Inflammatory Heart/Valves Flashcards by Brandy Wilson

Risk factors for endocarditis

IV Drug use (non sterile injections)
Valve disease or prosthetic valve
Pacemaker
Bacteremia, especially MRSA
Dialysis
Hx of endocarditis
Recent heart surgery or dental surgery
Aging

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What are biofilms?

Clusters of microorganisms that form a protective film around themselves and make ABx treatment difficult

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What are vegetations and what is the danger?

Lesions of endocarditis made of fibrin, leukocytes, platelets, microbes that stick to surface.

Danger is they can break lose and cause an emboli.

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S/sx of endocarditis.

Fever and generalized infection symptoms
Arthralgia and myalgia
Splinter hemorrhages (black streaks in fingernails)
Petechiae (all over)
Osler’s nodes (painful, tender, red, purple, pea size lesions on fingertips and toes)
Janeway’s lesions (flat, painless small red spots on hands and feet)
Systolic murmur
Heart failure

Emboli to different things:
1. Spleen: LUQ pain, tenderness
2. Kidneys
3. Limbs
4. Brain
5. Lungs

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What is the key to successfully treating endocarditis?

Identifying the cause and treating with right ABx
This is why blood cultures will be done routinely and often.

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What health hx questions will be important in suspected endocarditis?
–Your assessment will be the deciding factor in early diagnosis and treatment–

Recent surgery (especially dental, heart)
Dialysis
Immunosuppresants
IV drug use
Previous IE (infective endocarditis)
Recent staph/strep infection
Recent childbirth
Syphilis

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What is pericarditis?

Inflammation of pericardial sac often with fluid accumulation
Often idiopathic or viral

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What is a pericardial effusion?

Fluid leaking into pericardial sac
This can progress to cardiac tamponade.

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What is Dressler syndrome?

Pericarditis after MI

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What is endocarditis?

Inflammation of inner most layer of heart

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S/sx of pericarditis

Severe sharp chest pain
Worse on inspiration or lying down
Sitting up and leaning forward helps
Pericardial friction rub (hallmark sign)

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How do you distinguish from pain from MI and pain from pericarditis?

Pericarditis: Referred pain left trapezius
This is muscle in mid upper shoulders/back of neck
Will be positive for pericardial friction rub
Will be most comfortable leaning forward

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How do you listen for pericardial friction rub?

Scratching, grating high pitched
Have patient lean forward
Hold breath (because it can be hard to tell if it is pleural friction or pericardial if breathing)
The sound can be intermittent so take time.

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S/sx of pericardial effusion?

Cough
Dyspnea
Tachypnea
Hiccups
Hoarseness
Distant muffled heart sounds

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What is pulsus paradoxus?

Sign of cardiac tamponade
Drop in Systolic BP on inspiration

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How can ECG help differentiate between MI chest pain and pericarditis?

Pericarditis: Widespread ST segment elevation (this means will be across multiple leads)
MI: Localized ST segment elevation (on specific leads only)

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Tx for pericarditis.

Find cause
ABx
Corticosteroids
NSAIDs
Colchicine
Pericardiocentesis

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What is myocarditis?

Inflamm of heart muscle
Usually from virus and will recover spontaneously
Can have systemic general viral symptoms and then a week later develop pleuritic chest pain, friction rub, effusion.

Treatment for myocarditis

ACE
Beta blockers
Diuretics
Supportive measures
Tx like HF: lots of rest

What is rheumatic fever and rheumatic heart disease?

Abnormal immune response to bacteria
Fever: acute inflammation of all heart layers as a complication of strep A pharyngitis
Heart disease: Scarring and deformity of heart valves from the fever
Stenosis and regurgitation are common results

Which heart valves are usually damaged in rheumatic heart disease?

Mitral and aortic

What are S/Sx of rheumatic HD?

Carditis (murmur, HF, pericarditis)
Arthritis
Sydenham’s chorea (involuntary, jerky movements of face, hands, feet)
Recent strep infection

Tx of rheumatic heart disease?

