Valvular Heart Disease Flashcards Preview

Cardiovascular > Valvular Heart Disease > Flashcards

Flashcards in Valvular Heart Disease Deck (19):
1

Name a bacteria that can infect prosthetic materials such as replacement heart valves, but is also a common skin contaminant.

Staphylococcus epidermidis

2

What is important when taking blood cultures (for endocarditis)?

Take 3 sets - evidence of continuing bacteraemia/rule out contamination

Take before giving antibiotics

If negative, consider serology for unusual organisms

3

Give some risk factors for endocarditis.

Heart valve abnormality

Prosthetic heart valve

IV drug use

Intravascular lines

4

What is the pathogenesis of endocarditis?

Turbulent blood flow over a damaged heart valve causes the deposition of platelets and fibrin upon which bacteria can form a vegetation

5

What is the danger with infected vegetations on heart valves?

Infected vegetations are friable and can break off, lodging in capillary beds causing abcesses or (fatal) haemorrhage

6

Which valves are most commonly affected by endocarditis?

Mitral and aortic valves

7

How does endocarditis usually present?

overwhelming sepsis and cardiac failure

8

What are subacute presentations of endocarditis?

Fever

Malaise

Weight Loss

Tiredness

Breathlessness

9

Give some signs of a subacute presentation of endocarditis.

Fever

New/changing heart murmur

Finger clubbing

Splinter haemorrhages

Splenomegaly

Roth spots, Janeway lesions, Osler nodes

Microscopic haematuria

10

After blood cultures, what is the standard investigation for endocarditis?

Echocardiogram

11

What is the difference in causative organisms for early (within 60 days) and late presentations of prosthetic valve endocarditis?

Early - usually Staph. epidermidis or Staph. aureus

Late - co-incidental bacteraemia, wide range of possible organisms

12

What are the typical features of endocarditis in IV drug users?

Right-sided endocarditis - tricuspid valve

Usually Staph. aureus, may present as 'pneumonia'

May not require valve replacement, but long term prognosis poor

13

What are the empirical treatments for endocarditis?

High-dose, frequent IV antibiotics.

Native valve - Benzylpenicillin & gentamicin

Prosthetic valve - Vancomycin & gentamicin (usually valve replacement required)

IV drug users - Flucloxacillin

14

How long is IV therapy normally given for in infective endocarditis?

What else should be done?

4-6 weeks

Monitor cardiac function, temperature & CRP

Consider early referral for surgery if not responding

15

When should antibiotic prophylaxis for endocarditis be given?

Patients with heart valve lesions, congenital heart defects or prosthetic heart valves:

GI or GU procedures if infection suspected

16

What is myocarditis?

What are the symptoms and signs?

Inflammation of cardiac muscle.

Fever, chest pain, dyspnoea, palpitations

Arrhythmia, cardiac failure

17

What are the main causes of myocarditis?

How are they diagnosed?

Enteroviruses - Coxsackie A&B, echovirus

Viral culture/PCR

Throat swab, stool sample, serology

18

How are myocarditis and pericarditis managed?

Supportive treatment

(Antibiotics and drainage for bacterial pericarditis)

19