10/29-Valvular Heart Disease

Question 1

What side of the heart is more commonly affected by valvular disease?

Answer 1

Left>Right

MV>AV>TV>PV

Question 2

What is the most common cause of aortic stenosis? 2nd most common? 3rd most common?

Answer 2

Degenerative (60%, M:F 1:1)
Bicuspid (30%, M:F 2:1)
Rheumatic (5%, M:F 1:1)

Question 3

How frequent are aortic valve sclerosis and aortic valve stenosis in adults over 65? Which one is hemodynamically significant?

Answer 3

Aortic valve stenosis (present in 5% over 65 yrs) is hemodynamically significant. Sclerosis (present in 25%) is not hemodynamically significant.

Question 4

What do they think causes aortic stenosis?

Answer 4

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)

Question 5

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

Answer 5

True

Question 6

What is the most common congenital cardiovascular abnormality?

Answer 6

Aortic stenosis due to congenital bicuspid valve

Question 7

What are some symptoms of aortic stenosis? How is it treated in late stages?

Answer 7

• Angina pectoris
• syncope
• congestive heart failure
• Treated by surgical valve replacement

Question 8

T/F- 50% of people with untreated angina die within 5 years and 50% with untreated congestive heart failure die within 2 years

Answer 8

True

Question 9

T/F- mitral annular calcification leads to calcified deposits in the annulus that almost always affect valve function

Answer 9

False, these deposits generally do not affect valve function

Question 10

Although clinical consequences of mitral annular calcification are rare, what are some possible outcomes?

Answer 10

valve stenosis, regurgitation, arrhythmias, sudden death, thrombus development

Question 11

T/F- mitral annular calcification is more common in women and individuals with mitral valve prolapse and LV hypertrophy

Answer 11

True

Question 12

What are most common causes of mitral regurgitation?

Answer 12

1. Myxomatous (70%) M:F 1.5:1
2. Rheumatic (10%) M:F 1:2
3. Ischemica (10%) M:F 2:1
4. Endocarditis (5%) M:F 4:1

Question 13

Myxomatous mitral valve carries 3% risk of serious complications, what are they?

Answer 13

infective endocarditis, acute mitral regurgitation (ruptured cord), stroke or infarct (embolization of leaflet thrombi), arrhythmias

Question 14

What secondary effects on the heart does mitral regurgitation cause?

Answer 14

LV volume hypertrophy and left atrial dilatation

Question 15

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

Answer 15

true

Question 16

Acute rheumatic fever is diagnosed by the Jones criteria, what does this entail?

Answer 16

-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

Question 17

What is an Aschoff nodule?

Answer 17

composed of lymphocytes, plasma cells, macrophages that have owl eye or caterpillar appearance- Anitschkow cells- pathognomonic for acute rheumatic fever

Question 18

T/F- rheumatic heart disease affects MV>aortic>tricuspid>pulmonary and can result in secondary hypertrophy and dilatation of cardiac chambers

Answer 18

true

Question 19

Which valves are most commonly affected by infective endocarditis? Which are associated with IV drugs?

Answer 19

MV>AV>TV>PV

TV, PV associated with IV drug use

Question 20

T/F- staph aureus needs abnormal valves to cause endocarditis?

Answer 20

False, S. aureus is highly virulent and causes disease in abnormal or normal valves

Question 21

T/F- S. epidermidis is strongly associated with infectious endocarditis involving prosthetic valves

Answer 21

true

Question 22

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

Answer 22

true

Question 23

What are predisposing factors to infective endocarditis?

Answer 23

valve abnormalities, congenital heart disease, foreign devices, immune suppression, alcoholism, drug use, diabetes

Question 24

What are the differences between acute infective endocarditis (IE) and subacute (SBE)

Answer 24

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

Question 25

What are extra-cardiac complications from infective endocarditis?

Answer 25

-systemic emboli and renal disease/glomerulonephritis

Question 26

Symptoms of acute and subacute endocardtitis?

Answer 26

Subacute: fever, fatigue, weight loss
Acute: fever, chills, weakness

Question 27

What is Libman-Sacks Disease?

Answer 27

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

Question 28

T/F- carcinoid heart disease lesions are present in 90% of patients with with carcinoid syndrome

Answer 28

False, only 1/2

Question 29

Where do carcinoid heart lesions usually end up?

Answer 29

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

Question 30

What are carcinoid plaques composed of?

Answer 30

smooth muscle cells, sparse collagen in acid mucopolysaccharide-rich matrix