Valvular Heart Disease PDF - Mansoura University

Valvular heart disease Professor Monir Bahgat Professor Rasha Mahmoud Medical notes introduction Medical notes Definition - Malfunction of the cardiac valves. Medical notes Etiology - The two most important diseases affecting heart valves are: Rheumatic fever (p...

Valvular heart disease Professor Monir Bahgat Professor Rasha Mahmoud Medical notes introduction Medical notes Definition - Malfunction of the cardiac valves. Medical notes Etiology - The two most important diseases affecting heart valves are: Rheumatic fever (post-streptococcal) & Infective endocarditis. Medical notes Etiology - Others: e.g., congenital, ischemic, degenerative. Medical notes Etiology - Narrowing of a cardiac valve, restricting the forward flow, is termed stenosis, e.g., mitral stenosis. - It results in pressure overload, since higher pressures are needed to maintain cardiac output through the restricted opening. Medical notes Etiology - Leaking of the valve, resulting in backward flow, is termed regurgitation (incompetence), e.g., aortic incompetence. - It results in volume overload since a proportion of the blood returns and has to be ejected a second time. Medical notes Epidemiology - VHD is less common than CHD in developed countries, but rheumatic fever still occurs in developing countries and can cause long-term VHD. Medical notes Clinical picture - The usual clinical presentation of VHD: o Symptoms of HF. o A characteristic murmur. Medical notes Investigations - The definitive investigation is the echocardiogram.  Medical notes Treatment - Medical: - HF: diuretics. - Atrial fibrillation: - Common complication of mitral valve disease. - Digoxin or β-blockers for rate control, and - Warfarin to reduce the risk of thrombosis. - Surgical: e.g., valve replacement. Medical notes Rheumatic fever:  Medical notes Rheumatic fever: - Rheumatic fever is a systemic disease that occurs 2–3 weeks after a streptococcal upper respiratory tract infection; typically, a pharyngitis caused by group ‘A’, β-hemolytic Streptococcus.  Medical notes Rheumatic fever: - Inflammation at multiple sites including: o Heart. o Joints. o CNS. o Skin.  Medical notes Rheumatic fever: - Heart: - Pancarditis: - Endocarditis, Myocarditis and Pericarditis. - The damaging effects of endocarditis are long-lasting VHD. - The effects of myocarditis and pericarditis are transient.  Medical notes Rheumatic fever: - Joints: o Inflammation of the large joints. o Symptoms of ‘migratory’ or ‘flitting’ polyarthritis.  Medical notes Rheumatic fever: - Skin: - Erythema marginatum (skin rash). - Subcutaneous nodules.  Medical notes Rheumatic fever: - CNS: - Rheumatic chorea: Involuntary movement. Medical notes Infective endocarditis:  Medical notes Infective endocarditis: - Infection of a focal area of endocardium; usually heart valves. Medical notes Infective endocarditis: - In most cases there is a pre-existing abnormality of the endocardium that makes it susceptible to infection. - Examples: - Congenital heart disease. - Rheumatic heart disease. - Prosthetic heart valves. Medical notes Infective endocarditis: - The infective agents are usually commensal bacteria. - These organisms live in the oral cavity and oropharynx, gastrointestinal tract, genitourinary tract and the skin. Medical notes Infective endocarditis: - Following bacteremia, the infective agent can colonize the damaged endocardium, resulting in a thrombotic vegetation (Platelets + Fibrin). Medical notes Infective endocarditis: - The effects of infective endocarditis include both local and systemic effects. Medical notes Infective endocarditis: - The effects of infective endocarditis include both local and systemic effects. - Local effects (complications): o Due to valvular destruction. o The affected valve becomes incompetent. o The patient develops a new or changing heart murmur. Medical notes Infective endocarditis: - The effects of infective endocarditis include both local and systemic effects. - Systemic effects (complications): o Non-specific: Low grade fever, weight loss and malaise. Medical notes Infective endocarditis: - The effects of infective endocarditis include both local and systemic effects. - Systemic effects (complications): o Embolic: ✓ Mechanism: Fragments of infected vegetations produces small infarcts. ✓ Sites: Brain, spleen, skin and kidney. Medical notes Infective endocarditis: - The effects of infective endocarditis include both local and systemic effects. Skin: o Emboli typically affect skin of hands & feet, and the nail beds. o Janeway lesions: Irregular erythematous flat macules. o Osler’s nodes: Painful red raised lesions. o Splinter hemorrhages: Tiny linear subungual infarcts. o Finger clubbing. Medical