p.11
Management Strategies for Valvular Heart Disease
What additional conditions may lead to surgery consideration in asymptomatic patients with primary severe MR?
Atrial fibrillation or elevated systolic pulmonary artery pressure.
p.11
Complications Associated with Valvular Heart Disease
Why is secondary mitral regurgitation (MR) rarely operated on?
Due to significant operative mortality, high rates of recurrent MR, and no evidence of survival benefit.
p.1
Risk Factors for Valvular Heart Disease
What are some risk factors for valvular heart disease?
Age, history of rheumatic fever, and congenital heart defects.
p.20
Diagnostic Investigations for Valvular Heart Disease
What types of evidence can be obtained from imaging for Infective Endocarditis?
Echocardiogram showing vegetation, abscess, pseudoaneurysm, valvular perforation, or new partial dehiscence of a prosthetic valve.
p.8
Diagnostic Investigations for Valvular Heart Disease
What do fasting lipids and HbA1c screen for in patients?
Hypercholesterolaemia and diabetes, which are risk factors for cardiovascular disease (CVD).
p.4
Clinical Features and Symptoms of Valvular Heart Disease
What should be assessed when a patient reports palpitations?
Onset, duration, speed, and rhythm; it may be useful to have them tap out the rhythm.
p.23
Complications Associated with Valvular Heart Disease
When is the risk of embolism highest in infective endocarditis?
During the first 2 weeks.
p.3
Epidemiology and Aetiology of Valvular Heart Disease
What is the underlying cause of Secondary Mitral Regurgitation?
Left ventricular dilatation leading to annular dilatation and poor co-aptation between the leaflets.
p.23
Complications Associated with Valvular Heart Disease
What are some non-cardiac complications of infective endocarditis?
Splenic infarct, AKI, glomerulonephritis.
p.16
Clinical Features and Symptoms of Valvular Heart Disease
What temperature is often associated with infective endocarditis?
High temperatures (>38°C).
p.1
Diagnostic Investigations for Valvular Heart Disease
What should an investigation plan for valvular heart disease establish?
The severity of the condition and inform management.
p.20
Diagnostic Investigations for Valvular Heart Disease
What is required for a definite diagnosis of Infective Endocarditis (IE) according to Dukes Criteria?
Pathological evidence on histological examination of a vegetation or an intracardiac abscess, 2 major criteria, 1 major and 3 minor, or 5 minor criteria.
p.22
Management Strategies for Valvular Heart Disease
What are the frequently used antimicrobials for suspected prosthetic valve or MRSA in infective endocarditis?
Vancomycin + Gentamycin + Rifampicin.
p.22
Management Strategies for Valvular Heart Disease
What is the surgical approach for severe aortic or mitral valve regurgitation?
Urgent surgery is indicated if it presents with heart failure, obstruction, fistula, or refractory pulmonary edema.
p.3
Epidemiology and Aetiology of Valvular Heart Disease
What causes Primary Mitral Regurgitation?
Abnormalities in the mitral valve apparatus, such as mitral valve prolapse, perforation, or papillary muscle rupture.
p.17
Risk Factors for Valvular Heart Disease
What is a risk factor for infective endocarditis related to dental health?
Poor dentition, which can lead to repeated dental surgery.
p.16
Clinical Features and Symptoms of Valvular Heart Disease
What symptom may indicate advanced disease in infective endocarditis?
Shortness of breath, possibly due to exertional dyspnoea secondary to heart failure.
p.1
Management Strategies for Valvular Heart Disease
What is a key component of formulating a management plan for valvular heart disease?
It should be based on the clinical presentation of the patient.
p.20
Diagnostic Investigations for Valvular Heart Disease
What is a significant microbiological finding for major criteria in Infective Endocarditis?
Typical organisms from 2 separate blood cultures or microorganisms consistent with IE from persistently positive blood cultures.
p.8
Diagnostic Investigations for Valvular Heart Disease
What can elevated liver enzymes indicate in the context of valvular heart disease?
