Valvular heart disease Flashcards
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.
Disease shown?
Aortic coarctation
Cardinal symptoms of cardinal stenosis?
Chest pain
Breathlessness on exertion
Syncope/dizziness
Most common cause of heart valve damage?
Rheumatic heart disease
What are the symptoms of MV disease?
Breathlessness
Palpitation due to atrial fibrillation
Embolisation
What causes mitral stenosis? (congenital)
Thickening and scarring of the leaflets
Fusion of commissures
What causes mitral regurgitation? (congenital)
Leaflet abnormality
Mitral annular dilation
Right sided valves
Tricuspid
Pulmonary
What are the 2 types of heart valve replacement?
Mechanical
Tissue
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)
Does the pt need to be on anticoagulant for tissue heart valve replacement?
No
What does warfarin inhibit?
Vitamin K
What is INR?
‘international normalised ratio’
How long it takes you blood to clot
After heart valve replacement, how often to you test INR?
Every 6 week s
Are new anticoagulant suitable for the mechanical valve prosthesis?
No, stick to warfarin
What factors does vitamin K act upon in blood clot pathway?
II
V
VII
X
What oral anticoagulants acts upon factor x?
Apixiban
Rivaroxaban
Edoxaban
What anticoagulant acts upon prothrombin?
Dabigatran
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?
- Aorta
- Dilated aorta (e.g. hypertension.)
- Connective tissue disorders - 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