notes Infective endocarditis: - The effects of infective endocarditis include both local and systemic effects. Skin: o Emboli typically affect skin of hands & feet, and the nail beds. o Janeway lesions: Irregular erythematous flat macules. o Osler’s nodes: Painful red raised lesions. o Splinter hemorrhages: Tiny linear subungual infarcts. o Finger clubbing. Medical notes Infective endocarditis: - The effects of infective endocarditis include both local and systemic effects. Skin: o Emboli typically affect skin of hands & feet, and the nail beds. o Janeway lesions: Irregular erythematous flat macules. o Osler’s nodes: Painful red raised lesions. o Splinter hemorrhages: Tiny linear subungual infarcts. o Finger clubbing. Medical notes Infective endocarditis: - The effects of infective endocarditis include both local and systemic effects. Skin: o Emboli typically affect skin of hands & feet, and the nail beds. o Janeway lesions: Irregular erythematous flat macules. o Osler’s nodes: Painful red raised lesions. o Splinter hemorrhages: Tiny linear subungual infarcts. o Finger clubbing. Medical notes Infective endocarditis: - The effects of infective endocarditis include both local and systemic effects. - Skin: o Small infarcts may also be observed within the mucous membranes. o Retinopathy can develop following embolism to retinal vessels (Roth’s spots). Medical notes Infective endocarditis: - The effects of infective endocarditis include both local and systemic effects. - Skin: o Small infarcts may also be observed within the mucous membranes. o Retinopathy can develop following embolism to retinal vessels (Roth’s spots). Medical notes Infective endocarditis: Treatment: Medical: a prolonged course of high-dose antibiotics. Surgical: e.g., valve replacement.  Dental notes - Prophylactic antibiotic regimens for adult dental procedures: Can take oral? Yes No Not Allergic Allergic Not Allergic Allergic Amoxicillin Clindamycin Ampicillin Ceftriaxone 2g 600 mg 2 g IM / IV 1 g IM / IV Timing: 30–60 min before dental procedure. Review questions 36 Review questions 1 The two most important diseases affecting the heart valves are: 1. Rheumatic fever & infective endocarditis. 2. Rheumatic fever & congenital valvular disease. 3. Infective endocarditis & ischemic or degenerative valve disease. 4. Infective endocarditis & congenital valvular disease. 37 Review questions 1 The two most important diseases affecting the heart valves are: 1. Rheumatic fever & infective endocarditis. 2. Rheumatic fever & congenital valvular disease. 3. Infective endocarditis & ischemic or degenerative valve disease. 4. Infective endocarditis & congenital valvular disease. 38 Review questions 2 Cardiac valve stenosis: 1. Is defined as incompetence of a cardiac valve. 2. Restricts the forward flow. 3. Results in volume overload. 4. Results in backward flow. 39 Review questions 2 Cardiac valve stenosis: 1. Is defined as incompetence of a cardiac valve. 2. Restricts the forward flow. 3. Results in volume overload. 4. Results in backward flow. 40 Review questions 3 Cardiac valve regurgitation: 1. Is defined as narrowing of a cardiac valve. 2. Restricts the forward flow. 3. Results in pressure overload. 4. Results in backward flow. 41 Review questions 3 Cardiac valve regurgitation: 1. Is defined as narrowing of a cardiac valve. 2. Restricts the forward flow. 3. Results in pressure overload. 4. Results in backward flow. 42 Review questions 4 The characteristic feature of a cardiac valve lesion is: 1. Right-sided heart failure. 2. Left-sided heart failure. 3. Murmur. 4. Pressure overload. 43 Review questions 4 The characteristic feature of a cardiac valve lesion is: 1. Right-sided heart failure. 2. Left-sided heart failure. 3. Murmur. 4. Pressure overload. 44 Review questions 5 The definitive investigation in rheumatic valvular heart disease is: 1. ECG. 2. ESR. 3. Plain x-ray of chest. 4. Echocardiogram. 45 Review questions 5 The definitive investigation in rheumatic valvular heart disease is: 1. ECG. 2. ESR. 3. Plain x-ray of chest. 4. Echocardiogram. 46  Review questions 6 Atrial fibrillation is a common complication of mitral valve disease. Which of the following medications has no role in its treatment? 1. Digoxin. 2. β-blockers. 3. Diclofenac. 4. Warfarin. 47  Review questions 6 Atrial fibrillation is a common complication of mitral valve disease. Which of the following medications has no role in its treatment? 1. Digoxin. 2. β-blockers. 3. Diclofenac. 4. Warfarin. 48 Review questions 7 Rheumatic fever typically occurs 2–3 months after streptococcal pharyngitis. 1. True. 2. False. 49 Review questions 7 Rheumatic fever typically occurs 2–3 months after streptococcal pharyngitis. 1. True. 2. False. 50 Thank You!