Cardiac valve defects & Infective endocarditis
Valve lesion Causes Sx Signs Murmur Ix Mx
Asymptomatic =
ECG LVH, AV block
Crescendo- observe
CXR Post-stenotic
Senile Decrescendo Symptomatic = valve
dilation of ascending
calcification (>60 Ejection Systolic replacement
aorta
yrs) Murmur (ESM) Mechanical lasts
Chest pain Narrow pulse Calcification of valve on
Aortic Congenital radiates to the longer, needs lifelong
Syncope pressure lateral view
stenosis bicuspid valve, carotids anticoagulation =
Dyspnoea Slow rising pulse ECHO Confirms Dx
William’s In aortic sclerosis younger patients
Allows severity + valve
syndrome (valve thickening) Bioprosthetic lasts 10-
area to be assessed
Rheumatic fever there is no 15 years
Severe: pressure
radiation No anticoagulation =
gradient > 40mmHg
older patients
Water-hammer
Acute cusp
pulse
rupture,
Wide pulse
connective tissue
pressure
disorders, aortic
Traube’s sign ECG LVH
dissection,
‘Pistol shot’ over CXR Cardiomegaly +
perforation HF/LVF
femorals Decrescendo Early pulmonary oedema if
Aortic secondary to Chest pain Aortic valve
De Musset’s sign Diastolic Murmur patient has HF
regurgitation infection, Arrhythmia replacement
Head nodding in (EDM) ECHO Confirms Dx
infective s
time w/ heart Allows severity + aortic
endocarditis
beat root to be assessed
Chronic RA,
Quincke’s sign
Ankylosing
Capillary
spondylitis,
pulsation in nail
syphilis
bed
Dyspnoea
RHD
Palpitations
Calcification of ECG AF, bifid p waves
if in AF Low pitch mid-
valve Malar flush CXR Pulmonary
Mitral HF diastolic murmur w/ Mx AF + HF
RA Tapping apex oedema + enlarged LA
stenosis Haemoptysi loud S1 opening Valve replacement
Ankylosing beat may be seen
s: rupture snap
spondylitis ECHO Confirms Dx
of bronchial
SLE
veins
Valve
ECG AF, bifid p waves
Mitral valve repair/replacement
CXR Cardiomegaly +
prolapse Indications:
Dyspnoea A harsh pansystolic pulmonary oedema (if
Rheumatic fever Severe: symptomatic
Mitral Palpitations Displaced apex murmur radiating HF present)
Papillary muscle MR
regurgitation if in AF beat to the axilla, soft ECHO systolic
rupture Severe asymptomatic
HF S1, split S2 pulmonary flow reversal
Infective MR + diastolic
Regurgitation volume >
endocarditis dysfunction reduced
60ml
EF
Definition infection of the endocarditis. Signs + Symptoms ‘FROM JANE’
Involving the heart valves, w/ vegetation of Fever Roth spots (Fundoscopy) Osler’s nodes Murmur
the infectious agent Jane way lesions Anaemia Nails: splinter haemorrhages
Mitral valve > Tricuspid valve (implicated in Emboli
IVDU) Classification Modified Duke’s Criteria (Pathological
criteria/2 major/1 major + 3 minor/ 5 minor)
Risk factors Pathological criteria positive histology/microbiology of
Previous episode of endocarditis pathological material obtained @ surgery/autopsy
Affected patients Major criteria
Previously normal valves (50%) 2 separate positive blood cultures
Rheumatic valve disease (30%) Endocardial involvement: ECHO/New valvular
Prosthetic valves regurgitation
Congenital heart defects Minor criteria ‘FIIVE’
IVDU Fever > 38oC
IV drug user
Pathophysiology Immunological phenomena e.g. Osler’s node,
Usually affects those w/ structural valve Glomerulonephritis, Roth spots
abnormality + limited blood supply + WBC Vascular phenomenon e.g. mycotic aneurysm, splinter
cannot reach valves via blood Bacteria haemorrhages, splenomegaly, clubbing
colonise ECHO findings/ microbiology doesn’t match major
Mx
Aetiology Conservative good oral hygiene
Streptococcus viridans was the commonest Medical Benzylpenicillin + Gentamicin
agent- now in developing countries Strep Benzylpenicillin + Amoxicillin
Staphylococcus aureus common in acute Staph Flucloxacillin + Gentamicin
