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General medicine - cardiology > Valvular disease > Flashcards

Valvular disease Flashcards

(50 cards)

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1
Q

What is infective endocarditis

A

infection of the endothelium, most commonly affecting the heart valves

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2
Q

5 RFs for infective endocarditis

A
  • previous episode of endocarditis
  • rheumatic valve disease
  • IV drug users
  • prosthetic valves
  • congenital heart defects
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3
Q

What valve is most commonly affected in infective endocarditis

A

mitral valve

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4
Q

What valve is most commonly affected in IVDU with infective endocarditis

A

tricuspid valve

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5
Q

Infective causes of infective endocarditis

A
  • Staphylococcus aureus - mc
  • Strep viridans - poor dental hygiene
  • staph epidermidis - mc <2m post prosthetic valve surgery
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6
Q

Give a non-infective cause of infective endocarditis

A

systemic lupus erythematosus

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7
Q

What criteria is used to diagnose infective endocarditis

A

Modified Duke criteria

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8
Q

According to the modified Duke criteria, what is required for diagnosis of infective endocarditis

A
  • 2 major criteria, or
  • 1 major and 3 minor criteria, or
  • 5 minor criteria
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9
Q

What are the major criteria of the modified Duke criteria

A
  1. Positive blood cultures
    * two separate positive blood cultures showing typical organisms
    * persistent bacteraemia from two blood cultures taken > 12 hours apart
    * positive serology for Coxiella burnetii
  2. Evidence of endocardial involvement
    * positive echocardiogram: oscillating mass, abscess dehiscence of prosthetic valves)
    * new valvular regurgitation
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10
Q

What are the minor criteria of the modified Duke criteria

A
  • predisposing heart condition or IVDU
  • fever > 38ºC
  • vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura
  • Immunological phenomena: glomerulonephritis, Osler’s nodes, Roth spots
  • microbiological evidence does not meet major criteria
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11
Q

How is infective endocarditis investigated

A
  • three sets of blood cultures from different sites taken at 30-minute intervals
  • ECHO - vegetations
  • prosthetic valve - 18F-FDG-PET/CT and SPECT may be used
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12
Q

What is the empirical treatment of choice in infective endocarditis where the causative agent hasn’t been confirmed

A
  • amoxicillin +/- low dose gentamicin
  • if penicillin allergy: vancomycin + low-dose gentamicin
  • If prosthetic valve: vancomycin + rifampicin + low-dose gentamicin
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13
Q

What is the suggested antibiotic therapy for native valve endocarditis caused by staphylococci

A
  • Flucloxacillin
  • If penicillin allergic/ MRSA: vancomycin + rifampicin
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14
Q

What is the suggested antibiotic therapy for prosthetic valve endocarditis caused by staphylococci

A
  • Flucloxacillin + rifampicin + low-dose gentamicin
  • If penicillin allergic/ MRSA: vancomycin + rifampicin + low-dose gentamicin
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15
Q

What is the suggested antibiotic therapy for endocarditis causes by fully sensitive streptococci

A

Benzylpenicillin

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16
Q

When managing infective endocarditis, how long are antibiotic therapies continued for

A
  • native valve: 4-6 weeks
  • prosthetic valve: 6 weeks
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17
Q

What are the indications for surgical management of infective endocarditis

A
  • severe valvular incompetence
  • aortic abscess (lengthening PR interval)
  • infections resistant to antibiotics/fungal infections
  • congestive heart failure
  • recurrent emboli after antibiotic therapy
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18
Q

What is the most common valvular heart disease

A

aortic stenosis

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19
Q

What are the clinical features of symptomatic aortic stenosis?

A
  • Chest pain
  • dyspnoea
  • syncope/presyncope (e.g. exertional dizziness)
  • murmur
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20
Q

Describe the murmur typically heard in aortic stenosis

A
  • Ejection systolic, high-pitched murmur
  • crescendo-decrescendo
  • classically radiates to the carotids
  • this is decreased following the Valsalva manoeuvre
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21
Q

What are the features of severe aortic stenosis?

Study These Flashcards
A
  • narrow pulse pressure
  • slow rising pulse
  • soft/absent S2
  • S4
  • thrill
  • LVH
22
Q

What are some causes of aortic stenosis

Study These Flashcards
A
  • idiopathic age-related calcification (>65yrs)
  • bicuspid aortic valve
  • rheumatic heart disease
23
Q

What is the general management for asymptomatic aortic stenosis?

