Valvular heart disease, endocarditis Flashcards

1
Q

Valve components

A
  • valve ring
  • cusp
  • chordae
  • papillary muscles
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2
Q

functional failure in valves

A

mitral stenosis
mitral incompetence
aortic stenosis
aortic incompetence

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3
Q

Stenosis

A

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

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4
Q

Incompetence

A

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

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5
Q

First: heart sound

A

mitral and tricuspid - systole

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6
Q

Second: heart sound

A

aorta and pulmonary – diastole

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7
Q

Congenital heart disease

A

bicuspid valve, atresia

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8
Q

• Cardiomyopathy

A

hypertrophic, dilated

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9
Q

Acquired

A

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

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10
Q

aortic stenosis causes

A

calcification of congenital bicuspid valve senile calcific degeneration
rheumatic fever

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11
Q

consequences of aortic stenosis

A
  • increases the work of the heart
  • ventricular hypertrophy
  • causes cardiac failure late in the clinical course
  • clinical symptoms include:
    dyspnoea
    angina
    syncope
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12
Q

causes of aortic incompentance

A

infective endocarditis
rheumatic fever
marfans syndrome

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13
Q

aortic regurgitation

A
  • 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
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14
Q

cusp damage

A

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

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15
Q

causes of mitral incompetence

A
  • cusp damage
  • chordae
  • papillary muscle
  • valve ring
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16
Q

mitral stenosis

A
congenital 
post rheumatic fever 
restricts blood flow to left ventricle 
atrial fibrillation 
back pressure results in pulmonary hypertension 
finally causes heart failure
17
Q

Define infective endocarditis

A

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

18
Q

Risk factors for infective endocarditis

A
  • valve damage
  • bacteraemia
  • immunosuppression
19
Q

Rheumatic fever

A

• 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

20
Q

Acute Native Valve Endocarditis

A

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

21
Q

• Subacute Native Valve Endocarditis

A

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

22
Q

• Prosthetic valve endocarditis

A

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

23
Q

IV Drug abuse

A

– 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

24
Q

Principles of diagnosis, treatment and prevention of infective endocarditis

A
• Treat Strep. infection with antibiotics
• Prophylactic cover for invasive procedures eg
dental work
• Replacedamagedvalves
• Clinical suspicion & signs
• Imaging – especially echocardiography
• Blood culture
• Intravenous antibiotics
25
Q

Local and systemic complications of infective endocarditis

A

clubbing of fingers

prominent splinter heamoraghes

26
Q

composition and causes of vegetations

A

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

fibrin and platelets and bacteria