valvular dz & endocarditis Flashcards
these are causes of what valvular heart dz
supravalvular, subvalvular, valvular (bicuspid, rheumatic, senile degeneration)
aortic stenosis
what is the most common cause of aortic stenosis
senile degeneration
these are causes of what valvular heart dz
- can be from aortic root (marfans, ehlers-danlos, syphilis, dissection, etc) or the valve itself
- causes include endocarditis, dissection, trauma
aortic insufficiency
acute vs chronic aortic regurg (in terms of compliance & filling pressure)
- acute– LV non complaint + volume overload, diastolic pressure increases
- chronic– slow LV dilation w/ long asymp. period; ventricle complaint, near normal filling pressure
acute vs chronic aortic regurg (in terms of compliance & filling pressure)
- acute– LV non complaint + volume overload, diastolic pressure increases
- chronic– slow LV dilation w/ long asymp. period; ventricle complaint, near normal filling pressure
which valve dz is this
Almost always caused by rheumatic heart dz; sx many years after initial episode of rheumatic fever
mitral stenosis
Systolic buckling of the mitral valve leaflets into the L atrium; can result in mitral regurgitation
MVP
this is the etiology of what valve dz (from review sesh)
MVP w/ chordal rupture
endocarditis w/ leaflet destruction
papillary muscle dysfunction or rupture after MI
acute MR
this is the etiology for what valve dz
primary regurg– MVP, endocarditis
secondary/functional regurg– leaflet tethering or mitral valve annulus diltation, dilated cardiomyopathy
chronic MR
- syncope, angina, exertional dyspnea/CHF/decreased functional capacity (don’t need to have all three sx to send for surgery)
- soft or absent S2; pulsus parvus et tardus
AS
intensity does not correspond w/ severity; where it peaks does
these are sx of what
- Acute– few PE findings; murmur soft or nonexistent; sx of underlying process predominate
- Chronic– wide pulse pressure; water hammer pulse; deMusset sign (head bob w/ each heart beat), quincke’s pulse (capillary pulsations in fingertips or lips), laterally displaced PMI
sx of AR
these are sx of what
- Acute– few PE findings; murmur soft or nonexistent; sx of underlying process predominate
- Chronic– wide pulse pressure; water hammer pulse; deMusset sign (head bob w/ each heart beat), quincke’s pulse (capillary pulsations in fingertips or lips), laterally displaced PMI
sx of AR
these are sx of what
- exertional dysnea, afib
- low pitched mid-diastolic murmur w/ opening snap
- Sx of mitral stenosis
these are sx of what
- Acute– tachycardia, HF, hemodynamic shock, Pulmonary edema on CXR, murmur may be soft or inaudible, S3 often present
- Chronic– holosystolic murmur best heard at the apex
sx of MR
midsystolic click followed by a late apical systolic murmur
MVP
which valve dz has 2-3 yr mortality of 90% After sx occur
aortic stenosis
which murmur radiates to L axilla vs carotids
- AS to carotids
- MR to axilla
MR and MS cuddling
LLD position for MR and MS
listen to which two conditions at left sternal border
- aortic regurg
- hypertropic cardiomyopathy
listen to which three conditions at apex
- MS
- MR
- MVP
harsh/rumbling sounds should make you think of
stenosis
Caused by group A strep; acute febrile illness 2-4 wks after an episode of pharyngitis
rheumatic fever
what determines mild vs moderate vs severe valvular disease?
TEE
when do you tx AS and what is the treatment
- refer for AVR once symptomatic
which two valve dz requires emergent surgery when acute?
aortic & mitral regurgitations
which valve d/o is it that when severe & symptomatic can be treated with valve replacement & also percutaneous valvotomy
mitral stenosis
list the 3 sx of severe aortic stenosis
- syncope
- angina
- DOE
what two findings is the biggest red flag for endocarditis
mumur + infectious symp.
also oslor nodes, janeway lesions, splinter hemorrhages
3 populations at risk for endocarditis
- central lines or indwelling catheters
- IV drug user
- artificial valves/severe valve d/o
how many blood cultures are needed to dx endocarditis
2
gold standard imaging for endocarditis
TEE
which 4 patient groups need abx before dental work
- prosthetic heart valves/valve repair
- h/o endocarditis
- transplant pt w/ valve dz (immunocompromised)
- some congenital heart dz– unrepaired congential
Infection of the endocardium (inner lining of heart chambers and valves) when bacteria/fungus spreads through the bloodstream and attaches to damaged areas of the heart
endocarditis
1st line abx in endocarditis
amoxicillin PO
3 alternative 1st line abx for endocarditis if PCN allergic
- cephalexin
- azithro or clarithromycin
- doxycycline
3 IM/IV abx for endocarditis
- ampicillin
- cefazolin or ceftriaxone
- vancomycin
