SEMIO CH17 TRIGGER

VALVULAR HEART DISEASE DEF

DISEASE AFFECTING 1 OR MORE CARDIAC VALVE

MOST COMMONLY AFFECTED VALVES

THE LEFT SIDED → AORTIC + MITRAL

2 MAIN ORIGINS OF VALVE D° →

CONGENITAL → PRESENT AT BIRTH

ACQUIRED → SECONDARY TO …

SECONDARY TO … ?

RHEUMATIC FEVER

INFECTIVE ENDOCARDITIS

DEGENERATIVE VALVE DISEASE

TRIGGER RHEUMATIC FEVER

STREPTOCOCCAL PHARYNGITIS + POST INFECTIOUS INFLAMMATORY DISEASE

2 MAIN TYPE OF VALVULAR DISEASE

STENOSIS → OPENING PROBLEM

REGURGITATION → CLOSING PROBLEM

4 MAJOR COMPLICATIONS OF VALVULAR DISEASE

ARRYTHMIAS → TROUBLE DU RYHTME CARDIAQUE

ITNRAVASCULAR THROMOBOSIS → CAILLOT

ARTERIAL EMBOLISM → MIGRATION DU CAILLOT

INFECTIVE ENDOCARDITIS → INFECTION DE L’ENDOCARDE

MOST COMMON PREDISPOSING FACTOR FOR INFECTIVE ENDO° ?

PRESENCE OF ABNORMAL VALVES BEFORE THE INFECTION

COMPLICATIOS ASSOCIATED W/ MITRAL STENOSIS ?

ATRIAL FIBRILLATION

BACTERIAS CAUSING INFECTIVE ENDOCARDITIS (4)

VIRIDANS, STREPTO, STAPH° AUREUS, ENTEROCOCCI

2 HIGH-RISK GROUPS FOR INFECTIVE ENDO°

INJECTED DRUG USERS

PATIENTS AFTER RECENT DENTAL WORK

THE STEPS BETWEEN ABNORMAL VALVES → INFECTIVE ENDO°

ABNORMAL VALVE → TURBULENT BLOOD FLOW → ENDOCARDIAL DAMAGE → STERILE VEGETATION → BACTEREMIA → BACTERIAL ADHESION → INFECTED VEGETATION → INFECTIVE ENDO°

4 MAINS SYMPTOMS OF INFECTIVE ENDO°

FEVER + HEART MURMUR + OSLER NODES + JANEWAY LESIONS

TRIGGER OLSER NODES

PAINFUL PAPULES ON FIGERS AND TOES

TRIGGER JANEWAY LESION

PAINLESS HEMORRAGIC LESIONS ON THE PALM AND THE SOLES

MAIN DIFF OSLER VS JANEWAY

OSLER = PAINFUL

JANEWAY = PAINLESS

RIGHT SIDED INFECTIVE ENDO° CAUSES →

EMBOLI TO LUNGS

LEFT SIDED INFECTIVE ENDO° CAUSES →

SYSTEMIC EMBOLI

4 CONDITIONS FOR INFECTIVE ENDO° PROPHYLAXIS

PATIENT W/ →

PROSTHETIC CARDIAC VALVE

PREVIOUS INFECTIVE ENDO°

CONGENITAL HEART DISEASE

CARDIAC TRANSPLANTATION W/ VALVULOPATHY

PROPHYLAXIS BEFORE DENTAL TREATMENT ?

AMOXICILLIN 2G 30-60 MINUTES BEFORE TREATMENT

VALVE REPAIRE SURGERY =

VALVULOPLASTY

BIOPROTHESTIC VALVE : RISK AND TREATMENT

LOW RISK OF THROMBOSIS → ANTIPLATELETS LIKE ASPIRIN IF NECESSARY

MECHANICAL VALVE : RISK AND TREATMENT

HIGH RISK OF THROMBOSIS → HIGH RISK OF THROMBOSIS → ANTICOAGULANT LIKE WARFARIN → ALL LIFE

RAPPEL : MURMUR SIGN OF ?

TURBULENT BLOOD FLOW