Hepatic congestion secondary to right heart failure.
p.18
Complications Associated with Valvular Heart Disease
What is a differential diagnosis for infective endocarditis?
Sepsis (non-cardiac), cardio-embolic disease, and disseminated intravascular coagulation (DIC).
p.12
Management Strategies for Valvular Heart Disease
Is tricuspid stenosis treated surgically?
No, tricuspid stenosis is not treated surgically.
p.16
Clinical Features and Symptoms of Valvular Heart Disease
What is the most common presenting complaint in infective endocarditis?
Fever (90%) + Night sweats.
p.24
Prognosis of Valvular Heart Disease
How does older age affect the prognosis of infective endocarditis?
Outcomes are worse for individuals older than 60 years.
p.11
Management Strategies for Valvular Heart Disease
What symptoms indicate that patients with mitral stenosis (MS) should be considered for intervention?
Symptoms of moderate to severe MS.
p.1
Definition and Classification of Valvular Heart Disease
Name the four heart valves.
Aortic Valve, Mitral Valve, Tricuspid Valve, Pulmonary Valve.
p.24
Prognosis of Valvular Heart Disease
What significant effects can impact the prognosis of infective endocarditis?
Significant effect on valve function or peri-annular structures.
p.3
Definition and Classification of Valvular Heart Disease
What are the two sub-divisions of Mitral Regurgitation (MR)?
Primary (organic) MR and Secondary (functional/ischaemic) MR.
p.10
Management Strategies for Valvular Heart Disease
What defines severe aortic stenosis (AS) on transthoracic echocardiogram (TTE)?
V max >4 m/s, mean gradient >40 mmHg, aortic area ≤ 1 cm².
p.8
Diagnostic Investigations for Valvular Heart Disease
Why is exercise echocardiography useful?
It helps determine the severity of mitral regurgitation (MR), which can worsen with tachycardia.
p.2
Definition and Classification of Valvular Heart Disease
How is valvular heart disease (VHD) defined?
By the location (valve) and physiology (stenosis vs regurgitation), and it can involve multiple valves.
p.8
Diagnostic Investigations for Valvular Heart Disease
What does a normal calcium score indicate?
A score of zero to 100 indicates normal, while 100-300 indicates moderate risk of heart disease.
p.9
Management Strategies for Valvular Heart Disease
How can Mitral Stenosis (MS) symptoms be managed?
Diuretics improve dyspnoea; beta-blockers and calcium channel blockers improve exercise tolerance.
p.24
Prognosis of Valvular Heart Disease
What complications of infective endocarditis worsen prognosis?
Stroke, acute kidney injury (AKI), and congestive heart failure (CCF).
p.20
Diagnostic Investigations for Valvular Heart Disease
What constitutes possible Infective Endocarditis (IE)?
1 major criterion with 1 minor or 3 minor criteria.
p.18
Risk Factors for Valvular Heart Disease
What are some sources of bacteraemia that can lead to infective endocarditis?
IVDU, surgical procedures, recent GI/GU instrumentation, age >60, structural heart disease, valvular heart disease, previous endocarditis, chronic haemodialysis, immunocompromised individuals, and bowel cancer.
p.23
Complications Associated with Valvular Heart Disease
What factors are associated with the risk of embolism in infective endocarditis?
Size and mobility of vegetation.
p.22
Management Strategies for Valvular Heart Disease
What are absolute indications for urgent surgery in infective endocarditis?
Severe valve regurgitation with heart failure, uncontrolled infection on therapy, prevention of embolism, and large vegetations.
p.22
Management Strategies for Valvular Heart Disease
What are relative indications for surgery in infective endocarditis?
Onset of AV block, fungal etiology, recurrent emboli, persistent fever, recurrent endocarditis, and persistent tricuspid valve vegetations.
p.10
Management Strategies for Valvular Heart Disease
In which patients may surgical intervention be considered for asymptomatic severe aortic stenosis?
