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Cardiovascular > 04.28 - Valve Disease 1 (Nichols) > Flashcards

04.28 - Valve Disease 1 (Nichols) Flashcards

1
Q

Most common valvular disease in US

A

Mitral Valve Prolapse

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2
Q

“Sign” of Mitral Valve Prolapse

A

Midsystolic Click

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3
Q

2 Most common complications of Infective Endocarditis

A

Heart Failure, Septic Emboli

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4
Q

2 Most common physical “signs” of Infective Endocarditis

A

Fever, Heart Murmur

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5
Q

3 invariable consituents of septic emboli

A

Fibrin, Platelets, Organisms

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6
Q

3 Most common lab findings in Infective Endocarditis

A

High ESR, Anemia, Proteinuria

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7
Q

3 Salient Features of RHD

A

(1) Fibrinous Pericardial Exudate; (2) Aschoff Bodies; (3) Verrucae vegetations

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8
Q

4 Common symptoms of Infective Endocarditis

A

Fever (80%); Chills, Weakness, Dyspnea

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9
Q

4 Denerative Valve Changes

A

(1) Calcifications; (2) Decrease Fibroblasts; (3) Altered ECM; (4) Changes in prod. Of MMP’s, or their inhibitors

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10
Q

4 step Pathogenesis of Infective Endocarditis

A

(1) Valvular Endothelial Injury; (2) Platelet + Fibrin Deposition; (3) Microbial Seeding; (4) Microbial Multiplication

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11
Q

Appearance of Valves in Mitral Valve Prolapse

A

Can be micro- and macro-scopically normal

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12
Q

Ballooning (hooding) of Mitral Leaflets

A

Myxomatous Degeneration of Mitral Valve

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13
Q

Brugada Syndrome is a defect in

A

Sodium channels

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14
Q

Carditis and Migratory Arthritis

A

ARF

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15
Q

Causes of Acquired Mitral Stenosis

A

Only RHD

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16
Q

Children with syncope or sudden death due to Polymorphic V Tach

A

Presentation of Congenital Long QT

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17
Q

Chordae Tendinaie in Mitral Valve Prolapse are prone to

A

Rupture

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18
Q

Clincially important fact for Libman-Sacks Endocarditis

A

Rarely embolizes

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19
Q

Commissural fusion of aortic valve cusps is usually a sign of

A

Previous Inflammation

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20
Q

Complications of ARF

A

Arrhythmias, Cardiac Dilation, CHF (less that 1%)

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21
Q

Conditions with Aschoff Bodies

A

Just RHD

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22
Q

Disctinctive, glistening white intimal plaque-like thickenings on the endocardial surfaces of cardiac chambers and valve leaflets

A

CV lesions of Carcinoid Syndrome

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23
Q

Disctinctive, glistening white intimal plaque-like thickenings on the endocardial surfaces of cardiac chambers and valve leaflets

A

Carcinoid Heart Disease

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24
Q

Early, inconsequential stage of Calcific Aortic Stenosis

A

Aortic Valve Sclerosis

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25
Q

Epidemiology of Libman-Sacks Endocarditis

A

Part of Lupus

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26
Q

Epsilon wave can be a manifestation of

A

ARVCM

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27
Q

Exercise often triggers V Tach due to what

A

Long QT Syndrome

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28
Q

Histological changes in Myxomatous Degeneration

A

Thinning of Fibrosa, Expansion of Spongiosa

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29
Q

How does pregnancy change blood volume

A

Increase, average 45%

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30
Q

How to finalize dx of Infectious Endocarditis

A

3 blood cultures from 3 different sites, before starting antibiotics

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31
Q

In Mitral Valve Prolapse, which layer is expanded? Which thinned?

A

Inner Zona Spongiosa expanded, Zona Fibrosa thinned

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32
Q

Infected Emboli from Endocarditis commonly go to

A

Kidneys, Heart, Spleen, Brain

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33
Q

Mechanical valves require lifelong

A

Anticoagulation

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34
Q

Midsystolic Click is a sign of

A

Mitral Valve Prolapse

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35
Q

Mitral annular calcification is usually asymptomatic unless

A

it encroaches on adjacent conduction system

36
Q

Mitral Stenosis is buzzword for

A

RHD

37
Q

Mitral Valve in Chronic Rheumatic HD

A

Thick leaflet, commissural fusion, Thickening and fusion of Chordae

38
Q

Most common cause (organism) of infective endocarditis

A

S Aureus

39
Q

Most common cause of aortic stenosis

A

Calcific Aortic Degeneration

40
Q

Most common congenital valvular lesion

A

Bicuspid Aortic Valve

41
Q

Most important clinical features of RHD

A

Valvular inflammation and scarring

42
Q

Most important functional consequence of RHD

A

Valvular Stenosis and Regurgitation

43
Q

Most sensitive procedural test for Vegetations

A

Transesophageal Echo (>Transthoracic)

