Valvular Heart Disease

Question 1

What is infective endocarditis?

Answer 1

An infection of the endocardium or vascular endothelium

Question 2

Where does IE typically affect?

Answer 2

Heart valves
Usually due to bacteria entering blood stream and forming a vegetation

Question 3

What is a vegetation?

Answer 3

A bacterial infection surrounded by a layer of platelets and fibrin

Question 4

What is the most common infection in IE?

Answer 4

Streptococci (20-40%)

Question 5

Criteria to diagnose IE?

Answer 5

Duke’s Criteria

Question 6

Duke’s major criteria?

Answer 6

Consistently positive blood culture for typical organisms
ECHO - vegetation, dehiscence of prosthetic valve, abscess
New valvular regurgitation murmur
Coxiella burnetti infection

Question 7

Duke’s minor criteria?

Answer 7

Predisposing heart condition or IV drug use
Fever (over 38)
Vascular - emboli to organs or brain
Immunogenic - glomerulonephritis, Osler nodes, Roth spots
Positive blood cultures that do not meet specific criteria

Question 8

Which echo has higher sensitivity?

Answer 8

Trans oesophageal > trans thoracic

Question 9

Definitive endocarditis based on Duke’s?

Answer 9

-2 major criteria
-1 major and 3 minor
-5 minor
-positive gram stain

Question 10

Possible endocarditis?

Answer 10

-1 major and more than 1 minor
-3 minor

Question 11

Rejected endocarditis based on Duke’s?

Answer 11

Resolution after less than 4 days ABx
No evidence of infection after surgery
Definite or possible criteria not met

Question 12

Heart decompensation symptoms in IE?

Answer 12

Shortness of breath
Frequent coughing
Swelling of legs and abdomen
Fatigue

Question 13

Heart decompensation clinical signs in IE?

Answer 13

Raised JVP
Lung crackles
Oedema

Question 14

Other IE complications?

Answer 14

Vascular and embolic phenomena
Osler’s nodes, Roth spots

Question 15

What part of the heart does IE affect?

Answer 15

Endocardium, especially valves
Aortic valve most frequently affected (aortic > mitral > right side)

Question 16

IE most affected in IV drug use?

Answer 16

Right side as venous return

Question 17

Dilated cardiomyopathy definition?

Answer 17

Dilated and thin-walled cardiac chambers with reduced contractility
Echo shows dilated LV with reduced systolic function (ejection fraction) and typically GLOBAL HYPOKINESIS)

Question 18

Most common causes of dilated cardiomyopathy?

Answer 18

Idiopathic
Genetic
Toxins
Pregnancy
Viral infections (myocarditis)
Tachycardia related
Thyroid related
Muscular dystrophies

Question 19

How is dilated cardiomyopathy managed?

Answer 19

Heart failure therapy (ACEi, BB, mineralcorticoid receptor antagonists)
Diuretics for fluid overload
Anticoagulation for afibrillation
Cardiac devices
Transplant

Question 20

Future risks of dilated cardiomyopathy?

Answer 20

Risk of heart failure hospitalisation
Cardiac arrhythmias
Sudden cardiac death due to ventricular arrhythmias
Reduced survival

Question 21

What is heart failure with preserved ejection fraction?

Answer 21

EF greater than 50%
Presence of diastolic or right heart dysfunction

Question 22

What does diastolic dysfunction in HF with preserved EF lead to?

Answer 22

Increased reservoir of blood in pulmonary veins -> pulmonary hypertension and pulmonary oedema

Question 23

What is HF with reduced ejection fraction?

Answer 23

EF less than 50%
Impaired LV systolic function

Question 24

What does impaired LV systolic function in HF with reduced EF lead to?

Answer 24

Pulmonary oedema secondary to impaired systolic function and flow of blood via the aorta
Leads to back flow of blood into pulmonary veins and lungs -> pulmonary oedema

Question 25

Clinical signs of right sided heart failure?

Answer 25

Peripheral oedema (leg swelling, raised JVP)

Question 26

Clinical signs of left sided heart failure?

Answer 26

Pulmonary oedema

Question 27

What medications are used to treat heart failure with preserved EF?

Answer 27

Diuretics
SGLT2 inhibitors

Question 28

What medications are used to treat heart failure with reduced EF?

Answer 28

ACEi
Angiotensin II receptor blockers (performulated in Entrestro)
Beta blockers
Mineralcorticoid receptor antagonists
SGLT2 inhibitors
Diuretics

Question 29

How is heart failure monitored? Clinical, observations

Answer 29

Clinical - signs and symptoms of fluid overload (shortness of breath, leg swelling, orthopnea)
Reduced exercise tolerance due to shortness of breath
Obs- low oxygen saturation

Question 30

Heart failure bio marker?

Answer 30

NT-proBNP