Endo/pericarditis

Question 1

What happens with a narrowed or restricted valve?

Answer 1

Leaflets are thickened and stiff from calcification, fibrosis, inflammation or congenital abnormalities

Question 2

What does increased resistance to blood flow require?

Answer 2

Requires heart to pump harder

Question 3

What does valvular stenosis lead to?

Answer 3

Leads to hypertrophy and impaired function

Question 4

What does valvular stenosis most commonly affect?

Answer 4

the aortic and mitral valves

Question 5

What happens during valvular regurgitation?

Answer 5

leaflets do not close properly
blood leaks backward across the valve
volume overload
chamber dilation and remodeling
dec cardiac output

Question 6

What are key features of stenosis?

Answer 6

valve narrowing
inc pressure gradient
left ventricular or atrial ypertrophy
dec cardiac output

Question 7

What are key features of regurgitation?

Answer 7

backward flow of blood
inc volume in the affected chamber
chamber dilation

Question 8

What is endocarditis?

Answer 8

inflammation of innermost layer of heart (endometrium)

Question 9

What is endocarditis often a result of?

Answer 9

bacteremia causing an infection that colonizes on the valve

Question 10

What is endocarditis characterized by?

Answer 10

vegetations (fibrin, platelets, bacteria, on heart valves)

Question 11

What is endocarditis rarely caused by?

Answer 11

fungus or aseptic

Question 12

What valve is most commonly affected in endocarditis?

Answer 12

mitral valve

Question 13

What is the order of the valves affected in endocarditis?

Answer 13

mitral > aortic > tricuspid > pulmonic

Question 14

What is the exception of IV drug users with the valve affected in endocarditis?

Answer 14

tricuspid valve

Question 15

What are risk factors of endocarditis?

Answer 15

IV drug use
chronic rheumatic heart dz
chronic hemodialysis
HIV +
poor dentition
intra cardiac devices
iatrogenic infection
inc >60 yo
inc in male sex
prosthetic valves- greatest first 6-12 mo

Question 16

What is the most common overall cause of endocarditis?

Answer 16

Staph aureus

Question 17

What causes subacute endocarditis?

Answer 17

Strep viridans: oral/dental flora (poor dentition)

Question 18

What are the types of endocarditis?

Answer 18

Acute bacterial endocarditis
-infxn of normal valves with a virulent organism (Staph)
-febrile illness that rapidly damages cardiac structures, leads to death w/in weeks
-m/c valve affected: mitral

Subacute bacterial endocarditis
-infxn of abnormal valves with less virulent organism (Strep)

Endocarditis in IV drug users
-MRSA, Pseudomonas, Candida
-M/c valve affected: tricuspid

Prosthetic valve endocarditis
<60 days after surgical post-op valve implant

Question 19

How do damaged heart valves cause endocarditis?

Answer 19

“sticky” surface for bacteria to attach
catheters, electrodes/leads, intracardiac prosthetic devices
chronic inflammation –> autoimmune and degenerative valve dz

Question 20

What are causative agents of endocarditis?

Answer 20

bacteremia
-IV drug abuse
-central catheter/PICC line
-can come from gut (GI source)
-recent dental procedure

Question 21

If the cardiac valve tissue has no blood supply…

Answer 21

it has an inability to mount an immune response and fight infection

Question 22

What is the patho of endocarditis?

Answer 22

endothelial injury occurs and leads to altered flow –> leads to direct infection of heart or thrombus
organisms enter blood stream- organisms proliferate and cause inc coagulation, forming vegetations
leads to direct damage of cardiac structures, embolization, and hematogenous spread

Question 23

What are the sx of endocarditis?

Answer 23

non-specific: cytokine release
-malaise
-fatigue
-night sweats
-weight loss
-weakness

Question 24

What are the sx of endocarditis in an IV drug user?

Answer 24

usually tricuspid
faint or no murmur
pulmonary findings- cough, pleuritic chest pain, nodular infiltrates can come from septic pulm emboli that arise from tricuspid valve, FEVER, lack of peripheral lesions

Question 25

What are the signs of endocarditis?

Answer 25

fever, cardiac (new regurgitant murmur, CHF), non-cardiac: septic embolization, embolic event on specific organs (hematuria & proteinuria), inflamm arthritis/arthralgia, neuro comps

Question 26

What are the clinical manifestations or endocarditis?

Answer 26

Janeway lesions- painless erythematous macules on palms and soles
Osler nodes- tender nodules on pads of fingers, toes, or feet
Roth spots- retinal hemorrhage with pale center
Splinter hemorrhage- proximal nail bed (subungal)