heart 7b inflammation

Question 1

Myocarditis

Answer 1

Focal or diffuse inflammation of
the myocardium
Most patients with mild
symptoms completely recover
Others may develop cardiac
dysfunction and
cardiomyopathy
The degree of inflammation and
necrosis determines the
haemodynamic effect

Question 2

Myocarditis causes

Answer 2

Viral (influenza, HIV, coxsackievirus A &
B)
Bacterial
Parasitic
Rheumatic Fever
Patients with IE
Rheumatic disease (SLE, Chrohns)
Radiation therapy
Pharmacological agents
(immunosuppressants, anthracycline
antibiotics for cancer patients)

Question 3

Multidisciplinary Care and Management myocarditis

Answer 3

Determine cause and treat as appropriate.
• Educate and reassure patient
• Ensure adequate rest (physical activity to be reduced until cardiac
function improves, sometimes up to 6 months)
• Prevent thromboembolic complications
• Monitor for signs and symptoms of heart failure
• Patient may need cardiac monitoring

Question 4

Valvular Heart Disease

Answer 4

Stenosis:
• Prolapse
• Regurgitation

Question 5

Stenosis:

Answer 5

valve that is unable to open fully,

restricting the forward flow of blood.

Question 6

Prolapse:

Answer 6

valve (mitral) abnormality in the leaflet,
papillary muscles or cordae that allows the leaflets
to buckle back (prolapse) into the atrium during
systole

Question 7

Regurgitation

Answer 7

ncomplete closure of the valve
resulting in backwards flow of blood (also called
incompetence or insufficiency)

Question 8

Aortic Valvular Disease

Answer 8

Aortic Stenosis

Aortic regurgitation

Question 9

Aortic Stenosis

Answer 9

• One of the most commonly acquired
valvular diseases.
• Normal aortic valve has three leaflets,
however some people are born with 1
or 2 aortic valve leaflets.
• The narrowed aortic valve leads to LV
dilation. Eventually leading to LV
failure with decrease in cardiac output
and ejection fraction.

Question 10

Causes Aortic Stenosis

Answer 10

Aortic stenosis is often the result of
degenerative calcifications caused by
inflammatory processes, congenital
abnormalities or rheumatic endocarditis

Question 11

Aortic regurgitation

Answer 11

Leads to leakage of blood from the
aorta into the LV during
diastole/repolarisation as the valve
leaflets do not close properly
Regurgitation through the aortic valve
leads to LV dilation and hypertrophy,
eventually LVF.

Question 12

Aortic regurgitation causes

Answer 12

Causes include congenital heart
abnormalities, infectious diseases,
endocarditis, dissecting aneurysm or
deterioration of an aortic valve
replacement. Can also be idiopathic.

Question 13

Mitral Valve disease

Answer 13

Mitral valve prolapse
Mitral valve regurgitation
Mitral valve stenosis

Question 14

Mitral valve prolapse

Answer 14

This valve is under
significant pressure
• It is the most
common valve
disorder, 25
-50% of
cases are hereditary.
• Can progress to MR

Question 15

Mitral valve regurgitation

Answer 15

MR leads to leakage of
blood between the LV and
LA during systole
• Caused by degenerative
changes in the mitral valve
(stenosis) or ischaemia to
LV (MI), IE, RHD, structural
changes to the left atrium
or ventricle and collagen
-
vascular diseases (SLE)

Question 16

Mitral valve stenosis

Answer 16

Decreases the amount of
blood flowing into the LV
due to thickened,
narrowed valve.

Question 17

Pulmonary Valve Disease

Answer 17

Pulmonary valve disease usually
related to congenital problems
• Leads to right sided heart failure
• Often discovered in infants more
commonly than in adults
• Causes include congenital
anomalies, cardiac tumors,
pulmonary hypertension,
dilation of pulmonary artery and
trauma

Question 18

Tricuspid valve disease

Answer 18

rare/uncommon
• Stenosis occurs more commonly
than regurgitation
• Leads to right atrial enlargement
and elevated systemic venous
pressures
• Causes include RHD, congenital
anomalies, right atrial tumor,
extracardiac tumors and
pacemaker leads

Question 19

Although rare triple
valve disease can
occur in patients who
have RHD

Answer 19

involves
the mitral, aortic and
tricuspid valves.
Patients often present
in heart failure and
need prompt surgical
management

Question 20

Diagnosis of Valvular Heart Disease

Answer 20

• Patient history
• Physical assessment
• Chest X-ray
• ECG
• Echocardiogram (Doppler or
TOE)
• Cardiac catheterisation

Question 21

Management of Valvular Heart Disease

Answer 21

The purpose of valvular intervention is to improve symptoms and/or
prolong survival, as well as to minimize the risk of valvular heart
disease related complications such as asymptomatic irreversible
ventricular dysfunction, pulmonary hypertension, stroke and atrial
fibrillation.

Question 22

Management of Valvular Heart Disease

Conservative therapy

Answer 22

Prevent ARF and IE
• Ensure patient understands and adheres to medication regime
• Monitor for adverse effects of medications
• Monitor vital signs
• Auscultate heart and lung sounds and assess peripheral pulses
• Monitor for signs and symptoms of heart failure
• Monitor patient for angina and palpitations. Ensure patient is aware of how to
take glyceryl trinitrate for angina
• Ensure patient gets adequate rest and sleep
• Weigh patient daily and monitor for weight gain over 1.5 kg in a day or 3 kg in a
week

Question 23

Surgical Management

Answer 23

The majority of valve replacements are aortic valves followed by mitral. Many surgical
procedures require a sternotomy and cardiopulmonary bypass surgery. Some
procedures can not be performed via minimally invasive techniques