Patients with EF <50% not due to any other cause.
p.23
Complications Associated with Valvular Heart Disease
What is the mechanism of embolization in infective endocarditis?
Right-sided vegetations embolize to pulmonary circulation; left-sided vegetations embolize to peripheral circulation.
p.22
Complications Associated with Valvular Heart Disease
Why is infective endocarditis of cardiac devices concerning?
It carries a much higher mortality rate.
p.3
Epidemiology and Aetiology of Valvular Heart Disease
What conditions can lead to Secondary Tricuspid Regurgitation?
Pulmonary hypertension, acute/chronic pulmonary emboli, or severe lung disease.
p.2
Epidemiology and Aetiology of Valvular Heart Disease
What are the common causes of Aortic Stenosis?
Calcified normal trileaflet aortic valve or congenital bicuspid aortic valve (BAV).
p.10
Management Strategies for Valvular Heart Disease
What should be considered in asymptomatic patients with severe AR whose left ventricle is starting to dilate?
Surgery should be considered if LVEDD >70 mm or LVESD >50 mm.
p.21
Management Strategies for Valvular Heart Disease
What is the purpose of antibiotic prophylaxis in infective endocarditis?
To prevent infective endocarditis in patients at high risk undergoing high-risk dental procedures.
p.1
Clinical Features and Symptoms of Valvular Heart Disease
What are the key clinical features of valvular heart disease?
Symptoms such as shortness of breath, fatigue, and palpitations.
p.4
Clinical Features and Symptoms of Valvular Heart Disease
What are common symptoms associated with degenerative Valvular Heart Disease (VHD)?
Shortness of breath, palpitations, severe dyspnoea, presyncope/syncope, chest discomfort, and pyrexia of unknown origin.
p.17
Physical Examination Findings in Valvular Heart Disease
What are Janeway lesions?
Haemorrhagic painless macular plaques associated with infective endocarditis.
p.9
Diagnostic Investigations for Valvular Heart Disease
How does Doppler echocardiography assist in Valvular Heart Disease?
It allows calculation of gradients across valves, useful for grading severity.
p.9
Management Strategies for Valvular Heart Disease
What is the general management approach for most cases of VHD?
Conservative management due to slow degenerative processes.
p.8
Diagnostic Investigations for Valvular Heart Disease
What does a CT for Transcatheter Aortic Valve Implantation (TAVI) assess?
Whether a percutaneous approach to repair is possible.
p.12
Complications Associated with Valvular Heart Disease
What is a common complication associated with prosthetic valves?
Infection of prosthetic valves.
p.9
Management Strategies for Valvular Heart Disease
What is the recommended treatment for Mitral Regurgitation (MR) without heart failure?
No evidence supports pharmacotherapy; standard heart failure treatment if heart failure is present.
p.8
Diagnostic Investigations for Valvular Heart Disease
What is a common hematological finding in severe aortic stenosis?
Anaemia, which can be associated with Heyde syndrome.
p.10
Management Strategies for Valvular Heart Disease
What is the traditional intervention for aortic stenosis?
Surgical aortic valve repair.
p.10
Management Strategies for Valvular Heart Disease
What is a potential alternative for patients not fit for surgery or TAVI?
Balloon valvuloplasty, though it carries a higher risk of stroke.
p.2
Epidemiology and Aetiology of Valvular Heart Disease
What is the primary cause of Mitral Valve Stenosis?
A remnant of prior rheumatic infection.
p.21
Management Strategies for Valvular Heart Disease
Who should receive antibiotic prophylaxis for infective endocarditis?
Patients with any prosthetic valve, prior infective endocarditis, cyanotic congenital heart disease, and those with repaired congenital heart defects with indwelling prosthesis/patch for the first 6 months after the procedure.
p.11
Management Strategies for Valvular Heart Disease
When is surgery recommended for asymptomatic patients with primary severe mitral regurgitation (MR)?