44
Q

Myxomatous Degeneration of Mitral Valve occurs in what class of disorders

A

CT disorders (eg Marfans)

45
Q

Onset of what common process occurs much earlier with Bicuspid aortic valves

A

Calcific Aortic Stenosis

46
Q

Palpabe manifestation of valve disease

A

Thrill

47
Q

patients with primary myxomatous degeneration are at increased risk of

A

Mitral Regurg, CHF, Infective Endocarditis, Vent Arrhythmias

48
Q

Pregnancy effects on Heart Valves

A

Volume increase -> LV Dilation -> Redundant mitral valve leaflets coapt without regurgitation

49
Q

Prerequisite for heart damage in Carcinoid Syndrome

A

Massive Hepatic Metastatic burden

50
Q

Presentation of Brugada Syndrome

A

40 yo asian male with Syncope or SCD due to V Tach, especially during SLEEP

51
Q

Presentation of Congenital Long QT

A

Children with syncope or sudden death due to Polymorphic V Tach

52
Q

Primary form of Mitral Valve Prolapse is due to

A

Genetic defect in CT

53
Q

Primary form of Myxomatous Degeneration of Mitral Valve

A

Mitral Valve Prolapse

54
Q

Principal manifestations of ARF in children vs adults

A

Carditis vs Arthritis

55
Q

Risk factors for Calcific Aortic Stenosis are same as those for

A

Age-Related Arteriosclerosis

56
Q

Secondary form of Mitral Vavle Prolapse is due to

A

Injury

57
Q

Secondary Myxomatous Change presumably results from

A

Injury to Valve Myofibroblasts (eg IHD)

58
Q

Small-medium verrucous, berrylike or flat vegetations on multiple valves

A

Libman-Sacks Endocarditis

59
Q

The incidence of infection, marantic endocarditis, and rheumatic disease on a valve correlated with

A

Resting Pressure on the Closed Valve

60
Q

The larger the vegetation, the

A

more likely it is infective

61
Q

The vast majority of Infectious Endocarditis episodes are what organisms

A

Extracellular Bac’s

62
Q

Timecourse of Acute vs Subacute Bacterial Endocarditis

A

Days vs Weeks/Months

63
Q

Top 3 sites of Infective Endocarditis

A

Mitral, Aortic, Mitral + Aortic

64
Q

Top 3 species causing Infective Endocarditis

A

Staph Aureus, Strep Viridans, Enterococcus

65
Q

Type of Poly V Tach typical of congenital long QT

A

TDP

66
Q

Typical cardiac findings in Carcinoid Syndome

A

Tricuspid Insufficiency, Pulmonic Stenosis

67
Q

Usual precursor to NBTE

A

Hypercoagulable state, not valvular damage

68
Q

V Tach due to Long QT syndrome is often triggered by

A

Exercise

69
Q

Valve damage in Libman-Sacks Endocarditis

A

Fibrinoid necrosis adjacent to vegetation; Subsequent fibrosis and deformity can resemble chronic RHD

70
Q

Valvular damage by NBTE

A

Usually nondestructive

71
Q

Virchow’s Triad

A

Endothelial Injury, Abnormal Flow, Hypercoagulability

72
Q

What causes Carcinoid Syndome

A

Release of bioactive compounds such as 5-HT from Carcinoid Tumors

73
Q

What causes Ring Abcesses

A

Vegetations eroding into underlying myocardium

74
Q

What determines whether Infectious Endocarditis is Acute vs Subacute

A

Virulence of organism

75
Q

What is a vegetation

A

Friable masses of infecting organisms and blood clot

76
Q

What is unique about Libman-Sacks Endocarditis vs Most types of endocarditis

A

Vegetations on both sides of valves

77
Q

What parts of heart are pimarily affected in Carcinoid Heart Disease

A

Endocardium and Valves of Right Heart

78
Q

When to NBTE lesions cause valve damage

A

When bacteria colonize to become Infectious Endocarditis

79
Q

Where in heart does Infective Endocarditis most commonly occur

A

Valves (Mitral, Aortic, Mitral + Aortic)

80
Q

Where is ARVCM most prevalent

A

Northern Italy (similar to Long QT)

81
Q

Which layer of Mitral Valve determines structural integrity

A

Fibrosa (this is thinned in Myxomatous Degeneration)

82
Q

Which of the 4 Endocarditis’s do not damage valves

A

NBTE

83
Q

Which side of heart is affected in Carcinoid Syndrome

A

Right (coming from systemic circulation)

84
Q

Which side of valve do vegetations usually occur?

A

Side of valve closure (atrial side of Mitral)

85
Q

Which type of vegetative endocarditis can occur on both sides of valve

A

Libman-Sacks Endocarditis (SLE)

86
Q

Why is Spongiosa expanded in Myxomatous Degeneration

A

Increased deposition of myxomatous (mucoid) material)

Cardiovascular (18 decks)

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