Valvular heart disease

Question 1

When does rheumatic fever occur

Answer 1

Occurs 2-3 weeks after a streptococcal upper respiratory tract infection

Question 2

What causes rheumatic fever

Answer 2

β-haemolytic Streptococcus

Question 3

Where is rheumatic fever more common

Answer 3

Children in central Africa, the Middle East and India

Question 4

What is rheumatic fever associated with

Answer 4

Poot nutrition and over crowding

Question 5

What is rheumatic fever characterised by

Answer 5

Inflammation at multiple sites including the heart, arteries, joints and skin

Question 6

Describe a heart affected by rheumatic fever

Answer 6

Heart generally becomes inflamed and shows signs of endocarditis, myocarditis and pericarditis

Question 7

What does endocarditis at the heart valves produce

Answer 7

Small irregularities on the cusps of the valves called vegetations which composed of platelets and fibrin

Question 8

Describe a heart affected by rheumatic fever

Answer 8

Generally inflamed and shows signs of endocarditis, myocarditis and pericarditis

Question 9

Which valve is most frequently effected by rheumatic fever

Answer 9

Mitral valve

Question 10

What can recurrent infections of the heart lead to

Answer 10

Valvular fibrosis

Question 11

What is valvular fibrosis

Answer 11

Fusion of valve leaflets and calcification

Question 12

Other than inflammation of valves what else can be inflamed in rheumatic fever

Answer 12

Inflammation of the large joints this produces symptoms referred to as migratory or flitting polyarthritis

Question 13

Give some symptoms of rheumatic fever

Answer 13

1. Skin rash develops (erythema marginatum)
2. Subcutaneous nodules may appear
3. Neurological symptoms include chorea

Question 14

What can an episode of rheumatic fever increase the risk of

Answer 14

Developing infective endocarditis

Question 15

What is infective endocarditis

Answer 15

A disease resulting from infection of a focal area of the endocardium

Question 16

What does infective endocarditis affect

Answer 16

Usually the heart valves but infection can develop on the mural endocardium typically at the chordae tendineae or at the site of a congenital heart defect

Question 17

Give examples of heart abnormalities that can increase susceptible to infection

Answer 17

1. Congenital heart defects
2. Calcific aortic valve disease
3. Damage secondary to rheumatic fever
4. Prosthetic heart valves used to replace damaged and non functional valves

Question 18

Give examples of the infective agents that can cause infective endocarditis

Answer 18

Commensal bacteria sometimes fungal organisms

Question 19

Where do commensal bacteria that cause infective endocarditis reside

Answer 19

1. Oral cavity
2. Oropharynx
3. gastrointestinal tract
4. genitourinary tract 5. the skin

Question 20

What does colonisation of damaged endocardium edits i

Answer 20

1. Thrombotic vegetation composed of platelets and fibrin
2. the bacteria induce further platelet aggregation and fibrin deposition and inhabit an immune-privileged niche

Question 21

What are local complications of infective endocarditis a consequence of

Answer 21

Valvular destruction causing the affected valves to become incompetent an the patietn develops a heart murmur

Question 22

What risk do infected chordae tendineae

Answer 22

risk of rupture with fatal results that can lead to local spread of infection

Question 23

List soem systemic effects of endocarditis

Answer 23

1. Fever
2. Weight loss
3. Malaise
4. Night sweats
5. Finger clubbing
6. Enlarged spleen
7. Anaemia
8. Mycotic aneurysms
9. Heart murmur
10. Microscopic haematuria

Question 24

What can systemic embolism produce

Answer 24

Small infarcts within the brain, spleen and kidney

Question 25

What do emboli typically affect

Answer 25

skin of the hands and feet and the nail beds

Question 26

What do emboli typically affect

Answer 26

skin of the haWnds and feet and the nail beds

Question 27

What does a diagnosis of infective endocardititis rely on

Answer 27

Auscultation of the heart listening for a Newhart murmur or a changing murmur, blood cultures and an echocardiogram

Question 28

How is infective endocarditis treated

Answer 28

Prolonged course of high dose antibiotics
Occasionally surgery

Question 29

When is surgery indicated for infective endocarditis

Answer 29

if there is:
1. valvular obstruction,
2. heart failure repeated emboli
3. persistent bacteraemia

Question 30

Do we need to prescribe Prophylaxis for infective endocarditis patients prior to dental treatment

Answer 30

According to NICE guidelines it is no longer indicated as risk of anaphylaxis is greater than that of infective endocarditis