04.28 - Valve Disease 1 (Nichols) Flashcards
Most common valvular disease in US
Mitral Valve Prolapse
“Sign” of Mitral Valve Prolapse
Midsystolic Click
2 Most common complications of Infective Endocarditis
Heart Failure, Septic Emboli
2 Most common physical “signs” of Infective Endocarditis
Fever, Heart Murmur
3 invariable consituents of septic emboli
Fibrin, Platelets, Organisms
3 Most common lab findings in Infective Endocarditis
High ESR, Anemia, Proteinuria
3 Salient Features of RHD
(1) Fibrinous Pericardial Exudate; (2) Aschoff Bodies; (3) Verrucae vegetations
4 Common symptoms of Infective Endocarditis
Fever (80%); Chills, Weakness, Dyspnea
4 Denerative Valve Changes
(1) Calcifications; (2) Decrease Fibroblasts; (3) Altered ECM; (4) Changes in prod. Of MMP’s, or their inhibitors
4 step Pathogenesis of Infective Endocarditis
(1) Valvular Endothelial Injury; (2) Platelet + Fibrin Deposition; (3) Microbial Seeding; (4) Microbial Multiplication
Appearance of Valves in Mitral Valve Prolapse
Can be micro- and macro-scopically normal
Ballooning (hooding) of Mitral Leaflets
Myxomatous Degeneration of Mitral Valve
Brugada Syndrome is a defect in
Sodium channels
Carditis and Migratory Arthritis
ARF
Causes of Acquired Mitral Stenosis
Only RHD
Children with syncope or sudden death due to Polymorphic V Tach
Presentation of Congenital Long QT
Chordae Tendinaie in Mitral Valve Prolapse are prone to
Rupture
Clincially important fact for Libman-Sacks Endocarditis
Rarely embolizes
Commissural fusion of aortic valve cusps is usually a sign of
Previous Inflammation
Complications of ARF
Arrhythmias, Cardiac Dilation, CHF (less that 1%)
Conditions with Aschoff Bodies
Just RHD
Disctinctive, glistening white intimal plaque-like thickenings on the endocardial surfaces of cardiac chambers and valve leaflets
CV lesions of Carcinoid Syndrome
Disctinctive, glistening white intimal plaque-like thickenings on the endocardial surfaces of cardiac chambers and valve leaflets
Carcinoid Heart Disease
Early, inconsequential stage of Calcific Aortic Stenosis
Aortic Valve Sclerosis
Epidemiology of Libman-Sacks Endocarditis
Part of Lupus
Epsilon wave can be a manifestation of
ARVCM
Exercise often triggers V Tach due to what
Long QT Syndrome
Histological changes in Myxomatous Degeneration
Thinning of Fibrosa, Expansion of Spongiosa
How does pregnancy change blood volume
Increase, average 45%
How to finalize dx of Infectious Endocarditis
3 blood cultures from 3 different sites, before starting antibiotics
In Mitral Valve Prolapse, which layer is expanded? Which thinned?
