10/29-Valvular Heart Disease Flashcards
What side of the heart is more commonly affected by valvular disease?
Left>Right
MV>AV>TV>PV
What is the most common cause of aortic stenosis? 2nd most common? 3rd most common?
Degenerative (60%, M:F 1:1)
Bicuspid (30%, M:F 2:1)
Rheumatic (5%, M:F 1:1)
How frequent are aortic valve sclerosis and aortic valve stenosis in adults over 65? Which one is hemodynamically significant?
Aortic valve stenosis (present in 5% over 65 yrs) is hemodynamically significant. Sclerosis (present in 25%) is not hemodynamically significant.
What do they think causes aortic stenosis?
Once thought age related “wear and tear”
Now believed to be due to same risk factors involved in atherosclerosis (inflammation, proliferation, calcification, genetic, metabolic factors)
T/F- a bicuspid aortic valve deals with greater mechanical stress, leading to accelerated calcification and the Raphe is a common site for calcific deposits
True
What is the most common congenital cardiovascular abnormality?
Aortic stenosis due to congenital bicuspid valve
What are some symptoms of aortic stenosis? How is it treated in late stages?
- Angina pectoris
- syncope
- congestive heart failure
- Treated by surgical valve replacement
T/F- 50% of people with untreated angina die within 5 years and 50% with untreated congestive heart failure die within 2 years
True
T/F- mitral annular calcification leads to calcified deposits in the annulus that almost always affect valve function
False, these deposits generally do not affect valve function
Although clinical consequences of mitral annular calcification are rare, what are some possible outcomes?
valve stenosis, regurgitation, arrhythmias, sudden death, thrombus development
T/F- mitral annular calcification is more common in women and individuals with mitral valve prolapse and LV hypertrophy
True
What are most common causes of mitral regurgitation?
- Myxomatous (70%) M:F 1.5:1
- Rheumatic (10%) M:F 1:2
- Ischemica (10%) M:F 2:1
- Endocarditis (5%) M:F 4:1
Myxomatous mitral valve carries 3% risk of serious complications, what are they?
infective endocarditis, acute mitral regurgitation (ruptured cord), stroke or infarct (embolization of leaflet thrombi), arrhythmias
What secondary effects on the heart does mitral regurgitation cause?
LV volume hypertrophy and left atrial dilatation
T/F- acute rheumatic fever can develop 2-6 weeks after pharyngitis by group A strep and usually affect children 5-15 years, then recurs in adults
true
Acute rheumatic fever is diagnosed by the Jones criteria, what does this entail?
-Evidence of recent group A strep
Major criteria
-Carditis, migratory polyarthritis, subcutaneous nodules, erythema marginatum, sydenham chorea
Minor criteria
-Minor
-Fever, arthralgia, acute-phase reactants
Dx requires evidence of recent infection plus 2 major OR 1 major and 2 minor criteria
What is an Aschoff nodule?
composed of lymphocytes, plasma cells, macrophages that have owl eye or caterpillar appearance- Anitschkow cells- pathognomonic for acute rheumatic fever
T/F- rheumatic heart disease affects MV>aortic>tricuspid>pulmonary and can result in secondary hypertrophy and dilatation of cardiac chambers
true
Which valves are most commonly affected by infective endocarditis? Which are associated with IV drugs?
MV>AV>TV>PV
TV, PV associated with IV drug use
T/F- staph aureus needs abnormal valves to cause endocarditis?
False, S. aureus is highly virulent and causes disease in abnormal or normal valves
T/F- S. epidermidis is strongly associated with infectious endocarditis involving prosthetic valves
true
T/F- Strep viridans, enterococci, HACEK (haemophilus, actinobacillus, cardiobacterium, eikenella, and kingella) are oral organisms of lower virulence that (usually) require damaged or abnormal valve function to cause infective endocarditis
true
What are predisposing factors to infective endocarditis?
valve abnormalities, congenital heart disease, foreign devices, immune suppression, alcoholism, drug use, diabetes
What are the differences between acute infective endocarditis (IE) and subacute (SBE)
Acute: highly virulent (staph aureus), normal or abnormal valves, occurs over days-weeks, 25% fatal
Subacute: low virulence (Strep. viridans), affects abnormal valves, occurs over weeks-months, 10% fatal
What are extra-cardiac complications from infective endocarditis?
-systemic emboli and renal disease/glomerulonephritis
Symptoms of acute and subacute endocardtitis?
Subacute: fever, fatigue, weight loss
Acute: fever, chills, weakness
What is Libman-Sacks Disease?
Endocarditis associated with SLE
- Single or multiple sterile vegetations with verrucous appearance
- undersurface of valves
- tendinous cords
- mural endocardium
- valvulitis with fibrinoid necrosis of valve substances
T/F- carcinoid heart disease lesions are present in 90% of patients with with carcinoid syndrome
False, only 1/2
Where do carcinoid heart lesions usually end up?
right sided endocardial plaque leads to tricuspid regurgitation and pulmonary regurgitation. Left sided lesions are rare and usually result from patent foramen oval or lung tumor
What are carcinoid plaques composed of?
smooth muscle cells, sparse collagen in acid mucopolysaccharide-rich matrix
