Inflammatory and Structural Heart Disorders: Valvular Disease and Infective Endocarditis Lecture notes (Completed)

Valvular Stenosis

A condition characterized by the narrowing of the valve opening, which restricts forward blood flow.

Valvular Regurgitation (Insufficiency)

A condition where the valve leaflets do not close completely, resulting in the backward flow of blood.

Mitral Valve Prolapse

The most common valvular disorder, where the flaps of the mitral valve bulge (prolapse) upward into the left atrium.

Mitral Regurgitation

A condition where incomplete closure of the mitral valve causes blood to flow from the Left Ventricle (LV) back into the Left Atrium (LA). Best heard at the Left Lower Sternal Border (LLSB) and characterized by low pitch. Often caused by MI or IE.

Aortic Stenosis

Narrowing of the aortic valve causing obstructed blood flow from the Left Ventricle (LV) to the aorta; best heard at the Right Sternal Border (RSB) with a high-pitched musical sound.

Mechanical Valves

Manufactured from artificial materials; highly durable but have a high risk for thromboembolism.

Medical Requirements for Mechanical Valves

Patients must remain on lifelong anticoagulation therapy (e.g., warfarin) and monitor PT/INR levels.

Antidote for Anticoagulation Effects

Vitamin K

Biologic (Human) Valves

Tissue valves often derived from human or animal sources, associated with lower thromboembolism risk but generally less durable than mechanical valves.

What characterizes the subacute form of infective endocarditis?

It is characterized by a longer clinical course and typically involves preexisting valve disease, such as rheumatic heart disease.

What is the acute form of infective endocarditis?

The acute form can affect previously healthy valves and is marked by a rapidly progressive clinical course.

What are the most common causative organisms of infective endocarditis?

The most common bacteria are Staphylococcus aureus and Streptococcus viridans.

What is the mechanism of infection in infective endocarditis (IE)?

Occurs when blood turbulence within the heart allows a causative organism to infect previously damaged valves or other endothelial surfaces.

What is the composition of vegetation in IE?

A mixture of fibrin, leukocytes, platelets, and microbes.

What can left-sided heart embolizations travel to in IE?

Can travel to the Brain, Limbs, Kidneys, Liver, and Spleen.

What can right-sided heart embolizations travel to in IE?

Travel to the Lungs.

Risk Factors for Infective Endocarditis (IE)

Aging, IV Drug Abuse (IVDA), Prosthetic Heart Valves, Rheumatic Heart Disease, Intravascular Devices, Renal Dialysis.

What are the general/nonspecific manifestations of subacute infective endocarditis?

Common symptoms include low-grade fever (found in 90% of patients), chills, weakness, malaise, fatigue, anorexia, weight loss, arthralgias, myalgias, back pain, headache, and clubbing of the fingers.

What are the vascular manifestations associated with infective endocarditis?

Includes splinter hemorrhages (dark streaks in nail beds), petechiae (purplish-red spots on skin), Osler’s nodes (painful raised lesions on fingers/toes), Janeway’s lesions (painless red flat lesions on palms/soles), and Roth’s spots (hemorrhagic retinal lesions).

What are the embolic manifestations of infective endocarditis by organ?

May include heart murmurs and heart failure, sharp pain in the left upper quadrant (spleen), flank pain and hematuria (kidneys), limb gangrene, changes in mental status (brain), and dyspnea with decreased O₂ saturation (lungs).

Subjective Data for IE Assessment

Includes health history of valvular, congenital, or syphilitic cardiac disease, previous endocarditis, infections, surgeries, and assessment of IV drug abuse, alcohol use, and symptoms like fatigue and dyspnea.

Objective Physical Findings in IE

Signs include fever, Osler’s nodes, Janeway’s lesions, splinter hemorrhages, and respiratory or cardiac signs such as dysrhythmia and tachycardia.

Diagnostic Tests for IE

Blood cultures, CBC with differential, ESR, CRP, echocardiography for valvular dysfunction, and Chest X-ray for cardiomegaly.

What are Prophylactic Antibiotics indicated for?

Indicated for patients with specific heart conditions before undergoing certain dental procedures, respiratory tract incisions, tonsillectomy, adenoidectomy, and surgical procedures involving infected skin.

What are the Nursing Diagnoses for infective endocarditis?

Decreased cardiac output, Hyperthermia, Impaired comfort, Activity intolerance, and Deficient knowledge.

What are some key aspects of General Patient Teaching for infective endocarditis?

Avoiding infectious individuals, Managing stress and preventing fatigue, Importance of rest and good oral hygiene, Guidance on drug rehabilitation for IV drug abuse.

Duration of Antibiotic Therapy

Antibiotic therapy typically lasts 4 to 6 weeks.