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BDS2 BAMS Cardiovascular medicine > Valve disease and infective endocarditis > Flashcards

Valve disease and infective endocarditis Flashcards

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
Q

when does cyanosis exist

A

when there is 5g/dl or more of deoxygenated Hb in the blood

26
Q

when does finger clubbing happen

A

central cyanosis

lung cancer and IBD too

27
Q

what could be a sign of an atrial septal defect on an xray

A

enlargement of atria

28
Q

what is the narrowing of the aorta called

A

co-arctation of the aorta

29
Q

why does the patent ductus need to close immediately after birth

A
  • 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
Q

sign of patent ductus not closed?

A

central cyanosis (blue babies)

31
Q

do congenital heart abnormalities mean they are always a risk for endocarditis

A

case by case basis - check with cardiologist

32
Q

what is infective endocarditis

A

infection of the endocardium (usually on the valves)

33
Q

what causes infective endocarditis

A

microbial colonisation of thrombi on endocardial surface abnormalities

34
Q

how common is infective endocarditis

A

1400 new cases each year (UK) - 200 deaths

35
Q

what is happens in infective endocarditis?

A
  • enlargement of vegetation
  • surface abnormalities
  • haemodynamic changes
  • turbulence
  • platelet/ fibrin deposition
  • vegetation
    microbial attachment and multiplication
    (and back to the start)
36
Q

What are some common physical findings in patients with infective endocarditis

A
  • fever
  • heart murmur
  • embolic phenomena
  • skin manifestations
  • splenomegaly
  • septic complications e.g. pneumonia meningitis
  • mycotic aneurysm
37
Q

what organisms are involved in infective endocaridits

A
  • streptococci
  • staphylococci
  • fungi
38
Q

what are the effects of infective endocarditis

A
  • prolonged antibiotic treatment

- cardiac valve damage

39
Q

how can you prevent infective endocarditis

A
  • medical history to identify at risk patients
  • avoid risky procedures
  • use antibiotic prophylaxis when needed?
40
Q

What is the NICE guidelines for whether or not we can prescribe antibiotics for at risk patients

A

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
Q

What is the montgomery issue?

A
  • 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
Q

What dental issues should be considered if prophylaxis is recommended

A
  • is the procedure to be performed ‘high risk’
  • is patient wanting prophylaxis
  • what does SDCEP recommend in these circumstances
43
Q

what is the drug regime for antibiotic prophylaxis

A

amoxycillin 3g oral 1hr before procedure

unless allergic

44
Q

if allergic to amoxycillin, what is the drug regime for antibiotic prophylaxis

A

clindamycin 1.5g (higher risk) - only use if allergic to amoxycillin

45
Q

apart from giving antibiotics, how can we reduce the chance of a high risk patient getting infective endocarditis

A
  • attendance for oral care
  • rapid management infection
  • maximal oral hygiene and prevention
  • avoiding risk activity e.g. piercings

BDS2 BAMS Cardiovascular medicine (5 decks)

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