Flashcards in Valvular Disease Deck (59):
Why does rheumatic fever contribute to valve disease?
Inflammation caused by rheumatic fever is resolved with scarring and laying down of fibrous tissue, increasing the likelihood go bacteria attaching and forming a vegetation
What does a tapping apex beat indicate?
What does a diffuse apex beat indicate?
Left sided failure and cardiomyopathy
Which 5 features should you use to describe murmurs?
1) Intensity (according to Levine's grading)
2) Timing, eg. early, late or mid systolic/diastolic, pansystolic, holosystolic
3) Character & pitch (quality - plateau, crescendo etc; high/low pitch; blowing/rumbing character)
Mid-systolic ejection murmur, heard best over the aortic area, with radiation into the carotid, particularly on the right
High pitched early diastolic decrescendo murmur a with soft blowing character the left sternal edge with no radiation
Mid-diastolic decrescendo murmur with low pitched rumbling/tapping character heard best over the apex with no radiation
Pansystolic murmur with blowing character heard best in the apex which radiates to the axilla
Pansystolic murmur heard best at the left lower sternal border
Which underlying conditions predispose to infective endocarditis?
• Valvular heart disease, with stenosis or regurgitation (e.g calcifications or post rheumatic fever)
• Valve replacement surgery
• Structural congenital heart disease
• IV drug abuse
• Invasive vascular procedures such as intravascular lines
Which antibiotics should be used for streptococci viridians?
Benzylpenicillin + Gentamicin IV
Which antibiotics should be used for enterococcus faecalis?
Amoxicilin/Vancomycin + gentamicin IV
Which antibiotics should be used for staph aureus?
Flucloxacillin IV (non MRSA)
Vancomycin IV + rifampicin PO (MRSA)
Which antibiotics should be used for staph epidermis?
Vancomycin + gentamicin IV + rifampicin PO
What is a cardiac murmur?
Audible turbulence of blood flow
What is the most common value lesion?
What are the main underlying causes of aortic stenosis?
Degenerative process (age related) or congenital eg. bicuspid valve (2 cusps rather than 3) or rheumatic
What is the pathophysiology of aortic stenosis?
Calcium deposits occur on the cusps and the cusps actually fuse, limiting the volume of blood throug
What are the symptoms of aortic stenosis?
SOB, chest pain and dizziness
What kind of murmur occurs in aortic stenosis?
Ejection systolic murmur that can radiate to the carotids
What are the other signs of aortic stenosis?
• Low volume pulse
• Forceful displaced apex
What is the treatment of aortic stenosis?
Valve replacement, either:
- Conventional valve replacement
- Trans catheter aortic valve replacement (TAVI)
- Balloon Aortic valvotomy (BAV)
What is rheumatic heart disease?
Immune reaction following infection of streptococci
Abnormalities of which structures can cause mitral regurg?
- Leaflets eg. prolapse or rheumatic
- Chordae rupture
- Papillary muscle rupture
- Annular dilation
What are the symptoms of mitral regurg?
• Peripheral oedema
What are the signs of mitral regurg?
• Displaced apex
• Pansystolic murmur in mitral area radiating to the axilla
What is the treatment for mitral regurgitation?
- Primarily treat the HF that occurs with medicine
- Surgical: repair prolapse or replace
What is the main cause of mitral stenosis and what is the underlying pathophysiology?
Mitral stenosis - cusps become almost completely fused
What are the symptoms of mitral stenosis?
• Palpitations (AF)
(As the left atria has to work harder to force blood through the narrowed valve, it hypertrophies which makes it more likely to fibrillate)
What are the signs of mitral stenosis?
• Malar flush
• Tapping apex beat
• Mid diastolic rumbling diastolic murmur localised to apex (mitral area)
What is the treatment for mitral stenosis?
- Medication: Diuretics and treat AF
- Surgery: Valve replacement
- Balloon Valvuloplasty: Essentially uses a catheter to crack the valve open
What kind of problem is aortic regurg fundamentally?
Volume overload problem as opposed to pressure overload
What are the causes of aortic regurg in terms of the structures affected?
- Connective tissue disease
- Aortic dissection
Genetic disorder of connective tissue associated with long arms, high arched pallate, ocular problems and spontaneous pneumothorax
What are the signs of aortic regurg?
• Collapsing pulse
• Displaced apex (due to a volume problem)
• Early diastolic murmur left sternal edge in the tricuspid area
What is the treatment for aortic regurg?
- Medication: ACE inhibitors
- Surgery: Symptoms and LV dilatation or Valve replacement
Which valvular condition will cause a murmur in the aortic area?
Which valvular conditions will cause a murmur in the mitral area?
Mitral regurg and mitral stenosis
Which valvular condition will cause a murmur in the tricuspid area?
True or False: Blood is normally sterile
True, bacteria in the blood stream is bacteraemia
What are predisposing factors to endocarditis?
- Heart valve abnormality eg. calcification/sclerosis in elderly, congenital heart disease or post rheumatic fever
- Prosthetic heart valve
- Intravenous drug users
- Intravascular lines
What is the pathogenesis of endocarditis?
1. Heart valve damaged
2. Turbulent blood flow over roughened endothelium
3. Platelets / fibrin deposited
4. Bacteraemia (may be very transient) e.g. from dental treatment or central line - Organisms settle in fibrin/platelet thrombi becoming a microbial vegetation
6. Infected vegetations are friable and break off, becoming lodged in the next capillary bed they encounter causing abscesses or haemorrhage - may be fatal
Which side of the heart is most commonly affected in endocarditis?
Which organisms most commonly cause endocarditis?
Plus atypical eg. coxiella
Which is the presentation of acute endocarditis?
Overwhelming sepsis and cardiac failure
Which is the presentation of chronic endocarditis?
• Weight loss
• New or changing heart murmur
• finger clubbing
• splinter haemorrhages
• Janeway's lesions/osler's nodes and roth spots
How is endocarditis diagnosed?
1) 3 sets of blood cultures
2) If negative, serology for atypical organisms
Which side of the heart is most commonly affected by IVDU?
Right (tricuspid valve)
What is the most common organisms associated with early-presenting prosthetic valve endocarditis?
Staph aureus or epodermidis - Valve infected at the time of insertion
Which organism is most associated with endocarditis with IVDUs?
Which antibiotics are used for native valve endocarditis?
Amoxicillin & gentamicin IV
Which antibiotics are used for prosthetic valve endocarditis?
Vancomycin & gentamicin IV & rifampicin PO
But usually valve replacement is required
Which antibiotics are used for drug user endocarditis?
Which antibiotics are used for endocarditis caused by viridian's strep?
Benzylpenicillin & gentamicin IV
Which antibiotics are used for endocarditis caused by staph epidermidis?
Vancomycin & gentamicin IV & rifampicin P
Inflammation of cardiac muscle
What is the presentation of myocarditis?
Symptoms: fever, chest pain, shortness of breath, palpitations
Signs: arrythmia, cardiac failure
How is myocarditis diagnosed?
• viral PCR
• Throat swab and stool for enteroviruses
• Throat swab for influenza