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OMSII BECOM Exam 2 > General Valvular Disease I&II - Adje > Flashcards

General Valvular Disease I&II - Adje Flashcards

1
Q

infective endocarditis**

A
  • contains a vegetation = mass of platelets, fibrin, microcolonies of microorganisms, and inflammatory cells***
  • infection involves heart valves, low pressure side of VSD, mural endocardium damage, foreign bodies, intracardiac devices

-occur from endothelial injury with high-velocity blood flow –> develop erosion and bacteria subside on low pressure side of lesion

  • fever*, heart murmur most common clinical features
  • chest pain is least common*
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2
Q

prototypical lesion - vegetation

A
  • organism deep in vegetation are inactive/dormant (nongrowing) and resistant to antimicrobial agents bc don’t get enough blood/O2 supply
  • those on the surface can be shed into bloodstream –> brain infection
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3
Q

organisms that cause infective endocarditis***

A
  • Staph, strep viridans***
  • HACEK organisms
  • Strep gallolyticus aka bovis***
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4
Q

what organism do you worry about GI tract issues and colon cancer??***

A
  • strep gallolyticus/bovis***

- do colonoscopy

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5
Q

nonbacterial thrombotic endocarditis (NBTE)

A
  • platelet-fibrin thrombus
  • mitral* > aortic > tricuspid > pulmonic
  • marantic endocarditis (uninfected vegetations in malignancy patients)
  • bland vegetations in SLE and antiphospholipid syndrome
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6
Q

prosthetic valve endocarditis (PVE)**

A
  • caused by S. aureus, CoNS, gram negative bacilli, diphtheroids, fungi
  • can cause CHF and conduction system blocks (AV node)
  • regurge murmurs
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7
Q

endocarditis - cardiovascular impantable electronic devices (CIED)

A
  • caused by S. aureus and CoNS**

- staph usually mechicillin resistant**

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8
Q

most common valve involved in IV drug users??**

A
  • tricuspid valve* bc of injecting into vein
  • caused by S. aureus (MRSA)
  • usually polymicrobial
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9
Q

clinical manifestations of endocarditis

A
  • symptoms –> cytokine production (weight loss, fever, fatigue, malaise)**
  • embolization of vegetation fragments –> infection/infarction of other tissues
  • hematogenous infection during bacteremia
  • immune response –> tissue injury
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10
Q

Duke criteria for endocarditis

A

-clinical + microbiologic + ECHO
-definite endocarditis
A. 2 major criteria OR
B. 1 major and 3 minor OR
C. 5 minor criteria

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11
Q

major criteria

A
    • blood culture

2. evidence of endocarditis on ECHO

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12
Q

minor criteria***

A
  1. Predisposition: predisposing heart conditions or IV drug use
  2. Fever ≥38.0°C (≥100.4°F)
  3. Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions
  4. Immunologic phenomena: glomerulonephritis, Osler’s nodes, Roth’s spots, rheumatoid factor
  5. Microbiologic evidence: positive blood culture but not meeting major criterion, or + serologic of active infection with an organism consistent with IE
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13
Q

what do you do if someone comes in complaining of weakness, fatigue, arthalgias with minor criteria (ex. roth’s spots on eye)?***

A
  • order blood cultures**

- slide 24

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14
Q

blood cultures

A
  • do when suspected NVE, PVE, or CIED if haven’t received antibiotics in the past 2 weeks
  • 3 2 bottle cultures obtained at different venipuncture sites over 24 hr.
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15
Q

TEE

A
  • can see vegetations better than with TTE

- diagnosis of choice for endocarditis

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16
Q

endocarditis antimicrobial therapy***

A

-organism specific therapies of endocarditis due to group B,C, G strep –> treat with regimen for penicillin-resistant strep**

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17
Q

standard oral regimen***

A

Amoxicillin: 2 g PO 1 h before procedure

18
Q

inability to take oral meds***

A

Ampicillin: 2 g IV or IM within 1 h before procedure

19
Q

penicillin allergy***

A

 1. Clarithromycin or azithromycin: 500 mg PO 1 h before procedure
 2. Cephalexin: 2 g PO 1 h before procedure
 3. Clindamycin: 600 mg PO 1 h before procedure

20
Q

penicillin allergy, not able to take oral meds***

A

 1. Cefazolin or ceftriaxone: 1 g IV or IM 30 min before procedure
 2. Clindamycin: 600 mg IV or IM 1 h before procedure

21
Q

acute rheumatic fever (ARF)***

A
  • immune mediated disease* to pharyngeal infection with GAS**, not cutaneous GAS
  • molecular mimicry –> Abs cross react with human tissue
22
Q

what do you see on histo with ARF?***

A
  • Aschoff bodies***
  • areas of connective or interstitial tissue inflammation
  • macrophages surrounding necrotic tissue
23
Q

