VHD-endocarditis

Question 1

What are the heart sound phases?

Answer 1

S1: mitral/tricuspid closure

S2: aortic/pulmonic closure

Question 2

What are the 4 stages of VHD?

Answer 2

A: at risk
B: progressive
C: asymptomatic
D: symptomatic severe

Question 3

Describe stage A of VHD

Answer 3

Patients have risk factors for development of VHD

Question 4

Describe stage B of VHD

Answer 4

Patients with progressive VHD (mild-to-moderate severity and asymptomatic)

Question 5

Describe stage C of VHD

Answer 5

Asymptomatic patients who have the criteria for severe VHD:

 C1: asymptomatic patients with severe VHD in whom the left or right ventricle remains compensated

 C2: Asyptomatic patients with severe VHD, with decompensation of the left or right ventricle

Question 6

Describe stage D of VHD

Answer 6

Patients who have developed symptoms as a result of VHD…“full blown”

Question 7

What are the complications of VHD?

Answer 7

Ventricular Dysfunction
Pulmonary Hypertension
Stroke
Atrial Fibrillation

Question 8

What is the standard diagnostic tool for VHD?

Answer 8

Transthoracic Echocardiogram (TTE)

Question 9

What is the most common valvular disease?

Answer 9

Stenosis

Question 10

what are the symptoms of aortic valve stenosis?

Answer 10

Angina, syncope, heart failure (due to LV dysfunction), dyspnea

Question 11

What is the characteristic of aortic valve regurgitation

Answer 11

Retrograde flow of blood from the aorta back to the left ventricle during diastole

Question 12

What is the predominant cause of mitral valve stenosis?

Answer 12

Rheumatic heart disease (group A strep infection > global carditis)

Question 13

What is the predominant cause of mitral valve regurgitation?

Answer 13

Mitral valve prolapse (slippage)

Question 14

What is the GENERAL treatment of VHD?

Answer 14

1) Guideline-directed/evidence based mgt of concomitant disease states.
2) Influenza and pneumococcal vaccinations as appropriate.
3) Secondary prevention of rheumatic fever in those patients with rheumatic heart disease
4) surgical repair or replacement of affected valve(s)

Question 15

Secondary Prevention of Rheumatic Fever

What are the drugs and durations?

Answer 15

Penicillin G: 1.2 million U IM q4 weeks
Penicillin V: 200 mg PO BID
Sulfadiazine: 1 gram PO daily
Macrolide or Azalide: depends on agent chosen

Question 16

Duration of treatment of secondary rheumatic fever prevention

Answer 16

Rheumatic fever + residual VHD: 10 years or untl 40 y/o

Rueumatic fever + carditis, but NO VHD: 10 years or until 21 y/o

Rheumatic fever, no carditis: 5 years or until 21 y/o

Question 17

Bioprosthetic Valve:

• Durability
• Anticoag required?
• Thrombogenicity

Answer 17

• durability: 10-15 years
• anticoag: long-term NOT required
• thrombogenicity: LOW

Question 18

Mechanical Valve

• Durability
• Anticoag required?
• Thrombogenicity

Answer 18

• Durability: 20+ years
• Anticoag required? Long-term/lifelong IS required
• Thrombogenicity: significant

Question 19

What are the two structural types of valves and which ones are they?

Answer 19

Semilunar: aortic, pulmonic

Atrioventricular: mitral, tricuspid

Question 20

How do we prevent post-implant complications?

Answer 20

Adequate anticoagulation

Prevent infection of newly implanted valves

Question 21

What is the standard diagnostic tool for IE?

Answer 21

Transesophageal Echocardiogram (TEE)