presentations + IVDU
Valve lesion Causes Sx Signs Murmur Ix Mx
Asymptomatic =
ECG LVH, AV block
Crescendo- observe
CXR Post-stenotic
Senile Decrescendo Symptomatic = valve
dilation of ascending
calcification (>60 Ejection Systolic replacement
aorta
yrs) Murmur (ESM) Mechanical lasts
Chest pain Narrow pulse Calcification of valve on
Aortic Congenital radiates to the longer, needs lifelong
Syncope pressure lateral view
stenosis bicuspid valve, carotids anticoagulation =
Dyspnoea Slow rising pulse ECHO Confirms Dx
William’s In aortic sclerosis younger patients
Allows severity + valve
syndrome (valve thickening) Bioprosthetic lasts 10-
area to be assessed
Rheumatic fever there is no 15 years
Severe: pressure
radiation No anticoagulation =
gradient > 40mmHg
older patients
Water-hammer
Acute cusp
pulse
rupture,
Wide pulse
connective tissue
pressure
disorders, aortic
Traube’s sign ECG LVH
dissection,
‘Pistol shot’ over CXR Cardiomegaly +
perforation HF/LVF
femorals Decrescendo Early pulmonary oedema if
Aortic secondary to Chest pain Aortic valve
De Musset’s sign Diastolic Murmur patient has HF
regurgitation infection, Arrhythmia replacement
Head nodding in (EDM) ECHO Confirms Dx
infective s
time w/ heart Allows severity + aortic
endocarditis
beat root to be assessed
Chronic RA,
Quincke’s sign
Ankylosing
Capillary
spondylitis,
pulsation in nail
syphilis
bed
Dyspnoea
RHD
Palpitations
Calcification of ECG AF, bifid p waves
if in AF Low pitch mid-
valve Malar flush CXR Pulmonary
Mitral HF diastolic murmur w/ Mx AF + HF
RA Tapping apex oedema + enlarged LA
stenosis Haemoptysi loud S1 opening Valve replacement
Ankylosing beat may be seen
s: rupture snap
spondylitis ECHO Confirms Dx
of bronchial
SLE
veins
Valve
ECG AF, bifid p waves
Mitral valve repair/replacement
CXR Cardiomegaly +
prolapse Indications:
Dyspnoea A harsh pansystolic pulmonary oedema (if
Rheumatic fever Severe: symptomatic
Mitral Palpitations Displaced apex murmur radiating HF present)
Papillary muscle MR
regurgitation if in AF beat to the axilla, soft ECHO systolic
rupture Severe asymptomatic
HF S1, split S2 pulmonary flow reversal
Infective MR + diastolic
Regurgitation volume >
endocarditis dysfunction reduced
60ml
EF
Definition infection of the endocarditis. Signs + Symptoms ‘FROM JANE’
Involving the heart valves, w/ vegetation of Fever Roth spots (Fundoscopy) Osler’s nodes Murmur
the infectious agent Jane way lesions Anaemia Nails: splinter haemorrhages
Mitral valve > Tricuspid valve (implicated in Emboli
IVDU) Classification Modified Duke’s Criteria (Pathological
criteria/2 major/1 major + 3 minor/ 5 minor)
Risk factors Pathological criteria positive histology/microbiology of
Previous episode of endocarditis pathological material obtained @ surgery/autopsy
Affected patients Major criteria
Previously normal valves (50%) 2 separate positive blood cultures
Rheumatic valve disease (30%) Endocardial involvement: ECHO/New valvular
Prosthetic valves regurgitation
Congenital heart defects Minor criteria ‘FIIVE’
IVDU Fever > 38oC
IV drug user
Pathophysiology Immunological phenomena e.g. Osler’s node,
Usually affects those w/ structural valve Glomerulonephritis, Roth spots
abnormality + limited blood supply + WBC Vascular phenomenon e.g. mycotic aneurysm, splinter
cannot reach valves via blood Bacteria haemorrhages, splenomegaly, clubbing
colonise ECHO findings/ microbiology doesn’t match major
Mx
Aetiology Conservative good oral hygiene
Streptococcus viridans was the commonest Medical Benzylpenicillin + Gentamicin
agent- now in developing countries Strep Benzylpenicillin + Amoxicillin
Staphylococcus aureus common in acute Staph Flucloxacillin + Gentamicin
presentations + IVDU
