Valvular heart disease Flashcards by Hannah Maclean

Valvular stenosis?

type of heart valve disease (valvular heart disease).

The valve between the lower left heart chamber and the body’s main artery (aorta) is narrowed and doesn’t open fully.

This reduces or blocks blood flow from the heart to the aorta and to the rest of the body.

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Disease shown?

Aortic coarctation

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Cardinal symptoms of cardinal stenosis?

Chest pain

Breathlessness on exertion

Syncope/dizziness

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Most common cause of heart valve damage?

Rheumatic heart disease

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What are the symptoms of MV disease?

Breathlessness

Palpitation due to atrial fibrillation

Embolisation

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What causes mitral stenosis? (congenital)

Thickening and scarring of the leaflets

Fusion of commissures

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What causes mitral regurgitation? (congenital)

Leaflet abnormality

Mitral annular dilation

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Right sided valves

Tricuspid

Pulmonary

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What are the 2 types of heart valve replacement?

Mechanical

Tissue

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If you have mechanical heart valve replacement, what medication does the pt need to be on?

Warfarin - anticoagulant (acts on the pathway for fibrin mesh to form)

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Does the pt need to be on anticoagulant for tissue heart valve replacement?

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What does warfarin inhibit?

Vitamin K

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What is INR?

‘international normalised ratio’

How long it takes you blood to clot

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After heart valve replacement, how often to you test INR?

Every 6 week s

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Are new anticoagulant suitable for the mechanical valve prosthesis?

No, stick to warfarin

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What factors does vitamin K act upon in blood clot pathway?

VII

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What oral anticoagulants acts upon factor x?

Apixiban

Rivaroxaban

Edoxaban

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What anticoagulant acts upon prothrombin?

Dabigatran

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What INR do you need before carrying out a dental procedure?

INR = 2-4

72 hours prior

Anti-platelets?

Aspirin

Clopidogrel

What should you not prescribe after dental procedure for analgesia?

NSAIDs and COX-2 inhibitors

What are the risks of stopping oral anticoagulation?

Small but potentially fatal

Systemic thrombo-embolism or metallic valve malfunction

What is infective endocarditis?

Infection of the cardiac or vascular endothelium

Vegetation - pockets of infection

Vegetation?

Immune cells trying to help fight infection - infection releases toxins and…

Make hole in heart valve

What are the predisposing factors for IE?

Endothelium subjected to turbulent flow - any valvular or cardiac abnormality - prosthetic heart valves Bacteriamemia

Causes of bacteriaemia? (IE)

IVDU Dental procedures - common cause Surgical procedures at infected sites

Common microorganisms causing IE?

Strep Staph - major Enterococcus Pneumococcus Gram-coco-bacilli Fungi Mycobacteria

What bacteria is a major cause of IE?

STAPH

What microorganism are stubborn to get rid of in IE?

Fungi - pt often put on antibiotics but its a fungal infection

What are symptoms of IE?

Fever Malaise, anorexia, weight loss Heart failure due to active valvular destruction Systemic embolisation occult stroke Acute renal failure

Who are the high risk pts?

Prosthetic valve Previous IE CHD: (congenital heart disorders)

Congenital heart disorders meaning a pt is at high risk?

- Unrepaired cyanotic disease - Completely repair up to 6 months after procedure - Residual defect persists at the site of implantation prosthetic material

IE prophylaxis treatment?

3g amoxicillin 60 minutes before procedure

Why would you give amoxicillin over penicillin?

Amoxicillin for prophylaxis - covers you for that procedure that day No evidence of dental infection but high risk - heart valve problems

Symptoms of aortic regurgitation?

- dyspnoea (shortness of breath) Orthopnoea (shortness of breath when lying down) Paroxysmal nocturnal dyspnoea (shortness of breath that awakens a pt) Chest pain - nocturnal angina

Aetiology of MV disease?

Functional MR Rheumatic heart disease Infectious endocarditis Myxomatous degeneration (MVP)

MV disease symptoms?

Breathlessness Palpitations die to atrial fibrillation Embolism

aortic coarctation?

a narrowing of a part of the body's main artery, called the aorta

Is aortic coarctattion congenital or acquired?

congenital

2 types of valvular heart disease?

stenosis regurgitation

rheumatic fever?

Rheumatic fever is a very rare complication that can develop after a bacterial throat infection. It can cause painful joints and heart problems.

What can cause aortic regurgitation?

1. Aorta - Dilated aorta (e.g. hypertension.) - Connective tissue disorders 2. Leaflets - Bicuspid aortic valve - Rheumatic heart disease - Endocarditis

What causes dyspnea?

caused by acute myocardial ischemia, heart failure aortic regurgitation

Aetiology of MV disease?

- Myxomatous degeneration (MVP) - Functional MR - Rheumatic heart - Disease Infectious endocarditis

2 congenital heart diseases?

ventricular septal defects complex CHD

What are reasons for oral anticoagulation?

Atrial Fibrillation (INR 2-3) Metallic Heart valves INR (2.5-4.0) Tissue valves for 3 months after implantation

Dental procedures that anticoagulants could cause bleeding risk?

Root canal treatment Extractions Minor oral surgery Periodontal surgery Biopsies