Chapter 11: Valvular Heart Disease

Question 1

A febrile illness with widespread connective tissue acute

inflammation but especially heart and joints

Answer 1

Rheumatic fever (RF)

Question 2

True or false: Rheumatic fever is a hypersensitivity reaction.

Answer 2

True

Question 3

What causes rheumatic heart disease (RHD) a complication of? What does it result in?

Answer 3

Scarring of heart valves by rheumatic fever

Question 4

True or false: Rheumatic fever is a bacterial infection.

Answer 4

False; it is an immunologic complication following infection by group A beta hemolytic Streptococcus

Question 5

How do you prevent Rheumatic fever?

Answer 5

Treat beta-Strep promptly.

Question 6

How do you prevent Rheumatic heart disease in folks who have had RF before?

Answer 6

Provide prophylactic penicillin throughout childhood and young adulthood to prevent additional strep infections , recurrent RF, and further valve damage.

Question 7

What type of valvular disease may occur as a
result of a congenital bicuspid aortic valve
abnormality or calcific aortic stenosis?

Answer 7

Nonrheumatic Aortic Stenosis

Question 8

In what two ways can Nonrheumatic Aortic Stenosis occur?

Answer 8

1) Congenital bicuspid aortic valve abnormality

2) Calcific aortic stenosis

Question 9

Which part of the heart is strained by calcific aortic stenosis?

Answer 9

Left ventricle

Question 10

What is the treatment for calcific aortic stenosis?

Answer 10

prosthetic valve replasement

Question 11

What is the top cause of valve replacement in the US and Europe?

Answer 11

Calcific aortic stenosis

Question 12

True or false: the same risk factors that predispose a person to CAD also predispose a person to CAS (cardiac aortic stenosis).

Answer 12

True

Question 13

How is mitral valve prolapse diagnosed?

Answer 13

echocardiogram

Question 14

How is mitral valve prolapse treated?

Answer 14

Treat prophylactically with ABX prior to dental/surgical procedures; Valve repair or replacement if severe.

Question 15

What are the two major types of prosthetic heart valves?

Answer 15

1) Mechanical

2) Bioprosthetic

Question 16

What does an artificial heart valve increase the risk of?

Answer 16

Infective endocarditis

Question 17

What is the downfall of mechanical valve replacements?

Answer 17

Increased risk of blood clots

Question 18

On valves of which side of the heart is infective endocarditis usually seen?

Answer 18

Left side

Question 19

True or false: Subacute infective endocarditis is usually caused by highly virulent organisms.

Answer 19

False; low virulence

Question 20

Why do people with heart valve damage or artificial valves go on prophylactic antibiotic prior to dental or surgical procedures?

Answer 20

To prevent subacute infective endocarditis

Question 21

Which valve in the heart is most often infected by acute infective endocarditis?

Answer 21

R tricuspid valve (because this is soon after blood enters heart)

Question 22

True or false: Acute valve infections tend to affect valves on the L side of the heart.

Answer 22

False; right side

Question 23

What type of condition is rheumatic fever?

Answer 23

Acute autoimmune hypersensitivity

Question 24

How can rheumatic heart disease occur?

Answer 24

1) Strep infection
2) A couple of weeks later, rheumatic fever (body creates Abs against strep that attack joints and heart valve–especially the mitral valve).
3) This usually resolves with some scarring
4) Repeated scarring from additional strep infections leads to RHD

Question 25

What are the possible outcomes of RHD?

Answer 25

1) Stiff valves cause heart to work harder

2) Blood backs up to congest lungs

Question 26

What are the two main types of nonrheumatic aortic stenosis?

Answer 26

1) Congenital bicuspid valve (born with tricuspid valve containing 2 instead of 3 cusps)
2) Calciforic aortic stenosis

Question 27

What are the 5 main conditions affecting heart valves?

Answer 27

1) Rheumatic heart disease
2) Non-rheumatic heart disease
3) Mitral valve prolapse
4) Artificial valves
5) Infective endocarditis

Question 28

What is the prognosis for someone with calcific aortic stenosis with no valve replacement?

Answer 28

less than 5 years

Question 29

True or false: Infective endocarditis is common, but usually not serious.

Answer 29

False; it is rare, but usually serious.

Question 30

True or false: Patients with artificial heart valves are less vulnerable to endocarditis.

Answer 30

False; more vulnerable

Question 31

_______________ endocarditis is caused by low levels of low virulence bacteria.

Answer 31

Subacute

Question 32

_______________ endocarditis is caused by highly virulent bacteria (often staph).

Answer 32

Acute

Question 33

Which valve is usually affected by acute endocarditis?

Answer 33

R AV valve (tricuspid); because it is the first encountered in blood flow through the heart