Valve disease and infective endocarditis Flashcards

(45 cards)

1
Q

What valves are on the left side of the heart

A

aortic and mitral

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2
Q

what valves are on the right side of the heart

A

pulmonary and tricuspid

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3
Q

what valves most commonly fail

A

left

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4
Q

how are valve failures treated

A

prosthetic valves

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5
Q

what does stenosis mean

A

narrowing

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6
Q

what does valve incompentence mean

A

can’t close properly

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7
Q

what does stenosis and valve incompetence increase risk of

A

heart failure

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8
Q

how can an MI cause heart valves to fail

A

damages the papillary muscles that are attached to the cusplets of the valve. These muscles keep the valves under tension

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9
Q

how does valve stenosis cause heart problems

A

with the e.g. mitral valve not opening properly there is a build up of pressure in left atria and less is going into the ventricle to get pumped round the body

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10
Q

what are symptoms of valve problems

A

rarely any (most elderly don’t know they have it cause their activity is low)

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11
Q

what are common risk factors for valve problems

A
  • elderly
  • Downs
  • rheumatic heart disease
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12
Q

What causes valve disease?

A
  • Congenital abnormality
  • myocardial infarction
  • rheumatic fever
  • dilation of the aortic root
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13
Q

what is rheumatic fever

A

immunological reaction to streptococci

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14
Q

what could cause dilation of the aortic root

A
  • syphilis

- aneurysm formation

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15
Q

why might a myocardial infarction cause valve disease

A

papillary muscle rupture

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16
Q

how is valve disease investigated

A

ultrasound with the blood coloured (red = right direction, blue = wrong direction)

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17
Q

What are the options for valve replacement?

A
  • mechanical

- porcine

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18
Q

Advantages/ disadvantages of porcine valves

A

advantages:

  • right size
  • no need for anticoagulants
  • children will need a new one anyway
  • elderly might not live more than 10 years + don’t want them on anticoagulants

disadvantages:
- don’t last as long as metal

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19
Q

Advantages/ disadvantages of metal valves

A

Advantages:
- last a long time (fewer replacements the better)

Disadvantages:
- need to be on anticoagulants

20
Q

what do dentists have to be particularly aware of with patients that have valve replacements

A

high risk for infective endocarditis

- may need antibiotics

21
Q

What kind of congenital heart defects are there

A
  • atrial septal defects
  • ventricular septal defects
  • patent ductus arteriosus
  • great vessel malformations
22
Q

what are risk factors for congenital heart defects

A

other defects e.g. cleft palate, downs etc

23
Q

why are ventricular septal defects particularly bad

A
  • in a high pressure system
  • increases workload of right side of the heart as left side pumps to right as well as round the body if left is defected
  • needs repaired or right side could fail
24
Q

what can cause central and peripheral cyanosis

A

central - congenital heart disease

peripheral - cold environment

25
when does cyanosis exist
when there is 5g/dl or more of deoxygenated Hb in the blood
26
when does finger clubbing happen
central cyanosis | lung cancer and IBD too
27
what could be a sign of an atrial septal defect on an xray
enlargement of atria
28
what is the narrowing of the aorta called
co-arctation of the aorta
29
why does the patent ductus need to close immediately after birth
- connects pulmonary artery to aorta - when you start breathing oxygen tension increases - needs to shut otherwise blood will change direction (blood going from aorta to lungs) - will lead to heart failure if not treated
30
sign of patent ductus not closed?
central cyanosis (blue babies)
31
do congenital heart abnormalities mean they are always a risk for endocarditis
case by case basis - check with cardiologist
32
what is infective endocarditis
infection of the endocardium (usually on the valves)
33
what causes infective endocarditis
microbial colonisation of thrombi on endocardial surface abnormalities
34
how common is infective endocarditis
1400 new cases each year (UK) - 200 deaths
35
what is happens in infective endocarditis?
- enlargement of vegetation - surface abnormalities - haemodynamic changes - turbulence - platelet/ fibrin deposition - vegetation microbial attachment and multiplication (and back to the start)
36
What are some common physical findings in patients with infective endocarditis
- fever - heart murmur - embolic phenomena - skin manifestations - splenomegaly - septic complications e.g. pneumonia meningitis - mycotic aneurysm
37
what organisms are involved in infective endocaridits
- streptococci - staphylococci - fungi
38
what are the effects of infective endocarditis
- prolonged antibiotic treatment | - cardiac valve damage
39
how can you prevent infective endocarditis
- medical history to identify at risk patients - avoid risky procedures - use antibiotic prophylaxis when needed?
40
What is the NICE guidelines for whether or not we can prescribe antibiotics for at risk patients
can be used in special circumstances as possible harm from ABR and no indication from literature of benefit "Antibiotic prophylaxis against infective endocarditis is not recommended routinely"
41
What is the montgomery issue?
- not the dentist's decision - dentist's role to advise - advise high risk patients about evidence for and against Dental role: - consequences of having and not having AB prophylaxis must be discussed Patient role: - discuss with cardiac team (dentist informed of decision)
42
What dental issues should be considered if prophylaxis is recommended
- is the procedure to be performed 'high risk' - is patient wanting prophylaxis - what does SDCEP recommend in these circumstances
43
what is the drug regime for antibiotic prophylaxis
amoxycillin 3g oral 1hr before procedure | unless allergic
44
if allergic to amoxycillin, what is the drug regime for antibiotic prophylaxis
clindamycin 1.5g (higher risk) - only use if allergic to amoxycillin
45
apart from giving antibiotics, how can we reduce the chance of a high risk patient getting infective endocarditis
- attendance for oral care - rapid management infection - maximal oral hygiene and prevention - avoiding risk activity e.g. piercings