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83 Cards in this Set
- Front
- Back
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Define Infective endocarditis
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Inflammation of inner layer of heart wall due to bacterial infection (streptococcus or staphylococus). Usually affecting valves of the heart.
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What part of the heart is most commonly affected by infective endocarditis?
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The valves of the heart
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In Echo, how do you rule out infective endocarditis?
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Zoom the valves and check for vegetation
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What is the etiology of infective endocarditis?
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Usually caused by an infection settling into an area of an existing heart valve abnormality or endocardio abnormality. Bacteria settles into these unprotected areas and causes infection
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What 2 bacteria cause infective endocarditis?
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Streptococcus and staphylococcus
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What are the signs and symptoms of the patient with infective endocarditis?
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High fever
fast HR Anema (due to inflammation of spleen)' Positive blood culture High WBC (indicating infection) New heart murmur (due to damaged valves Flu-like symptoms |
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What are the major clinical criteria for Infective endocarditis?
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1) positive culture for streptococcus or staphylococus
2) visible mass or vegetation on Echo |
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What are the minor clinical criteria for Infective endocarditis?
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1) pre existing condition
2) high fever 3) vascular disease 4) immunologic disease 5) positive culture for bacteria other than strep or staph 6) Embolism |
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What are the goals of the endocardiography in patient with infective endocarditis?
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1) check for vegetations or absesses on valves
2) check for regurge/eccentric regurge 3) check for flail leaflets 4) check for aneurysm 5) check for pericarditis |
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What type of aneurysm is caused by infectio?
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Mycotic aneurysm
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Who are the people more suseptible to infective endocarditis?
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1) those with pre-existing valve disease
2) patients with a history of IE 3) people with prosthetic valves 4) IV drug users |
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When should prophylactic antibiotics be used?
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Prophylactic antibiotics should be used to prevent IE in all patients at risk prior to dental work or surgery
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What are the 2D findings in patient with infective endocarditis?
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1) Vegetations on the flow side of valve leaflets
2) absesses 3) flail leaflet 4) aneurysm 5) pericardial effusion |
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What do you do as an Echo tech when you suspect vegetation?
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Zoom --> measure --> find same vegetation in at least 2 views
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Vegetations > 1 cm are at high risk for ______
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Embolism
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What are the doppler findings associated with Infective endocarditis
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Severe/acute regurge
shunt Perforated regurge - through valve leaflet eccentric regurge - down the side Grade III diastolic dysfunction Hyperdynamic heart movements |
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What are the complications of infective endocarditis
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Flail leaflets
vegetation perforation mycotic aneurysm fistula pericarditis ring dehiscence shunt embolism severe regurge leading to --> acute heart failure or --> acute pulmonary edema |
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What are the treatments for infective endocarditis
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For @ risk patients -- Prophalyctic antibiotics
To cure --> antibiotics for 4-6 weeks, anti-coagulant drugs and follow up. For Severe --> valve replacement or repair |
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Which valve commonly affected with IE (in order)
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Mitral valve (most common)
Aortic Valve Tricuspid valve Pulmonic valve (least common) |
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Which part of the valve is most commonly affected with IE?
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Tips of leaflets on flow side
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Which valve commonly affected in drug abusers?
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Tricuspid
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Tricuspid vegetations put patient at risk for _____
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30% will develop pulmonary embolism
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Tricuspid vegetations are usually ______ in size
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Large
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What is vegetation?
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Masses of dead tissue, bacteria, pus, or clotted blood
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What is the differences between rheumatic heart disease and infective endocarditis?
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Both are caused by bacteria
-IE = directly - Rheumatic = indirectly IE can be treated with antibiotics Rheumatic cannot be treated with antibiotics |
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Stenosis of > 70% leads to _____
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Ischemia
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Stenosis of 100% leads to ____
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Myocardial infarction
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Cardiogenic shock happens when _____
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30-40% of LV is not working/not pumping blood
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Define Ischemic heart disease
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Lack of blood supply to tissue.
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What is Ischemia caused by
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Coronary artery disease
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What is the etiology of ischemic heart disease
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1) Atherlosclorosis - build up of plague
2) Embolism 3) Spasm |
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Who are at risk for developing ischemic heart disease?
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-lack of exercise
-smokers -high cholesterol (LDL) -poor diet - diabetic patients |
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What are the medical treatments for ischemic heart disease?
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Treatment medically with nitroglycerin, beta blockers and diuretics
Prevention with cholesterol lovweing drugs Angioplasty to open occlusion bypass graft to bypass occluded area |
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What are the complications of Myocardial infarction
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Aneurysm
- True ---> Embolism - Pseudo --> rupture Fistula/shunt Thrombosis Papillary muscle disease - dysfunction - Rupture Regurge Diastolic Dysfunction Pericarditis/Pericardial Effusion RV infarction --> Decreased Cardiac output Cardiogenic Shock |
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Describe the stress echo procedure
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Echo @ rest
Patient exercise or Dubontimine Echo within 45 sec of above COMPARE FINDINGS |
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What view can you see the posterior leaflet of the TV
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RVIT
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In all views EXCEPT RVIT what leaflets of the tricuspid valve are visible
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Anterior and Septal
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When should stress echo be performed?