Inner Zona Spongiosa expanded, Zona Fibrosa thinned
Infected Emboli from Endocarditis commonly go to
Kidneys, Heart, Spleen, Brain
Mechanical valves require lifelong
Anticoagulation
Midsystolic Click is a sign of
Mitral Valve Prolapse
Mitral annular calcification is usually asymptomatic unless
it encroaches on adjacent conduction system
Mitral Stenosis is buzzword for
RHD
Mitral Valve in Chronic Rheumatic HD
Thick leaflet, commissural fusion, Thickening and fusion of Chordae
Most common cause (organism) of infective endocarditis
S Aureus
Most common cause of aortic stenosis
Calcific Aortic Degeneration
Most common congenital valvular lesion
Bicuspid Aortic Valve
Most important clinical features of RHD
Valvular inflammation and scarring
Most important functional consequence of RHD
Valvular Stenosis and Regurgitation
Most sensitive procedural test for Vegetations
Transesophageal Echo (>Transthoracic)
Myxomatous Degeneration of Mitral Valve occurs in what class of disorders
CT disorders (eg Marfans)
Onset of what common process occurs much earlier with Bicuspid aortic valves
Calcific Aortic Stenosis
Palpabe manifestation of valve disease
Thrill
patients with primary myxomatous degeneration are at increased risk of
Mitral Regurg, CHF, Infective Endocarditis, Vent Arrhythmias
Pregnancy effects on Heart Valves
Volume increase -> LV Dilation -> Redundant mitral valve leaflets coapt without regurgitation
Prerequisite for heart damage in Carcinoid Syndrome
Massive Hepatic Metastatic burden
Presentation of Brugada Syndrome
40 yo asian male with Syncope or SCD due to V Tach, especially during SLEEP
Presentation of Congenital Long QT
Children with syncope or sudden death due to Polymorphic V Tach
Primary form of Mitral Valve Prolapse is due to
Genetic defect in CT
Primary form of Myxomatous Degeneration of Mitral Valve
Mitral Valve Prolapse
Principal manifestations of ARF in children vs adults
Carditis vs Arthritis
Risk factors for Calcific Aortic Stenosis are same as those for
Age-Related Arteriosclerosis
Secondary form of Mitral Vavle Prolapse is due to
Injury
Secondary Myxomatous Change presumably results from
Injury to Valve Myofibroblasts (eg IHD)
Small-medium verrucous, berrylike or flat vegetations on multiple valves
Libman-Sacks Endocarditis
The incidence of infection, marantic endocarditis, and rheumatic disease on a valve correlated with
Resting Pressure on the Closed Valve
The larger the vegetation, the
more likely it is infective
The vast majority of Infectious Endocarditis episodes are what organisms
Extracellular Bac’s
Timecourse of Acute vs Subacute Bacterial Endocarditis
Days vs Weeks/Months
Top 3 sites of Infective Endocarditis
Mitral, Aortic, Mitral + Aortic
Top 3 species causing Infective Endocarditis
Staph Aureus, Strep Viridans, Enterococcus
Type of Poly V Tach typical of congenital long QT
TDP
Typical cardiac findings in Carcinoid Syndome
Tricuspid Insufficiency, Pulmonic Stenosis
Usual precursor to NBTE
Hypercoagulable state, not valvular damage
V Tach due to Long QT syndrome is often triggered by
Exercise
Valve damage in Libman-Sacks Endocarditis
Fibrinoid necrosis adjacent to vegetation; Subsequent fibrosis and deformity can resemble chronic RHD
Valvular damage by NBTE
Usually nondestructive
Virchow’s Triad
Endothelial Injury, Abnormal Flow, Hypercoagulability
What causes Carcinoid Syndome
Release of bioactive compounds such as 5-HT from Carcinoid Tumors
What causes Ring Abcesses
Vegetations eroding into underlying myocardium
What determines whether Infectious Endocarditis is Acute vs Subacute
Virulence of organism
What is a vegetation
Friable masses of infecting organisms and blood clot
What is unique about Libman-Sacks Endocarditis vs Most types of endocarditis
Vegetations on both sides of valves
What parts of heart are pimarily affected in Carcinoid Heart Disease
Endocardium and Valves of Right Heart
When to NBTE lesions cause valve damage
When bacteria colonize to become Infectious Endocarditis
Where in heart does Infective Endocarditis most commonly occur
Valves (Mitral, Aortic, Mitral + Aortic)
Where is ARVCM most prevalent
Northern Italy (similar to Long QT)
Which layer of Mitral Valve determines structural integrity
Fibrosa (this is thinned in Myxomatous Degeneration)
Which of the 4 Endocarditis’s do not damage valves
NBTE
Which side of heart is affected in Carcinoid Syndrome
Right (coming from systemic circulation)
Which side of valve do vegetations usually occur?
Side of valve closure (atrial side of Mitral)
Which type of vegetative endocarditis can occur on both sides of valve
Libman-Sacks Endocarditis (SLE)
Why is Spongiosa expanded in Myxomatous Degeneration
Increased deposition of myxomatous (mucoid) material)
