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Med Surg II > Structural Heart Disorders > Flashcards

Structural Heart Disorders Flashcards

1
Q

How do you prevent rheumatic fever?

A

Treat strep throat with PO penicillin V or amoxicillan for 10 days

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2
Q

What are risk factors for infective endocarditis?

A

IV drug use
Prosthetic valves
Hemodialysis

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3
Q

Symptoms of infective endocarditis

A

Non-specific: fever, chills, fatigue
Specific: splinter hemorrhages, Roth spots (retina), Janeway’s Lesions, Oster’s Nodes

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4
Q

What is a common problem with infective endocarditis?

A

New or worsening systolic heart murmur due to regurgitation

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5
Q

Priority interventions for infective endocarditis

A
  1. Blood culture
  2. Long-term IV abx
  3. Repeat blood culture
  4. Valve replacement
  5. Antipyretics
  6. Fluids
  7. Rest
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6
Q

Labs for infective endocarditis

A
  • 2 separate blood cultures (usually staph aureus or strep)
  • CBC with differential
  • ESR
  • C-reactive protein
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7
Q

When would someone with infective endocarditis need prophylactic abx?

A
  • Dental procedures
  • Tonsillectomy or adenoidectomy
  • Respiratory tract incisions
  • Surgery involving skin or musculoskeletal incisions
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8
Q

What is the Duke criteria?

A

Used to diagnose infective endocarditis
Requires:
* 2 major and 1 minor; or
* 1 major and 3 minor; or
* 5 minor

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9
Q

What valves does infective endocarditis usually affect?

A

Mitral or aortic

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10
Q

What type of murmur does aortic stenosis cause?

A
  • 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
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11
Q

Symptoms of aortic stenosis

A

Angina
Syncope
Dyspnea

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12
Q

Should nitrates be used to treat chest pain for aortic stenosis?

A

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

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13
Q

Symptoms of acute mitral regurgitation

A
  • pulmonary edema (crackles, SOB, pink, frothy sputum)
  • Thready pulses
  • Cool, clammy extremities
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14
Q

Symptoms of chronic mitral regurgitation

A
  • 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)
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15
Q

What type of murmur does mitral valve prolapse cause?

A

Systolic murmur with mid systolic click (opening of leaflets)
-murmur occurs due to regurgitation

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16
Q

Symptoms of mitral valve prolapse

A
  • Usually asymptomatic
  • Chest pain unresponsive to nitrates
  • Infective endocarditis
17
Q

Who needs abx prophylaxis prior to dental procedures?

A
  • Infective endocarditis
  • Mitral valve prolapse and regurgitation
  • Biologic valves
18
Q

What is mitral valve stenosis?

A
  • Mitral valve cannot open completely when it should
  • Blood backs up into pulmonary vessels and causes pulmonary hypertension
19
Q

What kind of murmur is associated with mitral valve stenosis?

A

Diastolic murmur
Loud S1

20
Q

Symptoms of mitral valve stenosis

A
  • Palpitations
  • Exertional dyspnea and fatigue
  • Hemoptysis
  • Hoarsness
  • Can cause atrial fibrillation, which can lead to stroke
21
Q

What helps pericarditis pain?

A
  • Sitting up and leaning forward
  • NSAIDs combined with cholchicine (anti-gout med that is anti-inflammatory)
22
Q

Key finding with pericarditis

A

Pericardial friction rub
* Grating sound that continues when holding breath

23
Q

Difference between mechanical and biologic valves

A

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

24
Q

Target INR for mechanical valves

A

2.5-3.5 (depends on thrombotic risk factors)

Med Surg II (3 decks)

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