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8 Cardiac Pathology > 8.4 Valvular Disorders > Flashcards

8.4 Valvular Disorders Flashcards

1
Q

How is the mitral valve affected by Acute rheumatic fever vs Chronic rheumatic fever

A

Acute: mitral regurg (from endocarditis vegetations)

Chronic: mitral stenosis (from scarring)

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2
Q

Acute rheumatic fever

  • bacteria?
  • mech
  • timeframe
A
  • Strep Pyo (group A beta-hemolytic), which causes strep pharyngitis (strep throat)
  • molecular mimicry–bacterial M protein resembles heart tissue
  • occurs 2-3 weeks after strep throat
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3
Q

How to diagnose acute rheumatic fever?

A

JONES criteria:

Joint–migratory polyarthritis (pain migrates from joint to joint)

O–Heart: pancarditis (endo-, myo-, percarditis)

Nodules, subcutaneous

Erythema marginatum (rash with red border)

Syndenham’s chorea

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4
Q

Acute rheumatic fever:

-What are all the ways the heart is affected?

A
  • Pancarditis (endo, myo, pericarditis)
    1. Endocarditis
  • vegetations grow on mitral valve, cause mitral regurg
    2. Myocarditis
  • Aschoff bodies (granuloma from inflammation with Anitschkow cells, giant cells, fibrinoid material)
  • Anitschkow cells are macrophages with ‘caterpillar nuclei’
    3. Pericarditis
  • friction rub, chest pain
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5
Q

Aschoff bodies

A

Granulomas (inflammatory accumulation of macrophages) found in myocardium in Acute rheumatic fever.

-contain Anitschkow cells, giant cells, fibrinoid material

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6
Q

Anitschkow cells

A

Reactive histiocytes with ‘caterpillar nuclei’

  • found inside Aschoff bodies in myocardium
  • myocarditis of acute rheumatic fever
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7
Q

what is the main cause of death in acute rheumatic fever?

A

-myocarditis

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8
Q

Chronic rheumatic fever

-characteristics

A
  • valve scarring, leads to stenosis by fusion of valve commissues. causes mitral stenosis, sometimes also aortic stenosis
  • valve damage can predispose to infectious endocarditis
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9
Q

Aortic stenosis

  • causes
  • how to differentiate
A
  1. ‘wear and tear’ (old age)
  2. Chronic rheumatic fever
    - difference is that in chronic rheumatic fever, the stenosis is caused by fusion of commissures, and the pt will also have mitral stenosis.
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10
Q

Aortic stenosis:

-what congenital disorder is a risk factor for early onset?

A
  • Bicuspid aortic valve.
  • increased wear and tear
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11
Q

Aortic stenosis

-describe murmur

A
  • systolic murmur
  • systolic ejection click followed by crescendo-descrendo
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12
Q

Aortic stenosis

-complications (3)

A
  1. LV hypertrophy, L side heart failure
  2. Decreased systemic blood causes angina, syncope with exercise
  3. Microangiopathic hemolytic anemia–RBC damaged while crossing stenosed valve (forms schistocytes)
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13
Q

Aortic regurg

-causes (3)

A
  1. Isolated root dilation (most common, usu idiopathic)
  2. Root dilation from aortic aneurysm/dissection
  3. Valve damage (eg endocarditis)
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14
Q

aortic regurg

-murmur

A
  • diastolic murmur
  • early, blowing
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15
Q

aortic regurg

-clinical findings/symptoms

A
  1. LV dilation, eccentric hypertrophy (volume overload)
  2. Hyperdynamic circulation, from increased pulse pressure
    - diastolic pressure decreased b/c regurg
    - systolic pressure increased b/c returned blood increases stroke volume
    - Symptoms: bounding pulse (‘water-hammer pulse’), pulsating nail bed (Quincke pulse), head bobbing
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16
Q

mitral valve prolapse

  • what is it
  • cause
A
  • mitral valve balloons (floppy valve) during systole
  • caused by myxoid degeneration (accumulation of ground substance) on valve
  • unknown etiology, seen in Marfan’s and Ehlers-Danlos
17
Q

mitral valve prolapse

  • murmur
  • how is murmur affected by squatting.
  • complications
A
  • mid-systolic click, followed by regurg murmur
  • squatting decreases sound (opposite of mitral regurg) b/c a fuller ventricle means chordae are tighter to help keep the valve closed.
  • valve damage predisposes to infective endocarditis
  • also mitral regurg
18
Q

Mitral regurg

  • most common cause
  • other causes (4)
A
  1. mitral valve prolapse complication
  2. L sided heart failure (LV dilation pulls valve apart)
  3. infective endocarditis
  4. acute rheumatic fever
  5. MI–papillary muscle rupture
19
Q

Mitral regurg

  • murmur
  • how can pt bx change murmur
A
  • systolic murmur that is louding with:
    1. if pt squats, this will increase arterial resistance and decrease LV stroke volume. This pushes more blood backward through mitral valve.
    2. If pt expires, increased return to LA
20
Q

Mitral regurg

-complication

A

LV volume overload, L sided heart failure

21
Q

Mitral stenosis

  • main cause
  • clinical features/complications (2)
A
  • chronic rheumatic disease (scarring of valves with commissure fusion)
    1. LA Volume overload, leads to pulm congestion and eventual R sided failure.
    2. Conduction problems from dilated LA means Atrial fibrillation and mural thrombus risk
22
Q

mitral stenosis

-murmur

A
  • diastolic murmur
  • opening snap and rumble

8 Cardiac Pathology (7 decks)

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