Study These Flashcards
A

Observe the patient.

24
Q

What is the management approach for symptomatic aortic stenosis?

Study These Flashcards
A

Valve replacement

25
When should surgery be considered for asymptomatic aortic stenosis?
If valvular gradient > 40 mmHg and left ventricular systolic dysfunction is present
26
What are the options for aortic valve replacement (AVR)?
* Surgical AVR (young/low-medium risk) * transcatheter AVR ( for high-risk patients) * balloon valvuloplasty (children or adults unfit for surgery).
27
What is aortic regurgitation?
It is the leaking of the aortic valve causing reverse blood flow into the left ventricle during diastole.
28
Name causes of chronic aortic regurgitation due to valve disease.
* Rheumatic fever * calcific valve disease * bicuspid aortic valve.
29
Name causes of chronic aortic regurgitation due to aortic root disease
* Bicuspid aortic valve * ankylosing spondylitis * hypertension * connective tissue disorders e.g. Marfan’s syndrome, Ehlers-Danlos syndrome.
30
What are causes of acute aortic regurgitation?
Infective endocarditis and aortic dissection
31
What murmur is characteristic of aortic regurgitation?
Early diastolic, soft murmur - increased by the handgrip manoeuvre.
32
Name four peripheral signs of severe aortic regurgitation.
* Collapsing pulse * wide pulse pressure * Quincke’s sign (nailbed pulsation) * De Musset’s sign (head bobbing).
33
What is the Austin-Flint murmur and when is it heard?
A mid-diastolic rumbling murmur (heard at the apex) in severe AR caused by regurgitant blood flow partially closing the anterior mitral valve cusp.
34
What is the management for aortic regurgitation?
* medical management of any associated heart failure * surgery: for severe cases
35
What is mitral stenosis?
Obstruction of blood flow from the left atrium to the left ventricle, causing increased pressure in the left atrium, pulmonary vasculature, and right heart.
36
What are some causes of mitral stenosis
* rheumatic fever (mc) * carcinoid syndrome
37
What are the main clinical features of mitral stenosis?
* Dyspnoea * haemoptysis * murmur * loud S1 * opening snap (indicates mitral valve leaflets are still mobile) * low volume pulse * malar flush * atrial fibrillation
38
Describe the murmur heard in mitral stenosis
mid-late diastolic, low-pitched rumbling murmur (best in expiration)
39
What causes haemoptysis in mitral stenosis?
Pulmonary hypertension and vascular congestion; may be mild (pink frothy sputum) or severe (sudden haemorrhage).
40
What causes malar flush in mitral stenosis
due to the back pressure of blood into the pulmonary system. causing a rise in CO2 and vasodilation
41
What might a chest X-ray show in mitral stenosis?
Left atrial enlargement
42
What is the recommended anticoagulation for moderate/severe mitral stenosis with atrial fibrillation?
Warfarin (vitamin K antagonist).
43
How are asymptomatic patients with mitral stenosis managed?
Regular echocardiographic monitoring; no intervention if stable
44
What are management options for symptomatic mitral stenosis?
Percutaneous mitral balloon valvotomy or mitral valve surgery (commissurotomy or replacement).
45
What is mitral regurgitation ?
A condition where blood leaks back through the mitral valve during systole, reducing the efficiency of the heart’s pumping action.
46
What are some risk factors for mitral regurgitation?
* mitral valve prolapse * rheumatic heart disease * infective endocarditis * history of ischaemic heart disease/ MI * collagen disorders (e.g., Marfan's, Ehlers-Danlos).
47
What are the symptoms of mitral regurgitation?
often asymptomatic * fatigue * SOB * oedema * arrhythmias * murmur
48
What is the characteristic murmur of mitral regurgitation?
A pansystolic (holosystolic) blowing murmur, heard best at the apex and radiating to the axilla. S1 may be quiet, and severe MR may cause a widely split S2.
49
What findings on an ECG might suggest mitral regurgitation?
A broad P wave, indicative of atrial enlargement.
50
What is the medical management for acute mitral regurgitation?
* pre-surgery: Nitrates, diuretics, positive inotropes, and an intra-aortic balloon pump * emergency surgery

General medicine - cardiology (5 decks)

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