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After abnormal EKG
Patients with CAD or Ischemia Before major surgery before startiing diet program before chemotherapy |
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What are you looking for during stress echo?
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Wal motion abnormalities and verifying heart strength
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What is kawasaki's disease?
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Autoimmune disease causing inflammation of blood vessels
- Seen in children 2 - 5 years old - Leads to CAD and Ischemia - Found in proximal RCA and LMCA |
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In patients with IE, Do pre existing valve diseases obscure the presence of vegetation
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YES
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Can vegetations more than 3 mm in diameter be recongnized
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YES
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True or False. Vegetations usually not appear on the flow side of valve leaflets
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FALSE
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True or False. It is easy to distinguish between new and healed vegetations?
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FALSE. you cannot distinguish between new and old vegetations
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Who are at high risk for infective endocarditis
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1) Patients with existing valve disease
2) IV drug users 3) patients with history of IE 4) pacemaker patients 5) patients with prosthetic valves |
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60% of IV drug users develop vegetation in _____
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TV
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Who should NOT have a stress echo performed?
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- Patients with unstable angina
- Recent MI - Pregnant women - patients with severe arrythmias - Thrombosis - aortic insufficency - any other condition that makes exercise difficult |
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Prophylactic antibiotics are recommended for patients with
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-pre existing valve disease
- history of IE - congenital heart disease - pacemaker wires |
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Prophylactic antibiotics are recommended for patients to prevent ____
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Infective endocarditis
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True or false. During a stress echo there should be an increase in ejection fraction
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TRUE
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True or false. During stress echo there should be decreased cardiac output.
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FALSE. cardiac output should increase
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True or False. During stress echo there should be decreased ventricular end systolic dimension.
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True. The walls will be hyperkinetic and therefore there will be less space.
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True or false. During stress echo there should be symmetric wall thickening.
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True
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What is the meaning of right-dominate coronary circulation
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PDA originates from RCA
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When would a patient be considered left dominant and how often does that occur?
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When the PDA arises from the Circumflex. 15% of people
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The best position for recording left ventricular filling waveforms by PW doppler is _____-
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at the tips of the MV leaflets
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Left ventricular thormbosis is usually occur in ____
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Apex
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What causes thormbosis
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Slow moving blood due to CAD
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What are the 2 types of thrombosis?
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Mural/laminar = seen as layers in apex
Mobile/protruding = seen as hanging in apex |
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Which type of thrombosis is most dangerous?
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Mobile/protruding ... can lead to embolism
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What are the views used during stress echo?
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PLAX
PSAX - PM AP 2 AP 4 |
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What are the complications of Infective endocarditis?
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-Flail leaflets
- vegetations - Acute severe regurge - Acute pulmonary edema - perforation - valve ring absess - aneurysm - rupture -Embolism - heart failure - Pericarditis/pancarditis |
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Hypokinetic ....
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Decrease in movement
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hyperkinetic ...
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Increase in movement
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Akinetic ...
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No movement
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Dyskinetic ...
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Outward/opposite movement
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True or False. The size of aneurysm decreases in systole.
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FALSE. the size of the aneurysm increases during systole. The walls become dyskinetic and allows more room
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True or False. The apex of the heart is usually involved with aneurysms
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True
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True or false. When an aneurysm is present usually no thrombus is seen
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False. Thrombus is common due to slow moving blood
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True or false. Multiple views are needed to complete the assessment of an aneurysm
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True. At least 2 views are needed
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True or false. Aneurysms have thin walls
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True.
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How many layers of the heart walls are affected in true aneuryms?
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All 3 layers
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How many layers of the heart walls are affected in pseudo aneurysms?
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Only pericardium. Other layers have ruptured.
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The anterior and apical wall of the LV is supplied by ___-
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LAD
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Vegetations with diameter of less than _____ may not be seen by TTE
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3 mm
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A positive bloof culture, new murmur and fever are all signs of _____
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Infective endocarditis
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2D in infective endocarditis may show
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VEGETATION
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Vegetations are usually associated with ______ and best detetected using ____
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Vegetations are usually associated with INFECTIVE ENDOCARDITIS and are best detected using 2D exam
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The left main coronary artery arise to ____
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LAD and CX
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In 20% of people, the posterior descending coronary artery arise from ____
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CX
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In 85% of people the posterior descending coronary artery arises from ____
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RCA
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The anterolateral and inferolateral walls of LV are supplied by ___
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CX
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The inferior wall of the left ventricle and inferior IVS is supplied by ____
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RCA/PDA
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