Structural Heart Disorders Flashcards
How do you prevent rheumatic fever?
Treat strep throat with PO penicillin V or amoxicillan for 10 days
What are risk factors for infective endocarditis?
IV drug use
Prosthetic valves
Hemodialysis
Symptoms of infective endocarditis
Non-specific: fever, chills, fatigue
Specific: splinter hemorrhages, Roth spots (retina), Janeway’s Lesions, Oster’s Nodes
What is a common problem with infective endocarditis?
New or worsening systolic heart murmur due to regurgitation
Priority interventions for infective endocarditis
- Blood culture
- Long-term IV abx
- Repeat blood culture
- Valve replacement
- Antipyretics
- Fluids
- Rest
Labs for infective endocarditis
- 2 separate blood cultures (usually staph aureus or strep)
- CBC with differential
- ESR
- C-reactive protein
When would someone with infective endocarditis need prophylactic abx?
- Dental procedures
- Tonsillectomy or adenoidectomy
- Respiratory tract incisions
- Surgery involving skin or musculoskeletal incisions
What is the Duke criteria?
Used to diagnose infective endocarditis
Requires:
* 2 major and 1 minor; or
* 1 major and 3 minor; or
* 5 minor
What valves does infective endocarditis usually affect?
Mitral or aortic
What type of murmur does aortic stenosis cause?
- Systolic murmur with ejection click (opening of leaflets) and crescendo (pressure rises in L. ventricle because blood cannot pass)-decreschendo (blood passes through and pressure decreases in L. ventricle)
- Radiation to carotids
- Normal or soft S1 and possibly absent S2
Symptoms of aortic stenosis
Angina
Syncope
Dyspnea
Should nitrates be used to treat chest pain for aortic stenosis?
NO
* Aortic stenosis requires higher preload in order to maintain cardiac output
* Nitrates can cause systemic hypotension, which reduces preload and cardiac output
* This lowers blood pressure and can furthur reduce blood getting to coronary arteries
Symptoms of acute mitral regurgitation
- pulmonary edema (crackles, SOB, pink, frothy sputum)
- Thready pulses
- Cool, clammy extremities
Symptoms of chronic mitral regurgitation
- L. atrial dilation, L. ventricular dilation and L. ventricular hypertrophy
- S3 murmur (L sided heart failure)
- Fatigue
- Dyspnea (pulmonary hypertension and edema)
- Orthopnea
- Paroxysmal nocturnal dyspnea
- peripheral edema (right sided heart failure due to pulmonary hypertension)
What type of murmur does mitral valve prolapse cause?
Systolic murmur with mid systolic click (opening of leaflets)
-murmur occurs due to regurgitation
Symptoms of mitral valve prolapse
- Usually asymptomatic
- Chest pain unresponsive to nitrates
- Infective endocarditis
Who needs abx prophylaxis prior to dental procedures?
- Infective endocarditis
- Mitral valve prolapse and regurgitation
- Biologic valves
What is mitral valve stenosis?
- Mitral valve cannot open completely when it should
- Blood backs up into pulmonary vessels and causes pulmonary hypertension
What kind of murmur is associated with mitral valve stenosis?
Diastolic murmur
Loud S1
Symptoms of mitral valve stenosis
- Palpitations
- Exertional dyspnea and fatigue
- Hemoptysis
- Hoarsness
- Can cause atrial fibrillation, which can lead to stroke
What helps pericarditis pain?
- Sitting up and leaning forward
- NSAIDs combined with cholchicine (anti-gout med that is anti-inflammatory)
Key finding with pericarditis
Pericardial friction rub
* Grating sound that continues when holding breath
Difference between mechanical and biologic valves
Mechanical valves:
* Require life long anticoagulation due to risk of thromboembolism
* More durable
Biologic valves:
* Less durable
* Requires prophylactic abx prior to dental procedures
* No anticoagulation needed
Target INR for mechanical valves
2.5-3.5 (depends on thrombotic risk factors)
