Exam 2: Ch 19 Endocardial & Valve Disorders

Question 1

infective endocarditis

Answer 1

infection of endocardium including valves

vegetative growth on valve leaflets –> regurgitation

septic emboli break free from growths

requires both heart damage and introduction of the organism – dental work in person w/ valve disease

Question 2

infective endocarditis is most commonly seen in people with…

Answer 2

preexisting heart defects

IV drug use: staph. A

heart surgery: staph. epidermis from prosthetic valve

Question 3

symptoms of infective endocarditis

Answer 3

systemic infection

petechial (pinpoint) hemorrhages from emboli

Question 4

diagnosis and treatment of infective endocarditis

Answer 4

Dx: blood cultures and echo for regurgitation

Rx: antibiotics, treat cardiac symptoms

Question 5

rheumatic heart disease

Answer 5

immune response to beta-hemolytic strep infection

Question 6

symptoms of rheumatic heart disease

Answer 6

sore throat and swollen glands

carditis –> heart murmur and friction rub

polyarthritis of large joints

skin lesions

CNS involvement –> choreiform movements (jerking)

Question 7

diagnosis/treatment of rheumatic heart disease

Answer 7

Dx: clinical picture, echo, presence of anti-strep Ab

Rx: prevent by treating strep throat

antibiotics to control infection

anti-inflammatories to limit valve damage

Question 8

2 types of valvular heart disease

Answer 8

stenotic: produce resistance to forward blood flow

incompetent (regurgitate) valves: close incompletely, producing backflow

Question 9

mitral stenosis

Answer 9

mitral valve doesn’t open all the way, often from fused leaflets from RHD

LV fills poorly (low SV and CO)

LA pressure is increased (pulmonary congestion)

Question 10

symptoms of mitral stenosis

Answer 10

less CO: chest pain, weakness, fatigue

pulmonary congestion: SOB, AF, thrombi, Rt side HF

diastolic murmur

Question 11

mitral regurgitation

Answer 11

mitral valve fails to close fully

retrograde flow into LA during systole –> systolic murmur

high LAP leads to high SV, but low forward SV

enlarged LV b/c volume work increased

eventually LV function is impaired

Question 12

causes of mitral regurgitation

Answer 12

RHD

mitral valve prolapse

chordea tenineae/papillary muscle rupture

Question 13

mitral valve prolapse

Answer 13

caused by Marfan’s syn, other conn. tissue disorders

beta blockers relieve symptoms

antibiotic prophylaxis to prevent complications

can cause mitral regurgitation

Question 14

aortic stenosis

Answer 14

narrowed aortic valve increases resistance to LV ejection

pressure work of LV increased, SV decreased

systolic BP lowered, but LVP increased

systolic murmur

Question 15

causes and symptoms of aortic stenosis

Answer 15

causes: congenital defect, acquired calcification
symptoms: angina, syncope (fainting), HF

Question 16

aortic regurgitation

Answer 16

backflow from aorta to the LV during diastole

high SV, but CO to tissues decreased

low DBP, low CA perfusion

Diastolic murmur

LV failure if acute

LV dilation and hypertrophy if chronic

Question 17

symptoms of aortic regurgitation

Answer 17

LV failure symptoms (dyspnea)

angina if DBP too low

Question 18

pericardium

Answer 18

double-layered serous membrane … visceral and parietal

visceral: adheres to epicardium
parietal: fibrous and still

pericardium fluid in pericardial space

Question 19

pericardial disease 3 types

Answer 19

acute pericarditis

pericardial effusion

cardiac tamponade

Question 20

acute pericarditis

Answer 20

inflammation of pericardium from viral infection or systemic disease

exudate common –> scar formation

scar tissue on pericardium contracts = constrictive pericarditis

Question 21

symptoms of acute pericarditis

Answer 21

chest pain

pericardial friction rub

ECG changes (high ST segments, low PR interval)

Question 22

diagnosis and treatment of acute pericarditis

Answer 22

Dx: low VR –> ascites and distended jugular veins

Rx: antibiotics, NSAIDS

surgical resection

Question 23

pericardial effusion

Answer 23

accumulation of serous fluid or blood in pericardial space

develops from trauma, inflammation, abnormal starlings forces

Rx: NSAIDS, pericardiocentesis (depends on size)

Question 24

cardiac tamponade

Answer 24

life threatening complication of pericardial effusion

sudden increase in pericardial fluid & pericardial pressure

low venous return

patient in shock: high HR, low BP/CO, jugulars distended

Question 25

pulsus paradoxus

Answer 25

part of cardiac tamponade LV compressed from effusion inspiration leads to high VR, reptum bulges to left low SV and BP

Question 26

causes of cardiac tamponade

Answer 26

surgery trauma cardiac rupture from MI

Question 27

diagnosis/treatment of cardiac tamponade

Answer 27

Dx: ECG Rx: percutaneous pericardiocentesis surgical repair of trauma or cardiac rupture

Question 28

3 types of primary cardiomyopathy

Answer 28

genetic mixed acquired

Question 29

genetic: hypertrophic cardiomyopathy

Answer 29

excessive hypertrophy in septum causes outflow obstruction -> symptoms like aortic stenosis can cause sudden cardiac death

Question 30

cause of hypertrophic cardiomyopathy

Answer 30

autosomal dominant disorder: mutations of cardiac muscle genes seen in children/young adults

Question 31

symptoms of hypertrophic cardiomyopathy

Answer 31

dyspnes chest pain fatigue syncope with outflow obstruction

Question 32

diagnosis and treatment of hypertrophic cardiomyopathy

Answer 32

Dx: echo Rx: beta blockers to lower HR and increase LV filling surgical excision of septum

Question 33

mixed genetic: dilated cardiomyopathy

Answer 33

ventricles dilated w/ thin walls --> pump poorly from infection, toxins (EtOH), autoimmune, genetics

Question 34

symptoms and treatment of dilated cardiomyopathy

Answer 34

HF (low EF, PVCs), dyspnea, weakness Rx: relieve HF symptoms with Digoxin, diuretics, vasodilators

Question 35

2 types of acquired cardiomyopathy

Answer 35

myocarditis peripartum cardiomyopathy

Question 36

myocarditis

Answer 36

inflammation of heart muscle leads to necrosis usually viral: coxsackievirus or HIV

Question 37

mechanism of necrosis in myocarditis

Answer 37

direct cell destruction from infection toxins released by infectious agent autoimmune -- molecular mimicry

Question 38

symptoms, diagnosis, treatment of myocarditis

Answer 38

symptoms: none to HF, death, URI, flu-like symptoms Dx: ECG, echo, CXR, biopsy Rx: bed rest, O2, steroids, immune suppressants, antivirals, hemodynamic support

Question 39

peripartum cardiomyopathy

Answer 39

develops late in pregnancy or in months after delivery systolic HF causes: infection, immune response, genetics??? may resolve spontaneously, but maybe not