Valvular heart disease, endocarditis

Question 1

Valve components

Answer 1

• valve ring
• cusp
• chordae
• papillary muscles

Question 2

functional failure in valves

Answer 2

mitral stenosis
mitral incompetence
aortic stenosis
aortic incompetence

Question 3

Stenosis

Answer 3

Narrowing of the valve outlet caused by thickening of valve cusps, or increased rigidity or scarring.

Question 4

Incompetence

Answer 4

Or insufficiency or regurgitation (which is what happens) caused by incomplete seal when valves close, allowing blood to flow backwards

Question 5

First: heart sound

Answer 5

mitral and tricuspid - systole

Question 6

Second: heart sound

Answer 6

aorta and pulmonary – diastole

Question 7

Congenital heart disease

Answer 7

bicuspid valve, atresia

Question 8

• Cardiomyopathy

Answer 8

hypertrophic, dilated

Question 9

Acquired

Answer 9

– Rheumatic fever
– Myocardial infarction
– Age related – idiopathic aortic calcific stenosis – Endocarditis

Question 10

aortic stenosis causes

Answer 10

calcification of congenital bicuspid valve senile calcific degeneration
rheumatic fever

Question 11

consequences of aortic stenosis

Answer 11

• increases the work of the heart
• ventricular hypertrophy
• causes cardiac failure late in the clinical course
• clinical symptoms include:
  dyspnoea
  angina
  syncope

Question 12

causes of aortic incompentance

Answer 12

infective endocarditis
rheumatic fever
marfans syndrome

Question 13

aortic regurgitation

Answer 13

• increases the volume of blood to be pumped significantly
• increases the work of the heart
  cardiac hypertrophy
• cardiac failure
• occur in the presence of aortic stenosis

Question 14

cusp damage

Answer 14

– Rheumatic heart disease – scarring, contraction
– Floppy valve & Marfan syndrome - stretch
– Infective endocarditis - perforation

Question 15

causes of mitral incompetence

Answer 15

• cusp damage
• chordae
• papillary muscle
• valve ring

Question 16

mitral stenosis

Answer 16

congenital 
post rheumatic fever 
restricts blood flow to left ventricle 
atrial fibrillation 
back pressure results in pulmonary hypertension 
finally causes heart failure

Question 17

Define infective endocarditis

Answer 17

• Infection of valve with formation of
thrombotic vegetations
• Virulence of organisms determines damage and severity of the clinical illness

Question 18

Risk factors for infective endocarditis

Answer 18

• valve damage
• bacteraemia
• immunosuppression

Question 19

Rheumatic fever

Answer 19

• Acute multisystem disease
–heart (myocarditis, valvulitis, pericarditis), joints, connective tissue
• 3 weeks post Streptococcal infection(usually pharyngitis)
• Immune mediated rather than direct infection
• Occurs in children:4-16years
• May occur in recurrent episodes
• Chronic valve disease decades later

Question 20

Acute Native Valve Endocarditis

Answer 20

– valves may be normal
– aggressive disease
– virulent organisms, such as Staph. aureus and group B streptococci

Question 21

• Subacute Native Valve Endocarditis

Answer 21

– abnormal valves
– indolent but may deteriorate
– alpha-haemolytic streptococci, enterococci

Question 22

• Prosthetic valve endocarditis

Answer 22

– 10-20% of cases
– 5% of mechanical and bio-prosthetic valves become infected
– mitral are more susceptible than aortic

Question 23

IV Drug abuse

Answer 23

– 75% have no underlying valvular abnormalities
– 50% involve the tricuspid valve
– Staph. aureus most common
For more reading see
http://emedicine.medscape.com/article/216650-overview#a2

Question 24

Principles of diagnosis, treatment and prevention of infective endocarditis

Answer 24

• Treat Strep. infection with antibiotics
• Prophylactic cover for invasive procedures eg
dental work
• Replacedamagedvalves
• Clinical suspicion & signs
• Imaging – especially echocardiography
• Blood culture
• Intravenous antibiotics

Question 25

Local and systemic complications of infective endocarditis

Answer 25

clubbing of fingers

prominent splinter heamoraghes

Question 26

composition and causes of vegetations

Answer 26

Group D Streptococcus, gut commensals, skin Strep
(Coxiella, fungi, Candida)

fibrin and platelets and bacteria