JONES criteria***

A

-major criteria for ARF

  1. polyarthritis (migratory)
    - knees, elbows
    - responds to salicylates
    - sterile inflammatory synovial fluid
  2. carditis
    - usually mitral valve
  3. subcu nodules
    - on body surface
  4. erythema marginatum
  5. chorea
    - involuntary movement
  • need 2 major OR 1 major + 2 minor + evidence of GAS infection (+ throat culture, rapid antigen, rising ASO titer)
  • minor criteria –> prolonged PR interval, high CRP/ESR, fever, arthalgia
24
Q

carditis in ARF

A
  • endocarditis leading to mitral or aortic valvulitis (or both)*
  • tachycardia from myocarditis
  • pericarditis least common –> pericardial effusion/friction rub

-if myocarditis/pericarditis and no valvular involvement = unlikely to be due to ARF***

25
Q

erythema marginatum***

A

-pic on test**

  • macular rash with pale central clearing
  • on trunk/extremities, spares face
26
Q

aortic stenosis

A
  • calcified aortic valve due to aging “wear/tear”
  • in rheumatic fever, always associated with mitral stenosis*
  • congenital bicuspid valve –> overworked

-treat with valve replacement or TAVR (through groin)

27
Q

classic triad in aortic stenosis***

A
  1. angina - 5 year (average survival)
  2. syncope - 3 yr
  3. CHF - 2 yr
28
Q

clinical exam with aortic stenosis**

A
  1. carotid pulse slow to rise (pulsus parvus el tardus)
  2. palpable thrill in carotids (murmur radiates to neck)
  3. PMI: undisplacd and heaving (LVH)
  4. soft S2, diminished A2
  5. murmur: harsh systolic crescendo-decrescendo*** (best during respiration in RUSB)
  6. valsalva (decrease murmur), hand grip (increase murmur)
  7. opening snap with bicuspid AS
  8. gallavardin pheneomenon –> radiation of AS murmur to apex
29
Q

what murmur is heard in aortic stenosis?***

A
  • harsh crescendo-decrescendo systolic murmur often radiating to neck**
  • louder at apex in older patients
30
Q

clinical exam with aortic regurge***

A
  1. diastolic murmur at left 3rd intercostal space –> high pitch, blowing, decrescendo**
  2. S1 diminished (premature closure of MV with high LV pressure)
  3. wide arterial pulse pressure (water hammer)
  4. dicrotic pulse (bisferiens) - combined AR and AS
  5. quincke sign (pulsation in nail beds)
  6. head bobbing (musset’s sign)
  7. higher BP in legs than arms (Hill sign)
  8. systolic/diastolic murmurs in femoral artery (pistol shot/duroziez sign)
  9. austin flint murmur in diastole –> regurge jet displaces anterior mitral leaflet
31
Q

what murmur is heart in aortic regurge??**

A

-high pitch, flowing decrescendo murmur at left 3rd intercostal space*

32
Q

mitral stenosis clinical presentation

A
  • dyspnea on exertion
  • pulmonary congestion
  • RV failure –> ascites, pedal edema, weight gain
  • palpitations (Afib) due to LA dilation
  • hoarseness (ortner syndrome) –> compressing laryngeal nerve
  • cough
  • hemoptysis (rupture bronchial vessels)
  • embolisms (stroke, renal, MI)
33
Q

mitral stenosis auscultation***

A
  • opening snap following S2 (best at apex in left decubitus)**
  • mid-diastolic low-pitched rumbling murmur at apex in left lateral position using the bell***

-murmur worsened with exercise

34
Q

hear a diastolic murmur in patient who is hoarse and pregnant***

A

mitral stenosis***

35
Q

what do you see with left side heart failure (ex. mitral stenosis)*

A

-pulmonary congestion –> kerley B lines**

36
Q

when do you see large or bifid P waves?

A
  • during mitral stenosis (P mitrale)
  • LA having to work harder to push blood to LV

-also see Afib and RVH

  • treat with mitral valvotomy or replacement
  • treat in 3rd trimester of pregnancy with PCI balloon
37
Q

mitral regurge vs. aortic regurge**

A
  • mitral regurge –> SYSTOLIC

- aortic regurge –> DIASTOLIC

38
Q

mitral regurge

A
  • acute MI –> rupture of papillary muscle/chordae tendineae
  • chronic MR –> LA has time to compensate with dilation –> minimal elevated LA pressure preventing pulmonary congeston
  • also LVH to sustain volume –> exacerbates mitral regurge

-treat with valve repair or replacement

39
Q

clinical presentation of mitral regurgee

A

acute

  • severe SOB
  • tachypneic/cardic
  • S3 and systolic murmur at apex**

chronic

  • asymptomatic
  • dyspnea on exertion
  • pulmonary edema –> high JVP
  • high P2 and S3
40
Q

mitral regurge murmur***

A
  • S3 and systolic murmur at apex**

- pansystolic murmur** radiating into axilla

41
Q

mixed mitral valve disease (MMVD)

A
  • both mitral regurge and stenosis
  • due to chronic rheumatic heart disease
  • increased pressure in LA –> LAE, Afib, pulmonary HTN, RVH

OMSII BECOM Exam 2 (24 decks)

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