When there is evidence of an EF <60% or LVESD >45mm.
p.16
Clinical Features and Symptoms of Valvular Heart Disease
What symptoms may indicate a history of viral infection in infective endocarditis?
Previous viral prodromal symptoms.
p.1
Complications Associated with Valvular Heart Disease
What is the importance of distinguishing between associated symptoms and complications in valvular heart disease?
It impacts patient outcomes and management strategies.
p.16
Clinical Features and Symptoms of Valvular Heart Disease
What are common non-specific symptoms of infective endocarditis?
Myalgia and arthralgia (muscle pain and joint pain).
p.20
Diagnostic Investigations for Valvular Heart Disease
What are some minor criteria for diagnosing Infective Endocarditis?
Microbiology evidence not meeting major criteria, predisposing factors, vascular phenomena, immunological phenomena, and fever >38°C.
p.9
Diagnostic Investigations for Valvular Heart Disease
What is the advantage of Trans oesophageal echocardiography (TOE)?
It provides better image quality despite being invasive.
p.17
Physical Examination Findings in Valvular Heart Disease
What are Osler nodes?
Small painful nodular lesions most likely found on the pads of fingers.
p.8
Diagnostic Investigations for Valvular Heart Disease
What is the purpose of a CT Coronary Angiogram (CTCA) in valvular heart disease?
To calculate the calcium score, which helps identify severe aortic stenosis (AS) when echocardiography is inconclusive.
p.17
Physical Examination Findings in Valvular Heart Disease
What type of cardiac murmur is most likely to be present in infective endocarditis?
Aortic or mitral regurgitation.
p.9
Management Strategies for Valvular Heart Disease
What should be considered in the management of acute changes in VHD?
Treat as acute decompensated heart failure and request urgent surgical opinion.
p.10
Management Strategies for Valvular Heart Disease
When is early intervention recommended for patients with severe symptomatic aortic stenosis?
In all patients without severe comorbidities and a life expectancy >1 year.
p.9
Management Strategies for Valvular Heart Disease
What is the pharmacological treatment for Aortic Stenosis (AS)?
There is no pharmacological treatment shown to slow progression; co-morbidities should be treated.
p.12
Management Strategies for Valvular Heart Disease
Who typically treats pulmonary regurgitation and stenosis surgically?
Specialized centers with experience in adult congenital heart disease.
p.8
Diagnostic Investigations for Valvular Heart Disease
What is the significance of a coronary angiogram in patients with aortic stenosis?
It determines if there is underlying coronary artery disease, which can be present in up to 30% of patients with AS.
p.9
Management Strategies for Valvular Heart Disease
What is the treatment approach for Aortic Regurgitation (AR)?
Mainly symptomatic relief with diuretics and ACE inhibitors/ARBs.
p.19
Diagnostic Investigations for Valvular Heart Disease
What is the initial investigation of choice for diagnosing infective endocarditis?
Trans thoracic echocardiogram (TTE).
p.24
Prognosis of Valvular Heart Disease
What condition is associated with worse outcomes in infective endocarditis?
Insulin-dependent diabetes mellitus (IDDM).
p.11
Management Strategies for Valvular Heart Disease
What factors influence the choice of intervention for mitral stenosis?
Multiple clinical factors and echocardiographic anatomical variables.
p.24
Prognosis of Valvular Heart Disease
Which infections are linked to worse outcomes in infective endocarditis?
Infections caused by Staphylococcus aureus, fungal organisms, and Gram-negative bacilli.
p.20
Diagnostic Investigations for Valvular Heart Disease
What are the major criteria for diagnosing Infective Endocarditis?
Positive blood cultures, imaging evidence of IE, and specific findings like a single positive blood culture for Coxiella burnetii.
p.9
Diagnostic Investigations for Valvular Heart Disease
What is the primary investigation for diagnosing Valvular Heart Disease (VHD)?
Trans thoracic echocardiography (TTE).
p.18
Risk Factors for Valvular Heart Disease
What condition is associated with increased prevalence of fungi in infective endocarditis?
