Infective endocarditis

Question 1

How do valves open

Answer 1

atrium contacts
- increases the pressure inside the atrium
- Tricuspid / mitral valve open
- blood enters the ventricles
- ventricles contract pressure in the ventricles is greater than the atrium
-

Question 2

How do valves work

Answer 2

Papillary muscles hold valves in place
- chorda tendani : yellow fibres attached to edges of valves cusps to the ventricle walls: prevents the backflow of blood

Question 3

What are the function of heart valve

Answer 3

allows the flow of blood in one direction
- prevents backflow of blood

Question 4

What are the consequence of diseased heart valve

Answer 4

stenosis:
- increases load on the heart
-turbulent blood flow causes thrombi

regurgitation:
- heart failure
- prothrombotic circumstances
- infective endocarditis
-

Question 5

What is the foetal circulation

Answer 5

lungs are deflated as they would provide resistance as it would cause problems to the heart
- oxygenated blood comes from placenta
- lung circulation is by-passed

Question 6

How is lung circulation is bypassed

Answer 6

• Foramen Ovale
• Ductus arteriosus

Question 7

What is the patent foramen ovale

Answer 7

a hole that is between Right atrium and left atrium
- all blood is pushed into left atrium instead of the right ventricle

• shorter circuit

Question 8

What is the patent ductus arteriosus

Answer 8

Short circuit: Communicates with pulmonary artery and aorta

Blood into pulmonary artery→ meets resistance of lungs→ bypassed directly into the aorta

Question 9

What is the epidemiology congential heart diesease

Answer 9

more common with developmental syndomes- downs,
- more common if parent/ sibling
-

Question 10

Why do congential heart disease occur?

Answer 10

1. failure of heart to complete changes after birth
   - patent ductus arteriosus
   - patent formen ovale
2. failure of heart to develop normally
   - transposition of great veins
   - valve narrowing
   - ventricuar septal defect

Question 11

What is the consequence of patent ductus arteriosus and patent foramen ovale in babys

Answer 11

designed to be used with non-perfusing lung
- Interfere with perfusion of lungs

Question 12

What is tetralogy of fallot

Answer 12

4 abnormalities:
1. Ventricular septal defect
Hole between right and left ventricle - right heart has to work harder

2. Right venticular hypertrophy
   additional resistance to flow of blood from stenosis
   Right ventricle has to work harder→ more hypertrophic
3. ## Pulmonary stenosis
4. Overriding aorta: aortic valve is NOT at the edge of the left ventricle more in the middle of left & righ

Question 13

What is meant by ‘Eddy formation’?

Answer 13

Movement of fluid deviating from the general flow of a fluid
Swirling of a fluid & reverse current created by a slow turbulent blood flow
Causes coagulation of blood

Question 14

Give examples for acquired valve disease

Answer 14

1. Rheumatic heart disease
2. calcification/ degeneration of heart disease

Question 15

How does rheumatoid fever cause valvular heart disease

Answer 15

• common in developing countries
  -Caused by Streptococcal A → sore throat/ pharyngitis

Question 16

What are the risk favtors for s calcification of valves

Answer 16

• Age (1/50 over 80 years)
• Smoking
• High BP
• High cholesterol
• Obesity

Question 17

What are the effects of valvular/ congenital heart disease:

Answer 17

Reduced pumping efficiency: resulting in”

Heart failure
Shortness of breath
Reduced exercise tolerance
Failure to thrive in childree
n
risk of heart failure

Question 18

What is the tx of valve diease

Answer 18

Prosthetic heart valve:
- metal
- bovine valve
- cow valve
(animal is better as less co-anticoagulant requirements, better mechanically)

TAVI (Transcatheter Aortic Valve Implant)
- Require a dental assessment prior to TAVI
- Place a wire through patients femoral artery/ subclavian artery to arotic valve

Still risk of anticoagulant & risk of endocarditis

Question 19

How should a pt with valve disease affect your management

Answer 19

risk of infective endocarditis
- risk of thrombosis/ embolism so on DOAC/ Warfarin

Question 20

What are the risk factors for infective endocarditis

Answer 20

Structural heart disease→ cardiomyopathy / previous rheumatic fever
Prosthetic heart valve
Congenital heart disease
IVDA
Immunocompromised
Heart murmur

Question 21

What are the causes of infective endocarditis

Answer 21

1. Bacteraemia
2. valve/heart abnormality or immune suppressed
3. Bacterial infection of clots on valve: Vegetations (contain: fibrin, bacteria (live & dead), white cells) collect on surface of heart valves

This causes inflammation→ resulting in systemic complications

Question 22

What are the clinical features of endocarditis

Answer 22

Fever
Rigors (shakes)
Night sweats
Malaise
Weight loss
New heart murmur or change of existing murmur
Shortness of breath
Heart failure

Question 23

What is the cause of systemic complications from infective endocarditis

Answer 23

septic emboli:
- splinter hameorrhages
- eye
-kidney complications
- osler nodes
- janeway lesuons
- heart complications: thrombotic

Question 24

where is the source of bacteraemia in infecctive endocarditiis

Answer 24

Instrumentation of areas with high bacterial loads
Procedures of Upper GI
Procedures of Lower GI
Procedures of Urogenital tract
Procedures of Skin
Procedures of Mouth

Question 25

What are the NICE guidelines around infective endocarditis

Answer 25

Prophylaxis antibiotics not indicated routinely

Question 26

What are SDCEP guidelines

Answer 26

Patients can be split into 2 groups:
1. Those that require special consideration
2. Those that don’t require special consideration

Question 27

Who is a special consideration group

Answer 27

Previous IE
Prosthetic valve (including a transcather valve)
Patients with congenital heart disease (CHD)

Question 28

What is the routine management of patients at risk of IE but no special considerations according to SDCEP

Answer 28

1. Patient/ guardian are aware of their risk of IE
2. provide advice about prevention
3. Potential benefits & risks of antibiotic prophylaxis & explanation of why antibiotic prophylaxis is not recommended
4. OHI
5. Educate on Symptoms that indicate infective endocarditis & when to seek expert advice
6. Risk of undergoing invasive procedures including non-medical procedures such body piercing/ tattooing

Question 29

How do you manage pt with special considerations

Answer 29

TALK TO CARDIOLOGIST
1. provide prescription
2. Advise pt
3. give advice on adverse risks
4.give risks of undergoing invasive procedures

Question 30

What are the risks to all patients with antibioitcs prophylaxis use

Answer 30

Hypersensitivity
Anaphylaxis
Resistance
C.difficle