Valve Disease and Endocarditis

Question 1

what are the heart valves

Answer 1

tricuspid
pulmonary
mitral
aortic

Question 2

what are the av valves

Answer 2

atrioventricular
tricuspid and mitral

Question 3

what are the semi lunar valves

Answer 3

semilunar valves
pulmonary and aortic

Question 4

which valves are open during diastole

Answer 4

AV valves
- they close during systole

Question 5

which valves are closed during diastole

Answer 5

semilunar valves
- they open when the heart contracts (systole)

Question 6

what happens during diastole

Answer 6

when the muscles of the heart relax and fill with blood

Question 7

what happens during systole

Answer 7

when the muscles of the heart contract and pump blood into the arteries

Question 8

what are valve abnormalities

Answer 8

wear and tear
calcification
pannus
endocarditis
thrombus

Question 9

what are the two major problems caused by valve abnormalities

Answer 9

stenosis: very tight and hard for blood to get through
regurgitation: very loose and blood flows backwards with inc pressure

Question 10

what happens to myocardium when there are valve abnormalities

Answer 10

development of hypertrophic muscles bc inc workload

Question 11

what is the aortic stenosis triad

Answer 11

SAD:
syncope–> not enough blood being pumped to brain
angina –> coronary vessels are not getting enough blood
dyspnea –> blood is getting back up causing pulmonary edema

Question 12

what is mitral reguritation

Answer 12

mitral valve: btw LA and LV
- doesn’t close properly causing fatigue and SOB bc not enough blood being pushed out and there is a back up of blood in the lungs

Question 13

what is infective endocarditis

Answer 13

inflammation/growth of vegetation of the valve and inner lining of the heart
- growth on the valve that causes can get dislodged then travel as a septic clot to a capillary and spread infection

Question 14

risk factors for infective endocarditis

Answer 14

prosthetic valve
pacemaker associated
IV drug use

Question 15

which area of the heart is most frequently infected

Answer 15

tricuspid

Question 16

what are the causative organisms of IV drug use endocarditis

Answer 16

S. viridans
S. aureus
S. epidermis

Question 17

symptoms of infective endocarditis

Answer 17

fever, chills
anorexia, wt loss
myalgia: pain in muscles
arthralgia: joint pain
heart murmur
signs of ischemia or infarction of the extremities, spleen, kidney, bowel, brain
septic emboli

Question 18

what are septic emboli

Answer 18

• microorgs travel to the heart and adhere to the damaged endothelial tissue which attracks WBCs, platelets–> release of cytokines and coag factors
• stimulation of coag cascade results in fibrin deposition and development of vegetation
• vegetation can emobolize into circulation and be carried throughout the blood stream and can initiate infection or ischemia in remote tissues

Question 19

manifestations of infective endocarditis

Answer 19

many are cause by septic emboli
- petechiae
- splinter hemorrhages: linear streaks in the nailbeds
- janeway lesions: erythematous, non-tender lesions on the palms and soles
- Osler’s nodes: sub q nodules in the pulp of the fingertips
- roth spots: oval retinal hemorrhage with pale centers

Question 20

infective endocarditis in drug abusers

Answer 20

• viens are portals of entry for the orgs
• s. aureus: found on skin and most common cause of bacteremia
• travels from peripheral vein to inferior vena cava into R side of the heart
• can become emboli and affect enter pulm artery and cause PE

Question 21

what is the criteria of infective endocarditis

Answer 21

meet either two major criteria
one major and three minor
five minor criteria

Question 22

what are major criterias for infective endocarditis

Answer 22

+ blood culture x2 12 hrs apart
echocardiogram showing vegetation, abscesses, valve perforation
new regurgitant murmur

Question 23

what are minor criteria for infective endocarditis

Answer 23

predisposing heart condition
temp greater than 100.4
presence of embolic disease or hemorrhage
presence of immunological phenomena (glomerulonephritis, oslers nodes, roths spots, rheumatoid factor)
+ blood culture or echocardiogram

Question 24

what is the pharm for infective endocarditis

Answer 24

confirm with + blood culture and get right abx
4-6 weeks abx –> lengthy hospital stay