Immunocompromised individuals.
p.12
Management Strategies for Valvular Heart Disease
When is surgery indicated for tricuspid regurgitation (TR)?
In symptomatic patients with severe TR who are undergoing left-sided intervention.
p.4
Clinical Features and Symptoms of Valvular Heart Disease
What can severe dyspnoea and swelling in the legs indicate?
Acute decompensated heart failure, possibly due to papillary rupture in a history of previous myocardial infarction (MI).
p.17
Physical Examination Findings in Valvular Heart Disease
What might splenomegaly indicate in cases of infective endocarditis?
It may be appreciated in some cases.
p.22
Management Strategies for Valvular Heart Disease
What is the recommended treatment for infected cardiac devices?
Extraction (percutaneous or surgical) is recommended in all patients, with early discussion with a cardiothoracic surgeon.
p.17
Physical Examination Findings in Valvular Heart Disease
What are the signs of clubbing in relation to infective endocarditis?
There are 5 grades of clubbing that may be observed.
p.22
Management Strategies for Valvular Heart Disease
What should be done for patients with chronic infective endocarditis?
Give continuous antibiotic prophylaxis if required.
p.19
Diagnostic Investigations for Valvular Heart Disease
What are the requirements for blood cultures in the diagnosis of infective endocarditis?
Multiple blood cultures are required for Duke’s diagnostic criteria.
p.7
Risk Factors for Valvular Heart Disease
Which genetic condition is associated with valvular heart disease?
Congenital bicuspid valve.
p.4
Risk Factors for Valvular Heart Disease
What are some risk factors for Valvular Heart Disease associated with physical characteristics?
Marfan’s syndrome and Down’s syndrome.
p.19
Diagnostic Investigations for Valvular Heart Disease
What does a cardiac CT help with in the context of infective endocarditis?
It is useful if the diagnosis is unclear.
p.19
Diagnostic Investigations for Valvular Heart Disease
What is the significance of FDG-PET/CT in infective endocarditis?
It is useful in prosthetic valves that have been implanted for more than 3 months, but can be falsely positive.
p.7
Differential Diagnosis for Valvular Heart Disease
What is a differential diagnosis for systolic murmurs?
Aortic Stenosis (AS), Mitral Regurgitation (MR), Tricuspid Regurgitation (TR), Pulmonary Stenosis (PS).
p.13
Risk Factors for Valvular Heart Disease
How can patient-specific risk factors influence the pathogenesis of infective endocarditis?
Patient-specific risk factors such as pre-existing heart conditions and intravenous drug use can increase susceptibility to infection.
p.4
Clinical Features and Symptoms of Valvular Heart Disease
What does chest discomfort in Valvular Heart Disease usually indicate?
Poor cardiac perfusion, often seen on exertion.
p.4
Physical Examination Findings in Valvular Heart Disease
What physical sign may indicate peripheral oedema?
Swelling in the legs or around the abdomen.
p.2
Epidemiology and Aetiology of Valvular Heart Disease
What is the age-adjusted prevalence of valvular heart disease?
2.5%, but it can reach 13% in those over 75 years.
p.12
Complications Associated with Valvular Heart Disease
What is required for all patients with a metallic valve replacement?
Lifelong anticoagulation.
p.14
Definition and Classification of Valvular Heart Disease
What is infective endocarditis (IE)?
An infection of the endocardial surface of the heart, which may include heart valves, mural endocardium, or a septal defect.
p.5
Physical Examination Findings in Valvular Heart Disease
What type of pulse pressure is associated with Aortic Regurgitation (AR)?
Wide pulse pressure and water-hammer pulse.
p.21
Management Strategies for Valvular Heart Disease
What should be given to penicillin-allergic individuals for prophylaxis?
Clindamycin 600mg orally 30-60 minutes before the procedure.
p.21
Management Strategies for Valvular Heart Disease
What are common antimicrobial regimens for acute infective endocarditis?
