valve disease

Question 1

4 types of heart valves

Answer 1

pulmonary
mitral
tricuspid
aortic

Question 2

types or valve abormalities

Answer 2

wear and tear
calcification
pannus
endocarditis
thrombus

Question 3

aortic stenosis triad

Answer 3

S - syncope
A - angina
D- dyspnea
*many people with valve disease are unaware of any symptoms

Question 4

mitral regurgitation

Answer 4

valve doesn’t close tightly, which allows blood to flow backward in the heart.

Question 5

symptoms of mitral regurgitation

Answer 5

fatigue and SOB

Question 6

Infective endocarditis

Answer 6

infection of the inner lining of the heart muscle (endocardium) caused by bacteria, fungi, or germs that enter through the bloodstream.
vegetations on the valves in endocarditis can become septic emboli

Question 7

risk factors for infective endocarditis

Answer 7

prosthetic valve
pacemaker associated
IVDA

Question 8

causative organisms of IVDA

Answer 8

streptococcus viridans (s. viridans)
staphylococcus aureus (s. aureus)
staphylococcus epidermidis (s. epidermidis)

Question 9

symptoms of Infective Carditis

Answer 9

fever
chills
anorexia
wt loss
myalgias
arthralgias, joint pain
heart murmur

Question 10

initial clinical manifestations of IE

Answer 10

signs of ischemia or infarction of extremities, spleen, kidney, bowel, or brain

Question 11

where can septic emboli form in IE?

Answer 11

cerebral artery or arteriole and cause on ischemic stroke

pt’s may present with meningitis, seizures, encephalopathy, or abscesses of brain

Question 12

what are septic emboli in IE?

Answer 12

microorganisms travel to heart, adhere to damaged tissue, attracts WBC, releasing cytokines and coag factors.
stimulation of coag cascade resulting in fibrin deposition and developing vegitation

Question 13

where are vegetations found in IE?

Answer 13

valve leaflets; fragments of vegitations can embolize into circulation
carried by the bloodstream, fragments are called septic emboli, and can initiate infection or ischemia in remote tissues

Question 14

classic manifestations of IE

Answer 14

often caused by septic emboli
petechiae
splinter hemorrhages (linear streaks in nailbeds)
janeway lesions (erythematous, nontender lesions n palms and soles)
Osler’s nodes: subcutaneous nodules in the pulp of fingertips
Roth spots- oval retinal hemorrhages with pale centers

Question 15

IE in IV drug users

Answer 15

-veins are port of entry and s. aureus (skin flora) causes bacteremia
-s. aureus travel from veins into inferior vena cava and into right side of heart
-tricuspid valve most often affected in IV drug users
septic emboli can enter pulmonary artery and then —lungs

Question 16

duke criteria of IE

Answer 16

IE requires two major criteria are met, one major and three minor criteria are met, or that 5 minor criteria are met

Question 17

major Duke criteria

Answer 17

• positive blood cultures from at least 2 separate cultures drawn 12 hours apart
• echocardiogram showing vegetation, abscesses or valve perforation
• new regurgitant murmur

Question 18

minor duke criteria

Answer 18

• predisposing heart condition such as mitral valve prolapse, rheumatic or congenital heart disease, or iv drug use
• temp of great than 100.4
• presence of embolic disease or hemorrhage
• presence of immunological phenomena (glomerulonephritis, Osler’s nodes, Roth’s spots, rheumatoid factor)
• positive blood cultures but major criteria not met
• positive echocardiogram but major criteria not met

Question 19

pharmacotherapy of IE

Answer 19

antibiotic therapy
-blood culture results identify organisms and best abx therapy
prolonged therapy 4-6 weeks
lengthy hospital stay