Valvular Heart Disease Flashcards

1
Q

What is infective endocarditis?

A

An infection of the endocardium or vascular endothelium

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2
Q

Where does IE typically affect?

A

Heart valves
Usually due to bacteria entering blood stream and forming a vegetation

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3
Q

What is a vegetation?

A

A bacterial infection surrounded by a layer of platelets and fibrin

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4
Q

What is the most common infection in IE?

A

Streptococci (20-40%)

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5
Q

Criteria to diagnose IE?

A

Duke’s Criteria

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6
Q

Duke’s major criteria?

A

Consistently positive blood culture for typical organisms
ECHO - vegetation, dehiscence of prosthetic valve, abscess
New valvular regurgitation murmur
Coxiella burnetti infection

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7
Q

Duke’s minor criteria?

A

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

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8
Q

Which echo has higher sensitivity?

A

Trans oesophageal > trans thoracic

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9
Q

Definitive endocarditis based on Duke’s?

A

-2 major criteria
-1 major and 3 minor
-5 minor
-positive gram stain

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10
Q

Possible endocarditis?

A

-1 major and more than 1 minor
-3 minor

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11
Q

Rejected endocarditis based on Duke’s?

A

Resolution after less than 4 days ABx
No evidence of infection after surgery
Definite or possible criteria not met

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12
Q

Heart decompensation symptoms in IE?

A

Shortness of breath
Frequent coughing
Swelling of legs and abdomen
Fatigue

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13
Q

Heart decompensation clinical signs in IE?

A

Raised JVP
Lung crackles
Oedema

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14
Q

Other IE complications?

A

Vascular and embolic phenomena
Osler’s nodes, Roth spots

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15
Q

What part of the heart does IE affect?

A

Endocardium, especially valves
Aortic valve most frequently affected (aortic > mitral > right side)

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16
Q

IE most affected in IV drug use?

A

Right side as venous return

17
Q

Dilated cardiomyopathy definition?

A

Dilated and thin-walled cardiac chambers with reduced contractility
Echo shows dilated LV with reduced systolic function (ejection fraction) and typically GLOBAL HYPOKINESIS)

18
Q

Most common causes of dilated cardiomyopathy?

A

Idiopathic
Genetic
Toxins
Pregnancy
Viral infections (myocarditis)
Tachycardia related
Thyroid related
Muscular dystrophies

19
Q

How is dilated cardiomyopathy managed?

A

Heart failure therapy (ACEi, BB, mineralcorticoid receptor antagonists)
Diuretics for fluid overload
Anticoagulation for afibrillation
Cardiac devices
Transplant

20
Q

Future risks of dilated cardiomyopathy?

A

Risk of heart failure hospitalisation
Cardiac arrhythmias
Sudden cardiac death due to ventricular arrhythmias
Reduced survival

21
Q

What is heart failure with preserved ejection fraction?

A

EF greater than 50%
Presence of diastolic or right heart dysfunction

22
Q

What does diastolic dysfunction in HF with preserved EF lead to?

A

Increased reservoir of blood in pulmonary veins -> pulmonary hypertension and pulmonary oedema

23
Q

What is HF with reduced ejection fraction?

A

EF less than 50%
Impaired LV systolic function

24
Q

What does impaired LV systolic function in HF with reduced EF lead to?

A

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

25
Clinical signs of right sided heart failure?
Peripheral oedema (leg swelling, raised JVP)
26
Clinical signs of left sided heart failure?
Pulmonary oedema
27
What medications are used to treat heart failure with preserved EF?
Diuretics SGLT2 inhibitors
28
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
29
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
30
Heart failure bio marker?
NT-proBNP