Vancomycin + Gentamicin or Benzylpenicillin/Amoxicillin + Flucloxacillin + Gentamicin.
p.6
Complications Associated with Valvular Heart Disease
What is a sign of right heart failure associated with tricuspid regurgitation?
Pulsatile/enlarged liver with hepatojugular reflux.
p.6
Clinical Features and Symptoms of Valvular Heart Disease
What type of murmur is associated with tricuspid stenosis?
Short duration, low intensity diastolic murmur.
p.4
Physical Examination Findings in Valvular Heart Disease
What is a potential sign of Aortic Regurgitation (AR) during physical examination?
Head bobbing with de Musset’s sign.
p.2
Epidemiology and Aetiology of Valvular Heart Disease
What are the most common aetiologies of valvular heart disease requiring intervention?
Aortic Stenosis, Primary Mitral Regurgitation, Secondary Mitral Regurgitation, and Aortic Regurgitation.
p.12
Complications Associated with Valvular Heart Disease
Which anticoagulant must be used for patients with metallic valves?
Warfarin, instead of DOACs.
p.13
Clinical Features and Symptoms of Valvular Heart Disease
What are the key clinical features to identify in patients with infective endocarditis?
Key clinical features include fever, heart murmurs, and signs of embolic phenomena.
p.5
Physical Examination Findings in Valvular Heart Disease
What type of pulse pressure is observed in Aortic Stenosis (AS)?
Narrow pulse pressure and slow rising pulse.
p.2
Epidemiology and Aetiology of Valvular Heart Disease
What is the prevalence of Mitral Regurgitation in hospitalized patients?
It is the second most common VHD after Aortic Stenosis.
p.21
Management Strategies for Valvular Heart Disease
What dental procedures are considered high risk for infective endocarditis?
Procedures involving manipulation of gingival tissue, periapical region of teeth, or perforation of the oral mucosa.
p.14
Pathophysiology and Aetiology of Valvular Heart Disease
What predisposes valves or endocardial surfaces to infection in infective endocarditis?
Exposure to microemboli from bacteria or fungi in the bloodstream, and previously damaged tissue or non-native structures.
p.5
Physical Examination Findings in Valvular Heart Disease
What is the characteristic murmur of Aortic Regurgitation?
Blowing diastolic murmur at the left sternal edge.
p.3
Definition and Classification of Valvular Heart Disease
What is the difference between Primary and Secondary Tricuspid Regurgitation (TR)?
Primary TR is due to inherent abnormalities in the valve leaflets, while Secondary TR is due to increased RV pressure or volume causing RV annular dilatation.
p.3
Epidemiology and Aetiology of Valvular Heart Disease
What are common causes of Primary Tricuspid Regurgitation?
Infective endocarditis, Ebstein’s anomaly, carcinoid syndrome, or traumatic injury.
p.19
Diagnostic Investigations for Valvular Heart Disease
When is a transesophageal echocardiogram (TOE) indicated?
In cases of prosthetic valve, poor quality TTE, positive TTE, or negative TTE with high clinical suspicion.
p.10
Management Strategies for Valvular Heart Disease
When is surgery indicated for severe aortic regurgitation (AR)?
In symptomatic patients and asymptomatic patients with EF ≤ 50%.
p.12
Complications Associated with Valvular Heart Disease
What is a potential late complication after valve replacement?
Restenosis, usually occurring >10 years after replacement.
p.7
Differential Diagnosis for Valvular Heart Disease
What are the differential diagnoses for diastolic murmurs?
Aortic Regurgitation (AR), Mitral Stenosis (MS), Tricuspid Stenosis (TS), Pulmonary Regurgitation (PR).
p.14
Epidemiology and Aetiology of Valvular Heart Disease
What is the annual incidence of infective endocarditis?
3-10 cases per 100,000 patients.
p.13
Diagnostic Investigations for Valvular Heart Disease
What is the purpose of constructing a differential diagnosis in infective endocarditis?
