Valvular Heart Disease Flashcards
What is infective endocarditis?
An infection of the endocardium or vascular endothelium
Where does IE typically affect?
Heart valves
Usually due to bacteria entering blood stream and forming a vegetation
What is a vegetation?
A bacterial infection surrounded by a layer of platelets and fibrin
What is the most common infection in IE?
Streptococci (20-40%)
Criteria to diagnose IE?
Duke’s Criteria
Duke’s major criteria?
Consistently positive blood culture for typical organisms
ECHO - vegetation, dehiscence of prosthetic valve, abscess
New valvular regurgitation murmur
Coxiella burnetti infection
Duke’s minor criteria?
Predisposing heart condition or IV drug use
Fever (over 38)
Vascular - emboli to organs or brain
Immunogenic - glomerulonephritis, Osler nodes, Roth spots
Positive blood cultures that do not meet specific criteria
Which echo has higher sensitivity?
Trans oesophageal > trans thoracic
Definitive endocarditis based on Duke’s?
-2 major criteria
-1 major and 3 minor
-5 minor
-positive gram stain
Possible endocarditis?
-1 major and more than 1 minor
-3 minor
Rejected endocarditis based on Duke’s?
Resolution after less than 4 days ABx
No evidence of infection after surgery
Definite or possible criteria not met
Heart decompensation symptoms in IE?
Shortness of breath
Frequent coughing
Swelling of legs and abdomen
Fatigue
Heart decompensation clinical signs in IE?
Raised JVP
Lung crackles
Oedema
Other IE complications?
Vascular and embolic phenomena
Osler’s nodes, Roth spots
What part of the heart does IE affect?
Endocardium, especially valves
Aortic valve most frequently affected (aortic > mitral > right side)
IE most affected in IV drug use?
Right side as venous return
Dilated cardiomyopathy definition?
Dilated and thin-walled cardiac chambers with reduced contractility
Echo shows dilated LV with reduced systolic function (ejection fraction) and typically GLOBAL HYPOKINESIS)
Most common causes of dilated cardiomyopathy?
Idiopathic
Genetic
Toxins
Pregnancy
Viral infections (myocarditis)
Tachycardia related
Thyroid related
Muscular dystrophies
How is dilated cardiomyopathy managed?
Heart failure therapy (ACEi, BB, mineralcorticoid receptor antagonists)
Diuretics for fluid overload
Anticoagulation for afibrillation
Cardiac devices
Transplant
Future risks of dilated cardiomyopathy?
Risk of heart failure hospitalisation
Cardiac arrhythmias
Sudden cardiac death due to ventricular arrhythmias
Reduced survival
What is heart failure with preserved ejection fraction?
EF greater than 50%
Presence of diastolic or right heart dysfunction
What does diastolic dysfunction in HF with preserved EF lead to?
Increased reservoir of blood in pulmonary veins -> pulmonary hypertension and pulmonary oedema
What is HF with reduced ejection fraction?
EF less than 50%
Impaired LV systolic function
What does impaired LV systolic function in HF with reduced EF lead to?
Pulmonary oedema secondary to impaired systolic function and flow of blood via the aorta
Leads to back flow of blood into pulmonary veins and lungs -> pulmonary oedema
Clinical signs of right sided heart failure?
Peripheral oedema (leg swelling, raised JVP)
Clinical signs of left sided heart failure?
Pulmonary oedema
What medications are used to treat heart failure with preserved EF?
Diuretics
SGLT2 inhibitors
What medications are used to treat heart failure with reduced EF?
ACEi
Angiotensin II receptor blockers (performulated in Entrestro)
Beta blockers
Mineralcorticoid receptor antagonists
SGLT2 inhibitors
Diuretics
How is heart failure monitored? Clinical, observations
Clinical - signs and symptoms of fluid overload (shortness of breath, leg swelling, orthopnea)
Reduced exercise tolerance due to shortness of breath
Obs- low oxygen saturation
Heart failure bio marker?
NT-proBNP
