Valvular disease and heart failure

Question 1

What is infective endocarditis?

Answer 1

Infection of the endocardium or vascular endothelium of the heart

Typically affects the heart valves, Strep

Question 2

Common symptoms of infective endocarditis

Answer 2

Fever, malaise, sweats and unexplained weight loss.

Question 3

Duke criteria for infective endocarditis

BE FIVEPM

Answer 3

Maj. criteria:
Blood culture +ve (Strep microbes)
Endocardial involvement (echo showing vegetation/abscess or new valve regurg)

Min. criteria
Fever
Immunological phenomena (RhF)
Vascular phenomena (emboli/haemorrhage)
Echo findings
Predisposition (heart condition/IV drug user)
Microbes

Question 4

What is seen in the echocardiogram in infective endocarditis

Answer 4

Vegetation- mass of bacteria,platelets,fibrin
abscess,
valve perforation
Transoesophageal echo has ^ sensitivity vs transthoracic

Often regurg of affected valve

Question 5

What is heart decomposition

Answer 5

inability of the heart to maintain adequate circulation

Question 6

What features of heart decompensation would you look for in IE

Answer 6

Cardiac decompensation
Symptoms: dyspnoea, frq cough, swelling of legs and abdomen, fatigue
Signs: raised JVP, lung crackles and oedema

Question 7

What part of the heart does infective endocarditis affect?

Answer 7

endocardium, especially the valves of the heart
frequently (aortic > mitral > right-sided valves)

Question 8

Why does IE affect aortic/mitral valve most frq

Answer 8

Sites of turbulent flow which cause underlying damage to the valves. Easier for bacteria to attack.

Question 9

Why are IV drug users at greater risk of IE

Answer 9

Repeated injection – Exposure of bloodstream to skin surface bacteria / use of non-sterile needles.

Question 10

Users at risk of IE

Answer 10

Complication of routine surgeries
Immunosuppressed individuals
congenital heart defects -> damaged endocardium.

Question 11

What is the definition of dilated cardiomyopathy?

Answer 11

Characterised by dilated/thin-walled cardiac chambers with reduced contractility (red. ejection fraction)

Question 12

What is Global hypokinesis

Answer 12

Left ventricular ejection fraction of <45%.
Decreased motor function

Question 13

What are the commonest causes of dilated cardiomyopathy?

Answer 13

Idiopathic,
genetic,
toxins (alcohol, cardiotoxic chemotherapy), pregnancy (peripartum cardiomyopathy),
viral infections (myocarditis),
tachycardia-related cardiomyopathy,
thyroid disease,
muscular dystrophies

Question 14

Management of dilated cardiomyopathy

Answer 14

Medical heart failure therapy - ACE inhibitors, beta-blockers
Diuretics for fluid overload
Anticoagulation for atrial fibrillation
Cardiac devices
Transplant

Question 15

Future implications of DCM

Answer 15

risk of heart failure hospitalization,
cardiac arrhythmias,
sudden cardiac death due to ventricular arrhythmia,
reduced survival

Question 16

What happens in heart failure with preserved ejection fraction

Answer 16

EF > 50%.
Diastolic / right heart dysfunction.
Diastolic dysfunction -> ^ reservoir of blood in the pulmonary veins, -> ^ pulmonary htn + pulmonary oedema.

Question 17

What happens in heart failure with reduced ejection fraction

Answer 17

EF < 50%.
Impaired left ventricular systolic function
Backflow of blood into the pulmonary veins and lungs
-> pulmonary oedema

Question 18

Clinical signs of right heart failure

Answer 18

peripheral oedema e.g. leg swelling, ^ JVP

Question 19

Clinical signs of left heart failure

Answer 19

pulmonary oedema

Question 20

What medications are used to treat heart failure with preserved ejection fraction?

Answer 20

Diuretics and SGLT2 inhibitors.

Question 21

What medications are used to treat heart failure with reduced ejection fraction?

Answer 21

ACE inhibitors (ACEi)
angiotensin II receptor blockers (ARBs)
Beta blockers.
SGLT2 inhibitors,
diuretics.

Question 22

How is heart failure monitored?

Answer 22

Clinical signs and symptoms of fluid overload: Dyspnoea, leg oedema, orthopnoea, red. exercise tolerance
Obs: Low oxygen saturation
Biomarkers: NT-proBNP
Imaging: Echocardiogram