Valves: Infective Endocarditis, AS, AR, MR, MS

Question 1

IE
Pathophysiology
Presentation

Answer 1

Infection of endocardium via bacteria entering blood and heart

• bacterial damage of valve => thrombus forms
• thrombus infected => vegetation

Fever, chills
Mitral regurgitation
Osler’s nodes - immune complex deposition in hands
Splinter hemorrhages, Janeway lesions - microinfarcts
Organ infarcts - large septic septic emboli

Question 2

IE

-at risk patients and causative organisms

Answer 2

Staph aureus - most common in developed countries

• acute presentation
• IVDU, recent piercings

Strep viridans - most common in developing countries
-poor dental hygiene, procedures

Staph epidermidis - most common in post valve surgery

• colonise indwelling lines
• after 2 months, most common is SA

Strep bovis - colorectal cancer link

Past IE
Normal valves
Rheumatic valve disease
Congenital heart defects
Recent piercings

Question 3

IE

• investigations
• management

Answer 3

Investigations - Blood culture + echo

Management
-ABx
Surgery to repair/replace valve if
-no response to treatment
-heart failure
-abscess/fistula formation
-emboli

Question 4

Main cause and presentation of

• mitral stenosis
• mitral regurgitation
• aortic stenosis
• aortic regurgitation

Answer 4

ALL CAN PRESENT WITH SOB, MURMURS, HF
Mitral stenosis - rheumatic heart disease => palpitations

Mitral regurgitation - old age, LH dilation, HF, MI

Aortic stenosis - old age => chest pain

Aortic regurgitation - idiopathic, Marfans, EDS

Question 5

Main cause and presentation of

• tricuspid stenosis
• tricuspid regurgitation
• pulmonary stenosis
• pulmonary insufficiency

Answer 5

GENERALLY RARER

ALL CAN PRESENT WITH ASCITIES, PERIPHERAL EDEMA, HEPATOMEGALY, HIGH JVP, MURMUR

Tricuspid stenosis - RARE (rheumatic heart disease, congenital)

Tricuspid regurgitation -

• mild => no treatment needed
• severe - RV dilation, VSD, congenital

Pulmonary stenosis - congenital (ToF, Noonans)

Pulmonary regurgitation - RARE, treatment not needed