodstream, these fragments, called septic emboli, can initiate infection or ischemia in remote tissues.
clinical manifestations of IE
Manifestations of IE are often caused by septic emboli:
Petechiae
Splinter hemorrhages: linear streaks in the nailbeds
Janeway lesions: erythematous, nontender lesions on the palms and soles
Osler’s nodes: subcutaneous nodules in the pulp of the fingertips
Roth spots: oval retinal hemorrhages with pale centers
IE and IV drug use
Staphylococcus aureus (S. aureus), the flora of the skin, most commonly causes bacteremia.
S. aureus travel from the peripheral vein into the inferior vena cava and into the right side of the heart.
The tricuspid valve is most often affected in IV drug users.
Septic emboli can enter the pulmonary artery lungs.
duke criteria IE
know major criteria**
Infective endocarditis requires that two major criteria are met, one major and three minor criteria are met, or that five minor criteria are met.
Major Criteria
Positive blood cultures from at least two separate cultures drawn 12 hours apart
Echocardiogram showing a vegetation, abscesses, or valve perforation
New regurgitant murmur
Minor Criteria
Predisposing heart condition such as mitral valve prolapse, rheumatic or congenital heart disease, or intravenous drug abuse
Temperature greater than 100.4°F (38°C)
Presence of embolic disease or hemorrhage
Presence of immunological phenomena, such as glomerulonephritis, Osler’s nodes, Roth’s spots, rheumatoid factor
Positive blood culture but major criteria not met
Positive echocardiogram but major criteria not met
pharm IE
Antibiotic therapy
Blood culture results identify organism and best antibiotic therapy
Prolonged therapy - 4 to 6 weeks*, poss 8-10 weeks
Lengthy hospital stay
