Valvular disease Flashcards

1
Q

What is the pathophysiology behind rheumatic fever?

A

There is a laryngeal infection with a beta haemolystic streptococcus. This triggers rheumatic fever 2-4weeks later. This is caused by an antibody to the carbohydrate cell wall which cross reacts with valve tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the criteria for rheumatic fever suspicion?

A
The Jones criteria includes:
Evidence of beta haemolytic stretococcal infection:
-Positive thoat culture
-Rapid strep antigen test
-Elevated strep antibody titre
-Recent scarlet fever
Major criteria:
-Carditis - tachycardia, murmurs, pericardial rub etc
-Arthritis - migratory flitting polyarthritis
-Small subcuatneous nodules
-Erythema marginatum - geographical type rash
Minor criteria:
-Fever
-Raised CRP
-Arthralgia
-Prolonged PR interval
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the management of rheumatic fever?

A

Bedrest until CRP normal for 2 weeks
Benzylpenicillin then phenoxymethylpenicillin
Analgesia for carditis and arthritis - asprin or nsaids
Immobilise joints in severe arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What valves are most commonly affected by rheumatic fever?

A

Mitral (70%)
Aortic (40%)
Tricuspid (10%)
Pulmonary (2%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the causes of mitral regurge?

A
Functional (LV dilation)
Annular calcification (age related)
Rheumatic fever
Infective endocarditis
Papillary rupture/dysfunction (post MI)
Connective tissue disorders (marfan's)
Cardiomyopathy
Congenital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the symptoms of mitral regurge?

A

Dyspnoea, fatigue, palpatations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the signs of mitral regurge?

A

Pansystolic murmur at apex radiating to axilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the management of mitral regurge?

A

Control rate if in fast AF
Anticoagulate if at risk of embolism
Aim to replace or repair surgically before it is irreversibly damaged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the most common valvular abnormality?

A

mitral valve prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the causes of mitral stenosis?

A

Rheumatic fever
Congenital
prosthetic valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the signs of mitral stenosis?

A

malar flush

Rumbling mid-diastolic murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What diagnosis does a fever + a new murmur indicate?

A

Infective endocarditis unless proven otherwise

Require blood cultures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the commonest organism that causes infective endocarditis?

A

Staph aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the causes of infective endocarditis?

A
Bacteria:
-strep viridans
-strep bovis
-staph aureus
Fungi:
-candida
-aspergillosis
Other:
-sle
-malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the signs of infective carditis?

A

Septic signs - fever, rigors, night sweats, malaise, weight loss
Cardiac lesions - new murmur or a change in a murmur, vegetations may cause valve obstruction or destruction
Can cause av block
Immune complex deposition - vasculitis, microscopic haematuria, aki, roth spots (boat shaped retinal haemorrhage), splinter haemorrhages, osler nodes
Embolic phenomena - can cause abscesses in various organs e.g. brain, liver, janeway lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What tests should be used to diagnose infective endocarditis?

A

Three separate blood cultures should be done at the height of fever.
Blood tests for anaemia, neutophilia, rheumatoid factor (immunological)
Urinalysis for microscopic haematuria
Cxr - cardiomegaly, pulmonary oedema
Echo may show large vegetations
Ct for emboli

17
Q

What is the treatment of infective endocarditis?

A

Appropriate antibiotics and sometimes surgery e.g. valvular obstruction

18
Q

What antibiotics should be used for different causes of infective endocarditis?

A

Blind therapy - ampicillin, flucloxacillin and gentamycin
Staphs - flucloxacillin
Streps - penicillin

19
Q

What criteria os used for infective endocarditis and what are the inclusions?

A
The modified duke criteria
Major criteria:
-positive blood culture
-endocardial involvement (positive echo, ct etc)
Minor criteria:
-at risk individual
- fever greater than 38 degrees
-vascular phenomena
-immunological phenomena 

2 major or 1 major and 3 minor diagnostic

20
Q

What are the causes of aortic stenosis?

A

Senile age related calcification is most common
Congenital causes - bicuspid valve
Rheumatic heart disease

21
Q

What is the classic triad of symptoms for aortic stenosis?

A

Typically in older patients
Angina, syncope and heart failure
Also think: dyspnoea, dizziness, faints

22
Q

What are the signs of aortic stenosis?

A

SLow rising pulse with narrow pulse pressure
LV heave with non displaced apex beat
Aortic thrill
Ejection systolic murmur

23
Q

What tests should be done for aortic stenosis?

A

ECG for any abnormlities
CXR for LVH, aortic valve calcification or post stenotic dilation of ascending aorta
Echo is diagnostic - used to estimate gradient across valves - this estimates risk of complication

24
Q

What is the management of aortic stenosis?

A

Managed with valve replacement if symptomatic

If a patient is not fit for surgery then a transcatheter aortic valve replacement may be performed

25
What are the causes of aortic regurgitation?
Acute : ascenting aorta dissection, infective endocarditis, chest trauma Chronic : congenitatl, connective tissue disorders (marfans), rheumatic fever, SLE, Rheumatoid arthritis, seronegative arthritidies
26
What are the signs and symptoms of aortic regurgitation?
Symptoms - exertional dyspnoea, orthopnoea and paroxysmal noctural dyspnoea Signs - colapsing pulse, early diastolic murmur ( heard best in expiration with patient sat forward)
27
What is quinkes sign?
This is pulsatile nailbeds felt in aortic regurge
28
What tests should be done for aortic regurge?
ECG - LVH CXR - cardiomegaly, pumonary oedema echo - diagnostic cardiac catheterisation - to assess severity of lesion
29
What is the management of aortic regurge?
Main goal of medical therapy is to reduce systolic hypertension so usually on ACE i If there are lots of symptoms or dilation of aorta then surgery is indicated Aim to replace the valve before significant LV dysfunction occurs