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M3 Path Block 2 > 9 - The Heart: Valvular Heart Disease > Flashcards

9 - The Heart: Valvular Heart Disease Flashcards

1
Q

Valvular Heart Disease: Defined

A

Congenital or acquired

Stenosis usually - failure of valve to open completely

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2
Q

Valvular Heart Disease: Types (3)

A
  1. Aortic Stenosis - Aging
  2. Mitral stenosis: Rheumatic Heart Disease
  3. Mitral insufficiency: Mitral Valve Prolapse
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3
Q

Valvular Heart Disease: Aortic Stenosis (3)

A

Age Related

Seen in bicuspid valves

*Deposition of hydroxyapatite in elastic layer of valve

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4
Q

Valvular Heart Disease: Aortic Stenosis - Gross (3)

A

Calcific masses within the aortic cusps

Ca2+ deposition in the attachment of cusps

Congenital bicuspid aortic valve results form incomplete fusion

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5
Q

Valvular Heart Disease: Mitral Valve Prolapse (4)

A

Mitral valve is “floppy/hoodlike” and prolapse/ballon back

Common in females

Mutation in the Fibrillin-1 (FBN-1) –> altered TGF-B (Marfan’s Syndrome)

Leaflets are enlarged, thick, and rubbery

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6
Q

Valvular Heart Disease: Mitral Valve Prolapse - Associated Syndromes + Hint (5)

A
  1. Marfan’s
  2. Ehler-Danlos
  3. Klinefelter’s Syndrome
  4. Detective embryogenesis in cells of mesenchyme origin

Hint: Billowing of valve at postmortem

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7
Q

Valvular Heart Disease: Mitral Valve Prolapse - Microscopy (2)

A

Deposition of MUCUS material in spongiosa layer (Myxamatous degeneration)

Attenuation of collagenous layer

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8
Q

Valvular Heart Disease: Mitral Valve Prolapse - Clinical Features (4)

A

Asymptomatic

**MID-SYSTOLIC CLICK - sudden collapse

Angina on exertion

Detected by ECHO cardiography

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9
Q

Valvular Heart Disease: Mitral Valve Prolapse - Complications (4)

A
  1. Infective endocarditis
  2. Arrhythmias
  3. Stroke
  4. Mitral Insufficiency
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10
Q

Valvular Heart Disease: Rheumatic Heart Disease - Defined

A

Acute immunologically mediated, multisystem inflammatory response

After few weeks of group A streptococcal pharyngitis

Treatment with Penicillin have reduced the incidence of this disease

“Licks the joints but bites the heart” is a very popular way of reminding

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11
Q

Valvular Heart Disease: Rheumatic Heart Disease - Defined

A

Acute immunologically mediated, multisystem inflammatory response

After few weeks of group A streptococcal pharyngitis

Treatment with Penicillin have reduced the incidence of this disease

“Licks the joints but bites the heart” is a very popular way of reminding

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12
Q

Valvular Heart Disease: Rheumatic Heart Disease - Hints (3)

A

Age group: 5-15 years

Asia, Sri Lanka

Cardiac problems preceding throat infection history for about 2 weeks

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13
Q

Valvular Heart Disease: Rheumatic Heart Disease - Pathogenesis

A

Molecular mimicry between M protein of strep and the heart

Slide 63

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14
Q

Valvular Heart Disease: Rheumatic Heart Disease - Morphology: Aschoff Bodies

A

Are collection of T lymphocytes, plasma cells and activated plump macrophages known as Anitschkow cells –> endocardial manifestations

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15
Q

Valvular Heart Disease: Rheumatic Heart Disease - Morphology: Caterpillar/Cartwheel cells

A

A few show wavy chromatin

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16
Q

Valvular Heart Disease: Rheumatic Heart Disease - