100314 valvular disease Flashcards
which are more frequent: stenoses or insufficiencies
stenoses
dystrophic calcification
damage caused by wear and tear complicated by deposits of calcium phosphate
risk factors: hyperlipidemia, HTN, inflammation
ex of dystrophic calcification
calcific aortic stenosis
mitral annular calcification
what is the most common of all valvular abnormalities
calcific aortic stenosis
calcific aortic stenosis in 5th or 6th decade of life suggests
bicuspid or unicuspid valves
morphology of calcific aortic stenosis
heaped up calcified masses in cusps, primarily at bases
free cuspal edges NOT involved
no fusion of commisures
mitral annular calcification
degenerative calcific deposits on fibrous ring at base of valve
usually doesn’t affect valve fxn
but are sites for thrombi or infec
myxomatous degeneration of mitral valve (prolapse)
very common (3% of adults)
young women
one or both leaflets are enlarged, hooded, floppy
mid systolic click
rheumatic fever causative agent
group A Strep pyogenes-pharyngitis
most important complication of rheumatic fever
progression to chronic valvular dysfxn (mitral stenosis)
acute rheumatic fever affects what
pancarditis
bread and butter pericarditis (fibrinous)
myocarditis with Aschoff bodies
endocardium and left sided valves with fibrinoid necrosis and verrucae
subendocardial MacCallum plaques
what is the classic lesion of acute rheumatic fever
Aschoff body (foci of swollen eosinophilic collagen surrounded by T lymphocytes, plasma cells and plump macrophages)
plump macrophages are called Anitschkow cells or caterpillar cells
chronic rhuamtic heart disease
inflam and fibrosis leads to…
thickened valve leaflets
fusion of commissures (fishmouth)
fusion and thickening of chordae tendineae
what is the major effect of chronic rheumatic heart disease
mitral stenosis
diagonsis of rheumatic fever
jones criteria
preceding group A strep infec and 2 major manifes or (1 major and 2 minor)
major manifestations for rheumatic fever
migratory polyarthritis carditis (percardial friction rub, weak heart sounds, tachycardia, arrhythmia) subcutaneous nodules - rare erythema marginatum of skin -rare sydenham chorea
two forms of infective endocarditis
acute-highly virulent organism, normal valve, 50% mortality, requires surgery
subacute-low virulence, deformed valve, less destructive lesions, respond to antibiotics
causes of infective endocarditis
more common in pts with cardiovascular abnormalities
host factors-neutropenia, immunodeficiency, malignancy, diabetes, alcholics, IV drugs users
organism in 50-60% of cases of infected deformed valves
strep viridans
most common causative agent for infective endocarditis in IV drug users
staph aureus
morphology of acute and subacute infective endocarditis
friable, large bulky destructive vegetations
fibrin, inflam cells and bacteria (less often fungi)
may erode myocardium–leading to ring abscess
Duke criteria for bacterial endocarditis
major:
positive blood cultures
echo findings (valve related mass or abscess)
new valvular regurg (new murmur on auscultation)
minor:
predisposing heart lesion or IV drug abuser
fever
umcommon findings resulting from septic emboli, which are bits of vegetations that fly off (petechiae, splinter hemorrhages, Janeway lesions in palsm and soles, Osler nodes in digits, Roth spots in retina
complications of bacterial endocarditis
valvular insufficency or stenosis and possible heart failure
myocardial abscesses and possible performation
vegetations breaking off leading to embolic complications
glomeruloneprhitis (immune complexes)
nonbacterial thrombotic endocarditis
depositions of fibrin, platelets and other blood products (RBC) on leaflets
often in debilitated pts
may result in emboli
pathogenesis/etiology of nonbacterial thrombotic endocarditis
hypercoagulable states
associated with mucin producing adenocarcinomas
endocardial trauma
morphology of noninfec thrombotic endocarditis
nondestructive, noninflammatory, small (1-5 mm)
along lines of closure
Libman Sacks endocarditis
non infec vegetation
from SLE
mitral and triscupid valves involved
antiphospholipid antibodies present
morphology of Libman Sacks endocarditis
either or both sides of leaflets
may also be on endocardium
may have intense inflam
ex of vegetative endocarditis
rheumatic heart disease
infective endocarditis
nonbacterial thrmbotic endocarditis
Libman Sacks endocarditis
carcinoid syndrome
flushing, cramps, nausea, vomiting diarrhea
carcinoid heart disease
cardiac manifestation of the systemic syndrome caused by carcinoid tumors
in 50% of pts with carcinoid syndrome- plaque like fibrosis of R heart endocardium and valves
complications of artifical valves
mechanical prosthesis: thromboemboli, infective endocarditis
bioprothesis: structural deterioration, infective endocarditis
