valvular disease and heart failure

Question 1

what is infective endocarditis

Answer 1

infection of the endocardium or vascular endothelium of the heart

-from bacteria entering blood stream-> forming vegetation in endocardium
-commonest= streptococci

Question 2

How do you diagnose infective endocarditis?

Answer 2

Duke’s criteria:

major: BE
Blood culture positive (2x, 12 hr apart)
Echocardiographic evidence

minor: TIMER
Temp 38 +
Immunological phenomena
Microbiological evidence
Embolic Phenomenon
Risk factors (congenital heart path/IV drug use)

definitive diagnosis=2Maj/ 1maj+3min / 5 minor

poss diagnosis=1maj +1min /3 minor

Question 3

what is decompensation

Answer 3

inability of the heart to maintain adequate circulation

Question 4

What part of the heart does infective endocarditis affect?

Answer 4

Infective endocarditis affects the endocardium, especially the valves of the heart

Aortic valve is affected most frequently (aortic > mitral > right-sided valves)

bacteria attach to endocardium if underlying is damaged. More commonly-at turbulent blood flows like valves

Question 5

How might this vary for intravenous drug users?

Answer 5

increased risk of infective endocarditis due to repeated injection –
potentially exposing their bloodstream to skin bacteria/ use of non-sterile needles.

Question 6

HF with preserved ejection fraction

Answer 6

EF 50% +.
diastolic/right heart dysfunction.
Diastolic dysfunction-> increased blood in the pulmonary veins, leading to increased pulmonary hypertension and pulmonary oedema.

Question 7

HF with reduced ejection fraction- what is it

Answer 7

EF less than 50%.
Impaired left ventricular systolic function leading to pulmonary oedema secondary to impaired systolic function and flow of blood via the aorta.
->backflow of blood into the pulmonary veins and lungs (leading to pulmonary oedema).

Question 8

What are the clinical signs and symptoms of heart failure and how does it differ between left and right heart failure?

Answer 8

Right heart failure – peripheral oedema
e.g. leg swelling, raised jugular venous pressure

Left heart failure – pulmonary oedema

Question 9

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

Answer 9

Heart failure with preserved ejection fraction: Diuretics and SGLT2 inhibitors.

Question 10

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

Answer 10

Heart failure with reduced ejection fraction:
ACE inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) – e.g. preformulated in Entresto. Beta blockers. Mineralcorticoid receptor antagonists, SGLT2 inihbitors, diuretics.

Question 11

How is heart failure monitored?

Answer 11

Clinical signs and symptoms of fluid overload: E.g. shortness of breath, leg swelling, orthopnoea (needing an extra pillow at night), reduced exercise tolerance due to shortness of breath.

Observations: Low oxygen saturation

Biomarkers: NT-proBNP

Imaging: Echocardiogram