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31 Cards in this Set
- Front
- Back
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mitral valve inflow is a way of evaluating
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diastolic function
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stressh echo is look for
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ischemia and WA
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rheumatic disease attacks
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the mitral valve 1st
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Congenital aortic valve -
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bicuspid
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doming -
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stenosis
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Things that can go wrong with prosthetic valve
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dehiscence
-crack= variance -vegetation -thrombus -stenosis/regurgitation -prosthesis pt mismatch (ppm) ` |
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Prosthesis pt mismatch (ppm)
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-they put the wrong size prosthetic valve
-infective orifice area of the AO prosthesis smaller than that of a normal native valve - pt has a AO valve prosthesis : too small in realtionship to their body size = higher pressure gradient and low CO |
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What happens with Infective Endocarditis
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bacteria is release into the blood stream and looking for a place to land
- pt has scarred valves - its sticky and not smooth |
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Why so bd to get Infective Endocarditis (causes)
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stenosis
regurgitation break off embolus -can cause abscess or occlusion |
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Mortality rate of pts with IE is
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between 20-40%
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3 Basic populations that get endocarditis
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1. pts with any valves disease
2. prosthetic valves 3. IVDA - directly introducing bacteria to the heart 1st place is the right side of the heart |
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Infective Endocarditis 2D
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isolating intracardic mass ( on valve or supporting structures)
- might see : abscesses, new partial dischence of the prosthetic valves, new valuvar regurgitation |
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what side of the leaflet would vegetation initially occur
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inital attachement site to the valve is usally in the inside
- area of lower pressure |
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AO vegetation will happen in the
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ventricular side of the valve
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vegetation can be any shape and size
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freq show movement
-fluttering, isolating |
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sensitivity of 2D echo picking up a vegetation
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depends on the size and location
-THE -TEE - more sensitive |
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Pt with prosethetic valve to r/o vegetation use
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TEE
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Vegetation found in pt with endocarditis are usually larger if they are FOUNd
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-right side of the heart
- as opposed to vegetation found on the left side of the heart |
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Most vegetation are found on the
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left side of the heart
-Exceptions - are IVDA's vegetation on the right side of the heart - shooting up to the venous system and going to hit the right side of the heart |
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left side endocarditis Complications
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increases with greater the size of vegetation
- the bigger the size of the vegetation the more likely they would have worst complication |
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Valve replacement is required in
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1/3 of pts that endocarditis on the left side
- but less than 10% of those with involvement on the right side of the heart |
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Why would someone need a valve replacement post infective of endocarditis
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-bacteria is eating on the tissue
-cause conduction abnormalities -abscess |
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Complications of endocarditis
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pt develop abscess
perforation of the valve dehiscence of prosthetic vlve structural cusps or leaflet rupture develop aneurysm or fistula on the heart pericardial effection |
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Most common complications of endocarditis
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hemodynamic changes
-AI MR -CHF - esp if endocarditis spread to more than one valve |
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Noninfective endocarditis Associated with
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malignancy
associated with CT disease ( lupus) associated with rheumatic fever - myocarditis & pericarditis |
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Diagnosis of noninfective endocarditis
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clinically absence of vegetation does not exclude diagnosis of endocarditis if its suspected clinically
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biggest problem of endocarditis is the
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spreading of vegetation to other valves
-regurgitation -abscess formation perivaluvar (around the valve) |
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if abscess around the ao valve
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can cause sinus of valsalva to rupture
if sinus of valsalva does rupture - you will see a LEFT TO RIGHT SHUNT from the AO to RA |
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if abscess forms int he IVS
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conduction abnormality
rt and lt bundle branches - can cause heart block |
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Acute IE
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sudden fever
fast HR valves are damaged |
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Sub acute
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fast HR
sweating weight loss anemia |
