L8 Valvular and Congenital Heart Disease Flashcards
___________: failure of a valve to open completely (impedes forward flow)
Stenosis: failure of a valve to open completely (impedes forward flow)
_______________: failure of a valve to close completely (allows reverse flow)
Frequency of Involvement?
Incompetence (Insufficiency): failure of a valve to close completely (allows reverse flow)
Left Heart more prevalent
Mitral > Aortic
Right Heart less frequent
Tricuspid > Pulmonary
Can be Acquired or Congenital:
Acquired more common, typically post-inflammation
Typically in left heart due to higher pressure/ strain
Infective Endocarditis Findings?
Findings:
Sepsis
Murmur
Fever of Unknown Origin
Vegetations (1mm –4cm)
Necrosis/Perforation of Valve Tissue
__________________:
Difficult to diagnose
Fevers spike/ diminish
Subacute bacterial endocarditis
Insidious Onset (SBE) Endocarditis
Difficult to diagnose
Fevers spike/ diminish
Subacute bacterial endocarditis
___________
Rapidly fatal - early diagnosis essential
Acute bacterial endocarditis
Fulminant Onset (ABE) Endocardits
Rapidly fatal - early diagnosis essential
Acute bacterial endocarditis
Which valves are typically affected by endocarditis?
Left sided Valves >>> Right
Mitral Valve (bicuspid) > Aortic (often both)
Tricuspid Valve Endocarditis –“always” IV Drug Abuse
Risk Factors for Endocarditis?
Risk factors
Immunosuppression (except in AIDS)
Intravenous Drug Abuse (IVDA)
Any Low-Grade Chronic Bacteraemia
Preexisting Valvular Disease
- Congenital
- Rheumatic
- Mitral Valve Prolapse
- Prosthesis
Organisms involved in Infectious Endocarditis?
Different Valve types?
Organisms InvolvedTypically effects Valvular Endocardium
Normal Valve- Likely Staph Aureus
Diseased Valve - Less virulent organism (Streptococci)
Prosthetic Valve (Likely Staph Aureus)
HACEK Group
Fungi
10% culture negative
Complications of Endocarditis?
Complications
Valvular Insufficiency
Myocardial Abscess
Suppurative Pericarditis
Valve Dehiscence (rupture)
Embolic Disease –Brain, Kidney etc.
Infection elsewhere
Causes of Non-Infective Endocarditis
Rheumatic Fever/Valvular Heart Disease
SLE (Libman-Sacks) Endocarditis
Non-Bacterial Thrombotic Endocarditis
Rhematic Fever vs. Rhematic Heart Disease?
Acute (Rhematic Fever): multisystem
Chronic (Rhematic Heart Disease): valvular abnormalities, mainly mitral
Acute vs. Chronic Rheumatic Valvular Heart Disease
Acute:
Aschoff Bodies
Verrucous Vegetations: lines of valve closure –chordae tendineae
Chronic:
Fibrosis Scarring of Cusps/Chordae
=> Stenosis / Incompetence
Valves affected by Rhematic Valvular Heart Disease
Mitral >> Aortic >> Tricuspid >>> Pulmonary
Complications of Rheumatic Valvular Heart Disease
Complications:
Endocarditis
Cardiac Failure
Thrombosis/Embolisation
Pulmonary Hypertension
______________________:
- Small, sterile, verrucous (warty looking) vegetations occurring on the surface of the MITRAL (more common) and TRICUSPID Valves
- _________ Reduce Incidence
- Regurgitation manifestation
SLE (Libman-Sacks) Endocarditis
- Small, sterile, verrucous (warty looking) vegetations occurring on the surface of the MITRAL (more common) and TRICUSPID Valves
- Steroids Reduce Incidence
- Regurgitation manifestation
________________:
Calcified masses in cusps with fibrosis and degeneration
Congenital as a child
Calcification of Bicuspid Valve age 50-60
Aortic Stenosis (Sclerosis):
Calcified masses in cusps with fibrosis and degeneration
Congenital as a child
Calcification of Bicuspid Valve age 50-60
_______________:
Connective Tissue abnormality
Variable severity
Idiopathic (unknown cause)
Some overlap w/ Marfans Syndrome
Mitral Valve Prolapse
Connective Tissue abnormality
Variable severity
Idiopathic (unkown cause)
Some overlap w/ Marfans Syndrome
Ischemic (Papillary Muscle Infarction) => _____________
Ischemic (Papillary Muscle Infarction) => Mitral Regurgitation
Dilated Mitral Valve Ring => ____________
Dilated Mitral Valve Ring => Mitral Regurgitation
Examples of Degenerative Valvular Disease
Aortic Stenosis (Sclerosis)
Mitral Valve Prolapse
Ischemic (Papillary Muscle Infarction)
Dilated Mitral Valve Ring
Two examples of congenital heart disease which present for the first time in adults?
–Mitral Valve Prolapse
–Bicuspid Aortic Valve
Types of Shunts?
Shunts
Left to Right Acyanotic
Right to Left Cyanotic (Eisenmenger’s Syndrome)
_________________: due to an increase in pulmonary pressure, RV Hypertrophy exceeds LV pressure=> right to left shunt circulation leading to ___________
Eisenmenger’s Syndrome: due to an increase in pulmonary pressure, RV Hypertrophy exceeds LV pressure=> reversal right to left shunt circulation= Cyanosis: Dexoxygenated blood enters systemic ciruclation
___________________:
Most common congenital abnormality
“Hole in Heart”
Small => ___________
Large => ___________
Ventricular Septal Defect
Most common congenital abnormality
“Hole in Heart”
Small => spontaneous closure
Large => Cardiac failure / Eisenmenger’s Syndrome
What defect leads to Paradoxical Emboli?
Paradoxical Emboli (venous thrombus in systemic circulation) are caused by:
Atrial Septal Defect
4 Types (Based on Location)
Ostium Secundum (90%)
Ostium Primum (Downs Syndrome)
Sinus Venosus
Coronary Sinus
_______________:
Physiologic Shunt in Utero
Contracts post partum after breathing start and fibroses (closes)
Can be kept open w/ ___________ for treatment of _______
Patent Ductus Arteriosus:
Physiologic Shunt in Utero
Contracts postpartum after breathing starts and fibroses (closes)
Can be kept open w/ Prostaglandins (Treatment of Cyanotic Congenital Heart Disease)
Allows oxygenated blood to mix with deoxygenated
Congenital Aortic Stenosis
Supravalvular - ___________
Valvular– ____________
Subvalvular – ________
Congenital Aortic Stenosis
Supravalvular - hypercalcemia → Narrowing
Valvular– bicuspid valve stenosis
Subvalvular – fibrous band
Coarctation of the Aorta characteristics?
Preductal (Ductus Arteriosus): Presents early in childhood
Postductal: Presents as adult, secondary hypertension
Manifestations of Tetrology of Fallot
Cyanotic Congenital Heart Diseases?
Treatment?
Tetrology of Fallot
Transposition of the Great Vessels
Treatment: Patent Ductus Arteriosus can be kept open w/ Prostaglandins allowing oxygenated blood to mix with deoxygenated
Manifestations of Transposition of the Great Vessels?
