Valvular heart disease and endocarditis Flashcards Preview

Year 3 - CR > Valvular heart disease and endocarditis > Flashcards

Flashcards in Valvular heart disease and endocarditis Deck (81)
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1

What does a stenotic valve lead to

- leads to hypertrophy followed by dilatation and reduced function

2

What does a regurgitant valve result in

- Volume overload
- this leads to dilatation followed by reduced function

3

How do you assess valve disease

• History
• Examination
• ECG
• Echo
• CXR
• Cardiac catheterization +/- angiography

4

What causes aortic stenosis

• Bicuspid aortic valve (presents in there 30s to 40s) and other congenital abnormality
• Degenerative over the long term (present in there 60s, 70s, and 80s)
• rheumatic fever

5

What causes aortic regurgitation

• Bicuspid/other congenital abnormality
• Degenerative
• Dilated aortic root e.g. secondary to hypertension
• Endocarditis
• Aortic root dissection - such as marinas disease

6

What are the symptoms of aortic stenosis and how do they present

- Don't tend to get symptoms until aortic stenosis is moderately severe
Primarily on exertion in the early phase
• Chest pain
• Dyspnoea
• Syncope
• Symptoms of CCF

- as disease come more severe they have earlier onset and at rest
- can eventually lead to heart failure

7

Name the symptoms of aortic stenosis

• Chest pain
• Dyspnoea
• Syncope
• Symptoms of CCF

8

What sounds do you hear with an aortic stenosis

- systolic ejection murmur in the aortic area
- if bicuspid may hear a click after the first sound

9

What sounds do you hear with aortic regurgitation

- second sound followed by an early diastolic murmur

10

What do the echo parameters look for in aortic valve disease

• Valve appearance
• Valve gradient/valve area
• Severity of AR based on colour flow and CW Doppler
• LV size and function - hypertrophy, enlarged, contracting well?
• Associated or coincidental pathology

11

When do you intervene in aortic stenosis

• Symptoms
- LVEF less than 50%
• Irreversible changes in cardiac function
• Improve prognosis

12

What happens when you leave aortic stenosis for a long time

dilate and start to pump poorly

13

in what valve disease is it better to replace the valve earlier

Mitral regurgitation - better to replace the valve even in the absence of symptoms as once there has been changes to the valve structure the new valve may not work

14

What causes mitral stenosis

• Almost always rheumatic
• Often with associated regurgitation
• Frequently associated with other valve disease and PHT

15

What signs is mitral stenosis associated with

- mitral faces - redness of the cheek

16

What can cause mitral regurgitation

• Mitral valve prolapse; myxomatous or degenerative
• functional
• Ischaemic
• rheumatic
• Infection

17

What are the symptoms of mitral stenosis

• Dyspnoea
• Fatigue
• dizziness
• Other symptoms of CCF
• Palpitations (secondary to atrial arrhythmias)

18

what are the signs of mitral regurgitation

- AF
- displaced hyperdyanmic apex
- pan systolic murmur at apex radiating to axilla
- soft s1, split s2, loud p2

the larger the left ventricle the more severe

19

What are the signs of mitral stenosis

- malar flush on cheeks
- low volume pulse
- AF common due to enlarged LA
- non-displaced apex beat
- RV heave
- loud s1 opening snap
- mid diastolic murmur (heard best in expiration with the patient on the left side) - the more severe the stenosis the longer the diastolic murmur

20

In mitral valve disease what do you look for in an echo

• Valve appearance
• LA size
• LV size and function
• Various Doppler parameters to assess severity of stenosis and regurgitation
• Right heart size and function

21

What are the two ways to treat valve disease

- Pharmacology
- mechanical interventions

22

name some drugs that you can use for valve disease

Beta blockers, ACE I, diuretics, calcium antagonists

23

What are the indications for intervention in mitral valve disease

• Symptoms
• Irreversible changes in cardiac function
• Improve prognosis

24

What is the mainstay of endocarditis

presence or absence of vegetation on valves on echo

25

What criteria is the diagnosis of bacterial endocarditis based on

The Duke criteria

26

describe what is needed for a clinical diagnosis of bacterial endocarditis

The duke criteria
- Clinical diagnosis of definite infective endocarditis requires two major, one major and three minor or five minor criteria

27

What counts for major in the duke criteria (Bacterial endocarditis)

- typical blood culture
- positive Q-
fever serology,
- positive echo

28

What counts as minor in the duke criteria (Bacterial endocarditis)

- predisposition
- fever
- vascular phenomena including new clubbing, splinter haemorrhages and splenomegally
- immunological phenomena - raised CRP
- suggestive echo
- suggestive microbiology

29

what causes splinter haemorrhages

Bacterial endocarditis

30

What is defined as a positive echo in the duke criteria

• oscillating intracardiac mass on valve or supporting structures, in the path of a regurgitant jet or on implanted material in the absence of another explanation
• an abscess
• new partial dehiscence of a prosthetic valve
• completely new valve regurgitation