To differentiate infective endocarditis from other conditions with similar presentations.
p.13
Infective Endocarditis: Definition and Epidemiology
What is the significance of infective endocarditis prophylaxis?
It is important for patients at high risk to prevent the occurrence of infective endocarditis during certain medical procedures.
p.10
Management Strategies for Valvular Heart Disease
Who decides between transcatheter aortic valve implant (TAVI) and surgical aortic valve replacement?
The multi-disciplinary team.
p.17
Risk Factors for Valvular Heart Disease
What does the presence of scars from previous cardiac surgery indicate?
It may be evidence of a risk factor for infective endocarditis.
p.7
Differential Diagnosis for Valvular Heart Disease
What type of murmur is associated with Ventricular Septal Defect (VSD)?
Holo or pansystolic murmur.
p.13
Diagnostic Investigations for Valvular Heart Disease
What should an investigation plan for infective endocarditis include?
It should establish aetiology, severity, and the presence of complications.
p.14
Pathophysiology and Aetiology of Valvular Heart Disease
What role do virulence factors play in infective endocarditis?
Certain bacteria have virulence factors that increase the likelihood of colonization of tissue.
p.15
Infective Endocarditis: Definition and Epidemiology
What is the most common organism associated with prosthetic valve infective endocarditis?
Coagulase negative staphylococci, particularly S. epidermidis and S. aureus.
p.10
Management Strategies for Valvular Heart Disease
Which patients may benefit more from TAVI over surgical repair?
Older patients (generally >75 years old) with multiple comorbidities.
p.17
Clinical Features and Symptoms of Valvular Heart Disease
What are non-specific symptoms in the context of infective endocarditis?
Patients may be well or asymptomatic with non-specific symptoms.
p.3
Definition and Classification of Valvular Heart Disease
In which population are Pulmonary Stenosis and Pulmonary Regurgitation more commonly seen?
In pediatric cardiology, often associated with Tetralogy of Fallot.
p.10
Management Strategies for Valvular Heart Disease
What is the purpose of surgical intervention in mitral regurgitation?
To reduce the progression of LV dilatation, decrease EF, LA dilatation, and atrial fibrillation.
p.7
Differential Diagnosis for Valvular Heart Disease
What can cause continuous murmurs in patients?
A fistula for dialysis or a Patent Ductus Arteriosus (PDA).
p.5
Physical Examination Findings in Valvular Heart Disease
Where is the aortic area auscultated?
Right 2nd intercostal space at the sternal edge.
p.14
Epidemiology and Aetiology of Valvular Heart Disease
What is the significance of healthcare-acquired infective endocarditis?
It represents up to 30% of IE cases, highlighting the need for aseptic measures during invasive procedures.
p.12
Complications Associated with Valvular Heart Disease
What is recommended for patients with prosthetic valves undergoing certain procedures?
Prophylactic antibiotics.
p.15
Infective Endocarditis: Definition and Epidemiology
Which valve is more commonly affected in infective endocarditis?
Mitral valve is more commonly affected than the aortic valve.
p.9
Management Strategies for Valvular Heart Disease
What anticoagulation is recommended for patients with atrial fibrillation due to MS?
Warfarin should be used, as NOACs are not licensed for valvular atrial fibrillation.
p.5
Clinical Features and Symptoms of Valvular Heart Disease
What are splinter haemorrhages indicative of?
Stigmata of infective endocarditis (IE).
p.19
Diagnostic Investigations for Valvular Heart Disease
What does U+E testing indicate in the context of infective endocarditis?
It assesses for acute kidney injury (AKI) secondary to septic emboli.
p.19
Diagnostic Investigations for Valvular Heart Disease
What is the purpose of a chest X-ray (CXR) in diagnosing infective endocarditis?
To screen for cavitating lesions, multifocal pneumonia, and congestive heart failure (CCF).
p.21
Management Strategies for Valvular Heart Disease
What is the recommended antibiotic regimen for prophylaxis in non-allergic patients?