Abx (this will get rid of any residual strep in body but doesn’t get rid of the carditis)
Salicylates
NSAIDs
Corticosteroids
Rest is important to not damage heart further

Best tx is prevention! Treat strep infections early

Two types of valvular heart disease.

Stenosis (valves narrow and tighten, won’t open and close properly)
Regurgitation (valves don’t close tightly, are too loose, allow back flow)
Usually congenital

Main symptom of mitral valve stenosis? Other s/sx? --creates increased pressure in L atrium-- What are they at risk for?

Dyspnea on exertion Loud S1 CP Diastolic murmur At risk for a fib and emboli

Chronic mitral valve regurgitation s/sx --Increases workload of L atrium and L ventricle, leads to hypertrophy, dilation-- --Acute is an emergency, pulmonary edema and cardiogenic shock--

Weakness Fatigue Palpitations Dyspnea Progresses to orthopnea, peripheral edema, S3

Mitral valve prolapse info

Usually benign and asymptomatic Valve leaflets prolapse into left atrium during systole Chest pain, dyspnea, palpitations and syncope can occur during stress

Aortic stenosis info

Valve leaflets stiffen and retract Cause increased pressure in LV, hypertrophy and leads to HF S/sx: angina, syncope, dyspnea on exertion No nitroglycerin

What is cardiomyopathy? Three types?

Group of diseases that directly affect heart structure and function. Dilated (most common) Hypertrophic (young athletes) Restrictive

What is dilated cardiomyopathy? S/Sx and treatment? Common causes?

All ventricles dilate, no hypertrophy Inflammatory and rapid degeneration of heart fibers S/Sx and tx: all the same as HF Causes: Cardiotoxic agents (especially alcohol) CAD HTN Valve disease Pregnancy Doesn't respond well to therapy>>heart transplant needed

What is hypertrophic cardiomyopathy?

Left ventricular hypertrophy with no dilation. Stiff with poor filling of LV Most common in young, fit people May be asymptomatic or have HF symptoms Causes: HTN, genetic, ankylosing spondylitis

What is infective endocarditis?

Infection of inner heart layer including the valves Very serious and life threatening

What diagnostics will be done in suspected endocarditis?

Blood cultures ESR/CRP ECHO (looking for vegetation) Presence of murmur

Who needs prophylactic ABx when going in for procedures in hx of IE?

Congenital HD (repaired or unrepaired) Hx of IE Prosthetic heart valves in place

What type of procedures do patients high risk of IE need prophylactic ABx?

Dental that is beyond routine cleaning Respiratory tract infections Tonsillectomy and adenoidectomy Surgery involving skin or musculoskeletal tissue

Info on aortic regurgitation

Causes volume overload in LV LV dilates, hypertrophies S/Sx: If acute: sudden CV collapse If chronic: asymptomatic for years then will look like HF

What happens in pulmonic stenosis?

Increases pressure in RV and leads to hypertrophy Usually asymptomatic but later can present the classic triad similar to aortic stenosis: exertional dyspnea, angina, syncope

What happens in tricuspid stenosis?

BAD! Increased pressure in RA, RV enlargement. Leads to hepatomegaly, peripheral edema, fluttering in neck, fatigue.

What is chronic constrictive pericarditis? Looks like what? Most prominent sign? Tx?

Fibrosis/thickening/rigidity in pericardium Lose pericardial space Prevents adequate stretch of heart muscle Looks like HF or cor pulmonale Most prominent sign: JVD Tx: pericardiectomy Resect the pericardium

What is percutaneous transluminal balloon valvuloplasty?

PTBV cardiac cath lab procedure to open up valves (not permanent) Insert balloon to help widen the stenosis and then removed

Which is preferred-valve repair or replacement?

Repair

Pro/Con of mechanical valve replacement

Pro: More durable and last longer Con: Must take anticoags rest of life --Both carry risk of leaking and infective endocarditis--

Pro/Con of biological valve replacement

Pro: No anticoags needed Con: Don't last as long. Tend to stiffen, calcify, degenerate over time. --Both carry risk of leaking and infective endocarditis--