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BDS3 Human Disease > Valvular heart disease > Flashcards

Valvular heart disease Flashcards

1
Q

Valvular stenosis?

A

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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2
Q

Disease shown?

A

Aortic coarctation

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3
Q

Cardinal symptoms of cardinal stenosis?

A

Chest pain

Breathlessness on exertion

Syncope/dizziness

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4
Q

Most common cause of heart valve damage?

A

Rheumatic heart disease

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5
Q

What are the symptoms of MV disease?

A

Breathlessness

Palpitation due to atrial fibrillation

Embolisation

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6
Q

What causes mitral stenosis? (congenital)

A

Thickening and scarring of the leaflets

Fusion of commissures

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7
Q

What causes mitral regurgitation? (congenital)

A

Leaflet abnormality

Mitral annular dilation

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8
Q

Right sided valves

A

Tricuspid

Pulmonary

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9
Q

What are the 2 types of heart valve replacement?

A

Mechanical

Tissue

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10
Q

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

A

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

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11
Q

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

A

No

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12
Q

What does warfarin inhibit?

A

Vitamin K

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13
Q

What is INR?

A

‘international normalised ratio’

How long it takes you blood to clot

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14
Q

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

A

Every 6 week s

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15
Q

Are new anticoagulant suitable for the mechanical valve prosthesis?

A

No, stick to warfarin

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16
Q

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

A

II

V

VII

X

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17
Q

What oral anticoagulants acts upon factor x?

A

Apixiban

Rivaroxaban

Edoxaban

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18
Q

What anticoagulant acts upon prothrombin?

A

Dabigatran

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19
Q

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

A

INR = 2-4

72 hours prior

20
Q

Anti-platelets?

A

Aspirin

Clopidogrel

21
Q

What should you not prescribe after dental procedure for analgesia?

A

NSAIDs and COX-2 inhibitors

22
Q

What are the risks of stopping oral anticoagulation?

A

Small but potentially fatal

Systemic thrombo-embolism or metallic valve malfunction

23
Q

What is infective endocarditis?

A

Infection of the cardiac or vascular endothelium

Vegetation - pockets of infection

24
Q

Vegetation?

A

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

Make hole in heart valve

25
Q

What are the predisposing factors for IE?

A

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

Bacteriamemia

26
Q

Causes of bacteriaemia? (IE)

A

IVDU

Dental procedures - common cause

Surgical procedures at infected sites

27
Q

Common microorganisms causing IE?

A

Strep
Staph - major
Enterococcus
Pneumococcus
Gram-coco-bacilli

Fungi
Mycobacteria

28
Q

What bacteria is a major cause of IE?

A

STAPH

29
Q

What microorganism are stubborn to get rid of in IE?

A

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

30
Q

What are symptoms of IE?

A

Fever

Malaise, anorexia, weight loss

Heart failure due to active valvular destruction

Systemic embolisation occult stroke

Acute renal failure

31
Q

Who are the high risk pts?

A

Prosthetic valve

Previous IE

CHD: (congenital heart disorders)

32
Q

Congenital heart disorders meaning a pt is at high risk?

A
  • Unrepaired cyanotic disease
  • Completely repair up to 6 months after procedure
  • Residual defect persists at the site of implantation prosthetic material
33
Q

IE prophylaxis treatment?

A

3g amoxicillin 60 minutes before procedure

34
Q

Why would you give amoxicillin over penicillin?

A

Amoxicillin for prophylaxis - covers you for that procedure that day

No evidence of dental infection but high risk - heart valve problems

35
Q

Symptoms of aortic regurgitation?

A
  • 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

36
Q

Aetiology of MV disease?

A

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

37
Q

MV disease symptoms?

A

Breathlessness

Palpitations die to atrial fibrillation

Embolism

38
Q

aortic coarctation?

A

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

39
Q

Is aortic coarctattion congenital or acquired?

A

congenital

40
Q

2 types of valvular heart disease?

A

stenosis

regurgitation

41
Q

rheumatic fever?

A

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

42
Q

What can cause aortic regurgitation?

A
  1. Aorta
    - Dilated aorta (e.g. hypertension.)
    - Connective tissue disorders
  2. Leaflets
    - Bicuspid aortic valve
    - Rheumatic heart disease
    - Endocarditis
43
Q

What causes dyspnea?

A

caused by acute myocardial ischemia, heart failure

aortic regurgitation

44
Q

Aetiology of MV disease?

A
  • Myxomatous degeneration (MVP)
  • Functional MR
  • Rheumatic heart
  • Disease
    Infectious endocarditis
45
Q

2 congenital heart diseases?

A

ventricular septal defects

complex CHD

46
Q

What are reasons for oral anticoagulation?

A

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

47
Q

Dental procedures that anticoagulants could cause bleeding risk?

A

Root canal treatment
Extractions
Minor oral surgery
Periodontal surgery
Biopsies

BDS3 Human Disease (15 decks)

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