Valve Disorders

Question 1

Heart Valves

Answer 1

1. Tricuspid (3)
2. Pulmonary (3)
3. Mitral (2) [bicuspid]
4. Aortic (3)

Question 2

AV Valves

Answer 2

Tricuspid + Bicuspid (Mitral)

• Open during diastole to direct blood flow to ventricles
• Close during systole

Question 3

Pulmonary + Aortic valves

Answer 3

• Open with systole directing blood flow from ventricles out of the heart
• Close during diastole

Question 4

Valve abnormality causes

Answer 4

1. Wear and Tear
2. Calcification
3. Pannus
   - on leaflets of valves
4. Endocarditis
   - infection of valves
5. Thrombus

Question 5

Valve abnormalities (2 types)

Answer 5

Stenosis

• very tight/stiff and hard for the blood to get through
• ex) Aortic valve

Regurgitation

• Very loose and blood flows backward with increased pressures
• ex) Atria (mitral/bicuspid valve)

Question 6

What happens to the heart muscle when it has to pump against a STENOTIC valve?

Answer 6

Cannot close or open as FULLY

Heart muscle develops HYPERTROPHY (increases in size)

Question 7

Aortic Stenosis Triad (SAD)

Answer 7

**Not everyone has symptoms

SAD

1. (Syncope) Lightheadedness
2. (Angina) Chest pain
3. (Dyspnea) Short of breath

These symptoms often occur with EXERTION

Question 8

Mitral Regurgitation: symptoms

Answer 8

Fatigue
-not enough blood

Shortness of breath
-pulmonary symptoms

Usually need surgey

Question 9

Infective Endocarditis (IE)

Answer 9

Vegetations on the valves can become septic emboli

• can be seen on ECHO
• depending on which valve it can land in lungs or periphery

Question 10

Infective Endocarditis (IE): risk factors

Answer 10

1. Prosthetic Valve
2. Pacemaker-associated
3. IVDA
   - Streptococcus viridians
   - Staphylococcus aureus
   - Staphylococcus epidermidis

Question 11

In drug users, vegetations are most often seen on which valve?

Answer 11

Tricuspid

Question 12

Symptoms of Infective Endocarditis (IE)

Answer 12

Fever
Chills
Anorexia
Weight loss
Myalgias: pain in muscles
Arthralgias: joint pain
Heart murmur

Signs of ischemia or infarction of the extremities, spleen, kidney, bowel, or brain may be the initial clinical manifestation

Question 13

Septic emboli of brain

Answer 13

Septic emboli can lodge in a cerebral artery or arteriole and cause an ISCHEMIC STROKE. Neurological symptoms from embolic stroke occur in up to 40% of patients with IE. Patients may also present with meningitis, seizures, encephalopathy, or abscesses of the brain

Question 14

IE patient Labs

Answer 14

Will have + blood cultures

-long term antibiotic treatment

Question 15

What are septic emboli in IE?

Answer 15

Microorganisms travel into the heart, adhere to damaged endothelial tissue, and attract WBCs and platelets, which release cytokines and coagulation factors

Stimulation of the coagulation cascade results in fibrin deposition and eventually, development of a vegetation

Vegetations are most commonly found on valve leaflets, fragments of vegetations can EMBOLIZE into circulation

Carried by the bloodstream, these fragments, called SEPTIC EMBOLI, can initiate infection or ischemia in remote tissues.

Question 16

Manifestations of IE

Answer 16

Often caused by septic emboli: Mitral Valve to systemic circulation:

• Petechiae
• Splinter hemorrhages: linear streaks in the nailbeds
• Janeway lesions: erythematous, nontender lesions on the palms and soles
• Osler’s nodes: subcutaneous nodules in the pulp of the fingertips
• Roth spots: oval retinal hemorrhages with pale centers

Question 17

IE in IV Drug Users

Answer 17

In IV drug users the veins are the portal of entry and Staphylococcus aureus, the flora of the SKIN, most commonly causes bacteremia

S. aureus travels from the peripheral vein into the INFERIOR VENA CAVA and into the RIGHT side of the heart

The TRICUSPID VALVE is most often affected in IV drug users

Septic emboli can enter the PULMONARY ARTERY (Lungs)

Question 18

The Duke Criteria of IE

Answer 18

Infective endocarditis requires:

• 2 major criteria are met
• 1 major + 3 minor criteria
• 5 minor criteria

Question 19

IE Antibiotic therapy

Answer 19

Blood culture results identify organism and best antibiotic therapy

Prolonged therapy (4-6 weeks)
-could be 8-10 weeks

Lengthy hospital stay!