Amoxicillin 2g orally 30-60 minutes before the procedure.
p.13
Management Strategies for Valvular Heart Disease
What factors should be considered when formulating a pharmacological management plan for infective endocarditis?
Patient-specific factors such as allergies, renal function, and the type of infective organism.
p.5
Physical Examination Findings in Valvular Heart Disease
What does a laterally displaced apex beat indicate?
May be secondary to left ventricular dilatation, e.g., in severe Aortic Regurgitation.
p.8
Diagnostic Investigations for Valvular Heart Disease
Why are urea and electrolytes important in the context of valvular heart disease?
To assess renal function if considering the use of contrast.
p.12
Complications Associated with Valvular Heart Disease
When is long-term anticoagulation required for patients with bioprosthetic valves?
Only if there is another indication.
p.19
Diagnostic Investigations for Valvular Heart Disease
What blood tests are important for aetiological investigations in infective endocarditis?
FBC and CRP to check for raised inflammatory markers and white cells.
p.15
Infective Endocarditis: Definition and Epidemiology
What are the common organisms associated with enterococcal endocarditis?
Enterococcus faecalis and Enterococcus faecium.
p.15
Infective Endocarditis: Definition and Epidemiology
What conditions are enterococcal endocarditis associated with?
Lower GI or GU disease, bowel malignancy, or after invasive procedures.
p.14
Pathophysiology and Aetiology of Valvular Heart Disease
Which microorganism is considered the most aggressive in infective endocarditis?
Staphylococcus aureus (31%).
p.6
Clinical Features and Symptoms of Valvular Heart Disease
What is a characteristic finding in tricuspid regurgitation?
Soft holosystolic murmur along the left sternal border.
p.14
Complications Associated with Valvular Heart Disease
What are the significant complications associated with infective endocarditis?
Septic shock, embolic disease including stroke, and valvular heart failure.
p.13
Physical Examination Findings in Valvular Heart Disease
What is a focused clinical examination used for in the context of infective endocarditis?
To elicit specific clinical signs such as Janeway lesions, Osler nodes, and petechiae.
p.5
Clinical Features and Symptoms of Valvular Heart Disease
What does elevated JVP indicate?
Evidence of heart failure overload or tricuspid regurgitation (TR).
p.6
Clinical Features and Symptoms of Valvular Heart Disease
What is a characteristic finding in mitral regurgitation?
Laterally displaced apex and pansystolic murmur loudest at the apex.
p.15
Infective Endocarditis: Definition and Epidemiology
Which fungi are commonly associated with infective endocarditis?
Candida, Aspergillus, and Histoplasma.
p.15
Infective Endocarditis: Definition and Epidemiology
What is the 'HACEK' group in infective endocarditis?
A group of organisms including Haemophilus spp, Actinobacillus sp, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae.
p.13
Management Strategies for Valvular Heart Disease
How can one distinguish between patients who require pharmacological versus surgical intervention in infective endocarditis?
By assessing the severity of the infection, presence of complications, and response to medical therapy.
p.21
Management Strategies for Valvular Heart Disease
What are common antimicrobial regimens for subacute infective endocarditis?
Benzylpenicillin/Amoxicillin + Gentamicin.
p.14
Epidemiology and Aetiology of Valvular Heart Disease
Which gender is more likely to be affected by infective endocarditis?
Men, who are 2.5 times more likely than women.
p.6
Clinical Features and Symptoms of Valvular Heart Disease
What type of murmur is heard in mitral stenosis?
A 'rumbling' diastolic murmur at the apex.
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Clinical Features and Symptoms of Valvular Heart Disease
What is a common associated condition with mitral stenosis?
Atrial fibrillation (Afib).
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Physical Examination Findings in Valvular Heart Disease
What type of murmur is associated with Aortic Stenosis?
Ejection systolic murmur that radiates to the carotids, crescendo-decrescendo in nature.
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Complications Associated with Valvular Heart Disease
What is a common sign of fluid overload in valvular heart disease?
Oedema in the sacrum and ankles.
