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Human Diseases > 17.1 Valvular heart disease and infective endocarditis > Flashcards

17.1 Valvular heart disease and infective endocarditis Flashcards

1
Q

What is rheumatic fever?

A

An autoimmune disease that arises as a rare complication from a group A streptococcal throat infection.

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2
Q

What disease arises as a complication of rheumatic fever?

A

Rheumatic heart disease

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3
Q

How is rheumatic heart disease characterised?

A

Characterised by deforming valvular fibrotic disease- usually of the mitral valve.

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4
Q

What are the risk factors for rheumatic fever?

A
  • Poverty
  • Overcrowded living conditions
  • Family history of rheumatic fever
  • D8/17B antigen
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5
Q

What are the symptoms of rheumatic fever?

A
  • Fever
  • Joint pain
  • Sydenham chorea (rapid irregular limb movements)
  • Erythema marginatum (circular rash)
  • Pancarditis (inflammation of the pericardium, myocardium and endocardium)
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6
Q

Give examples of valvular diseases.

A
  • Aortic stenosis
  • Aortic regurgitation
  • Mitral stenosis
  • Mitral regurgitation
  • Tricuspid regurgitation
  • Pulmonary stenosis
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7
Q

Which guidelines are followed with regards to valvular heart disease?

A

Nice guidlines for valvular heart disease Nov 2021

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8
Q

What is aortic stenosis?

A

Narrowing of the aortic valve opening causing restricted blood flow from the heart to the body.

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9
Q

Describe the aetiology of aortic stenosis.

A
  • Can arise as a complication of rheumatic fever
  • Congential abnormality: bicuspid aortic valve (aortic valve only has 2 cusps instead of 3)
  • Degenerative cause: build up of calcium on the aortic valve over time
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10
Q

Describe the symptoms and presentation of aortic stenosis.

A
  • May be asymptomatic
  • Dyspnoea (shortness of breath)
  • Angina
  • Syncope on exertion (fainting)
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11
Q

What are the signs of aortic stenosis?

A
  • Ejection systolic murmur
  • Slow rising arterial pulse
  • Systolic thrill (murmur)
  • Left ventricular hypertrophy
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12
Q

What are the complications of aortic stenosis?

A
  • Heart failure
  • SBE (subacute bacterial endocarditis)
  • Arrythmias
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13
Q

How is aortic stenosis treated?

A
  • Aortic valve replacement
  • TAVI (transcatheter aortic valve implantation)
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14
Q

What is aortic regurgitation?

A

Aortic valve doesn’t close tightly enough causing backflow of the blood back into the heart.

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15
Q

Describe the aetiology of aortic regurgitation.

A
  • Complication of rheumatic fever
  • Congential defect, bicuspid aortic valve
  • Aortic root enlargement
  • Aortic dissection (tear or injury to the aorta can cause back flow of blood through the aortic valve)
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16
Q

Describe the symptoms and presentation of aortic regurgitation.

A
  • Asymptomatic
  • Dyspnoea on exertion
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17
Q

What are the signs of aortic regurgitation?

A
  • Early diastolic murmur
  • Collapsing arterial pulse
  • Left ventricle enlargement and hypertrophy
18
Q

What is the possible complication of aortic regurgitation?

A

Heart failure

19
Q

How is aortic regurgitation treated?

A

Aortic valve replacement

20
Q

What is mitral stenosis?

A

Narrowing of the mitral valve orifice, restricts blood flow through the heart.

21
Q

Describe the aetiology of mitral stenosis.

A
  • Congenital (very rare)
  • Rheumatic fever
22
Q

Describe the symptoms and presentation of mitral stenosis.

A
  • Asymptomatic
  • Dyspnoea on exertion
  • Paroxysmal noctrunal dyspnoea (sudden shortness of breath during sleep)
  • Development of atrial fibrillation
  • Systemic embolism
  • Pulmonary hypertension
23
Q

What are the signs of mitral stenosis/how is it diagnosed?

A
  • Mid diastolic murmur
  • Tapping apical impulse
  • Right ventricular hypertrophy
24
Q

How is mitral stenosis treated?

A
  • Anticoagulants
  • Balloon valvotomy
  • Valve replacement
25
Q

What is mitral regurgitation?

A

Mitral valve doesn’t close properly causing blood to leak backwards.

26
Q

Describe the aetiology of mitral regurgitation.

A
  • Mitral valve prolapse
  • Degenerative
  • Left ventricle enlargement
  • Papillary muscle rupture after MI
27
Q

Describe the symptoms and presentation of mitral regurgitation.

A
  • Dyspnoaea on exertion
  • Orthopnoea (shortness of breath when lying down)
  • Heart failure
  • Pulmonary hypertension
  • Atrial fibrillation
28
Q

What are the signs of mitral regurgitation?

A
  • Pan-systolic murmur
  • Enlarged left heart
  • Right ventricular hypertrophy
29
Q

How is mitral regurgitation treated?

A
  • Diuretics
  • ACE inhibitors
  • Anticoagulation if patient is in AF
  • Mitral valve repair
  • Mitral valve replacement
30
Q

What is tricuspid regurgitation?

A

Tricupsid valve between the right ventricle and right atrium don’t close properly.

31
Q

What are the signs of tricuspid regurgiation?

A
  • Pan-systolic murmur
  • Enlarged right heart
  • Right ventricular hypertrophy
  • Pulmonary hypertension
  • High JVP (jugular venous pulse)
32
Q

How is tricuspid regurgitation treated?

A
  • Diuretics (spironolactone)
  • Tricuspid valve repair
33
Q

What is infective endocarditis?

A

An infection involving the endocardium of the heart (innermost layer protecting the heart), the valves and chordae tendineae.

34
Q

What are the clinical signs of infective endocarditis?

A
  • Fever, with rigors
  • Peripheral emboli
  • Microscopic haematuria (blood in urine)
  • Intracranial haemorrhage or septic pulmonary infarction
  • New or changing cardiac murmurs
  • Retinal haemorrhage / Roth spots
  • Splenomegaly
  • Splinter haemorrhage (nails)
35
Q

What are the cutaneous signs of infective endocarditis?

A
  • Petechial rash
  • Splinter haemorrhages
  • Conjunctival or palatal petechiae
  • Olser’s nodes
  • Janeway lesiosn
  • Lecucocytoclastic vasculitis
36
Q

How is suspected infective endocarditis investigated?

A
  • Clinical assessment
  • Blood cultures
  • ECG
  • Echocardiogram: mobile masses (vegetations) and local complications (regurgitation, perforation, abscesses, aneurysms)
  • Transoesophageal echocardiogram
37
Q

What criteria is used to diagnose infective endocarditis?

A

Duke criteria

38
Q

What are the Duke major critera?

A
  • Positive blood culture
  • Evidence of endocardial involvement
  • New valve regurgitation
39
Q

What are the Duke minor criteria?

A
  • Predisposing condition or behaviour
  • Temperature >38 degrees celsius
  • Vasulcar phenomena
  • Immunological phenomena
  • Blood culture (not meeting major criteria)
  • Echo features not meeting major criteria
40
Q

What Duke criteria must be met for a definitive infective endocarditis diagnosis?

A
  • 2 major criteria or
  • 1 major and 3 minor criteria
  • 5 minor criteria

Or through pathological conformation

41
Q

Is antibiotic prophylaxis against IE routinely recommended for dental treatment?

A

No

Human Diseases (47 decks)

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