Valve disease and endocarditis Flashcards

1
Q

What are the 2 left heart valves called?

A
  • Aortic, Mitral
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2
Q

What are the 2 right heart valves called?

A
  • Pulmonary, Tricuspid
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3
Q

Which side of heart valves most commonly fail?

A
  • Left side valves:
  • Aortic stenosis & incompetence
  • Mitral stenosis and incompetence
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4
Q

What is used to treat valve failure problems?

A
  • Prosthetic valves
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5
Q

What is Valve stenosis?

A
  • Stenosis is a term for a valve that doesn’t open properly. The flaps of the valve thicken, stiffen or fuse together. As a result the valve cannot fully open
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6
Q

Who are heart valve failures commonly affected by? (2 points)

A
  • Elderly

- Downs

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7
Q

What are the common symptoms of heart valve failure?

A
  • Rarely any symptoms - undiagnosed
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8
Q

What is an example of a congenital abnormality of a heart valve?

A
  • Bicuspid Aortic Valve

- (normal is a tricuspid aortic valve)

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9
Q

What are possible causes of heart disease? (4 points)

A
  • Congenital abnormality
  • Myocardial infarction (papillary muscle rupture)
  • Rheumatic fever (immunological reaction to streptococci)
  • Dilatation of the aortic root (syphilis, aneurysm formation)
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10
Q

Is taking an ultrasound of the heart a good investigation into valve disease?

A
  • Yes
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11
Q

What are the 2 main oprti9ons for valve replacement?

A
  • Mechanical valve

- Porcine (pig) valve

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12
Q

What is a benefit of being given a pig valve?

A
  • Pic valve is roughly the same size and has a natural collagen reflex so blood will not stick to them anymore than it would in a pig
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13
Q

What is a disadvantage of a pig valve?

A
  • It will only last about 10 years
  • So good for the young and the old - choosing not to put a metal valve in can be good for people at extremes of life
  • Every time you replace a valve there is a chance of the patient dying so want to do it as little as possible
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14
Q

What is a disadvantage of giving a mechanical valve?

A
  • As it is metal blood will stick to it and clot so the patient ha s to be on anticoagulants
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15
Q

What is there a risk of in patients who have had a valve replacement?

A

Risk of endocarditis - infection of the heart muscles layer which can happen with bacteria such as streptococci which can be found in the mouth

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16
Q

There is a risk of endocarditis following a valve replacement. How can you minimise the risk? (4 points)

A
  • Maximise oral health
  • Be sensitive to patient and surgeon needs
  • Be aware or international disagreement in this area
  • Sometimes antibiotics are given - case by case
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17
Q

What are the 2 different types of mechanical valve?

A
  • One that flips open and shut

- One with a little ball - the ball moves with different pressures

18
Q

How can you tell if a patient has a mechanical heart valve or a pig valve?

A
  • Every time a mechanical valve opens and shuts it makes a noise
  • So if you have a patient and it doesn’t tick then it is a pic valve and if it is a mechanical valve it will tick
19
Q

What is a congenital heart defect?

A
  • Failures in the normal development and fusion of the embryonic heart
20
Q

Congenital heart defects are often undetected and asymptomatic. What are 4 examples of these?

A
  • ATRIAL septal defect
  • VENTRICULAR septal defect
  • Patent ductus arteriosus
  • Great vessel malformations
21
Q

What is cyanosis?

A
  • A physical sign causing bluish discolouration of the skin and mucous membranes. Cyanosis is caused by a lack of oxygen in the blood. It is also associated with cold temperatures, HF, lung diseases and smothering. It is seen in infants as a result of heart defects
22
Q

What causes central cyanosis?

A
  • Congenital heart defects
23
Q

What causes peripheral cyanosis?

A
  • Cold environment
24
Q

What are the figures that show someone has cyanosis?

A
  • When there is 5g/dl or more of deoxygenated Hb in the blood
25
Q

What is central cyanosis?

A
  • Cyanosis throughout the body not just in the peripheral tissues
  • Where patients core tissues are cyanosed
26
Q

What is a common sign of someone with cyanosis?

A
  • Finger clubbing

- Swelling of the terminal tissues of the fingers

27
Q

How could you investigate a congenital heart defect?

A
  • Using an ultrasound scan
28
Q

What is an atrial septal defect?

A
  • A problem going from one atria to the other (hole in wall between them)
  • Takes oxygenated blood from the lungs and squeezes some blood into the right atrium which pumps blood round the lungs again
29
Q

Why may there be an enlarged atria when there is an atrial septal defect?

A
  • As the atria is doing more work as it has to pump more blood than normal
30
Q

What is a ventricular septal defect?

A
  • VSD is a hole in the wall separating the 2 ventricles (lower chambers) of the heart.
  • In normal development, the wall between the chambers closes before the fetus is born, so that by birth, oxygen-rich blood is kept from mixing with the oxygen-poor blood. When the hole does not close, it may cause higher pressure in the heart or reduced oxygen to the body
31
Q

What is co-arctation of the aorta?

A
  • A congenital narrowing of the aorta
32
Q

What is patent ductus arteriosus?

A
  • A heart problem which affects some babies soon after birth. In PDA, abnormal blood flow occurs between 2 of the major arteries connected to the heart. These arteries are the aorta and the pulmonary artery
33
Q

What is infectious endocarditis?

A
  • Infection of the endocardium - usually on the valves

- Microbial colonisation of thrombi on endocardial surface abnormalities

34
Q

How many new cases of infective endocarditis are there per year in the UK and how many of these result in death?

A
  • 1400 new cases
  • 200 deaths
  • 50% of patients are over 50
35
Q

What are the predisposing factors of infective endocarditis? (3 points)

A
  • Often NO predisposing factors
  • Rheumatic fever less common
  • Prosthetic valves more common
36
Q

What signs and symptoms can help to diagnose infective endocarditis? (7 points)

A
  • Fever (90%)
  • Heart murmur (85%)
  • Embolic pneumonia (>50%)
  • Skin manifestations e.g. olser nodes, splinter haemorrhages(18-50%)
  • Splenomegaly (20-57%)
  • Septic complications e.g. pneumonia, meningitis (20%)
  • Mycotic (infective) aneurysm (20%)
37
Q

What are 3 possible organisms involved in infective endocarditis?

A
  • Streptococci
  • Staphylococci
  • Fungi
38
Q

What prolonged antibiotic treatment may be needed for someone with infective endocarditis? (2 points)

A
  • 4+ weeks of bacteriocidal treatment

- Often combinations of drugs

39
Q

Can infective endocarditis cause cardiac valve damage?

A
  • Yes, can cause valve dysfunction which can result in urgent valve replacement needed
40
Q

How can you prevent infective endocarditis in the dental setting? (3 points)

A
  • Only possible if ‘at risk’ patients are identified via medical history or prominent identification in case records
  • Would avoid risk procedures
  • May use antibiotic prophylaxis when needed
41
Q

If treating a patient for prevention of infective endocarditis in the dental setting what medication would you give them?

A
  • 3g of Amoxicillin orally 1 hour before the procedure - even if used recently
  • UNLESS ALLERGIC
  • If allergic would give 0.6g of Clindamycin (higher ADA risk - ONLY use if penicillin allergic)