Valvular disease and heart failure Flashcards
What is infective endocarditis?
Infection of the endocardium or vascular endothelium of the heart
Typically affects the heart valves, Strep
Common symptoms of infective endocarditis
Fever, malaise, sweats and unexplained weight loss.
Duke criteria for infective endocarditis
BE FIVEPM
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
What is seen in the echocardiogram in infective endocarditis
Vegetation- mass of bacteria,platelets,fibrin
abscess,
valve perforation
Transoesophageal echo has ^ sensitivity vs transthoracic
Often regurg of affected valve
What is heart decomposition
inability of the heart to maintain adequate circulation
What features of heart decompensation would you look for in IE
Cardiac decompensation
Symptoms: dyspnoea, frq cough, swelling of legs and abdomen, fatigue
Signs: raised JVP, lung crackles and oedema
What part of the heart does infective endocarditis affect?
endocardium, especially the valves of the heart
frequently (aortic > mitral > right-sided valves)
Why does IE affect aortic/mitral valve most frq
Sites of turbulent flow which cause underlying damage to the valves. Easier for bacteria to attack.
Why are IV drug users at greater risk of IE
Repeated injection – Exposure of bloodstream to skin surface bacteria / use of non-sterile needles.
Users at risk of IE
Complication of routine surgeries
Immunosuppressed individuals
congenital heart defects -> damaged endocardium.
What is the definition of dilated cardiomyopathy?
Characterised by dilated/thin-walled cardiac chambers with reduced contractility (red. ejection fraction)
What is Global hypokinesis
Left ventricular ejection fraction of <45%.
Decreased motor function
What are the commonest causes of dilated cardiomyopathy?
Idiopathic,
genetic,
toxins (alcohol, cardiotoxic chemotherapy), pregnancy (peripartum cardiomyopathy),
viral infections (myocarditis),
tachycardia-related cardiomyopathy,
thyroid disease,
muscular dystrophies
Management of dilated cardiomyopathy
Medical heart failure therapy - ACE inhibitors, beta-blockers
Diuretics for fluid overload
Anticoagulation for atrial fibrillation
Cardiac devices
Transplant
Future implications of DCM
risk of heart failure hospitalization,
cardiac arrhythmias,
sudden cardiac death due to ventricular arrhythmia,
reduced survival
What happens in heart failure with preserved ejection fraction
EF > 50%.
Diastolic / right heart dysfunction.
Diastolic dysfunction -> ^ reservoir of blood in the pulmonary veins, -> ^ pulmonary htn + pulmonary oedema.
What happens in heart failure with reduced ejection fraction
EF < 50%.
Impaired left ventricular systolic function
Backflow of blood into the pulmonary veins and lungs
-> pulmonary oedema
Clinical signs of right heart failure
peripheral oedema e.g. leg swelling, ^ JVP
Clinical signs of left heart failure
pulmonary oedema
What medications are used to treat heart failure with preserved ejection fraction?
Diuretics and SGLT2 inhibitors.
What medications are used to treat heart failure with reduced ejection fraction?
ACE inhibitors (ACEi)
angiotensin II receptor blockers (ARBs)
Beta blockers.
SGLT2 inhibitors,
diuretics.
How is heart failure monitored?
Clinical signs and symptoms of fluid overload: Dyspnoea, leg oedema, orthopnoea, red. exercise tolerance
Obs: Low oxygen saturation
Biomarkers: NT-proBNP
Imaging: Echocardiogram
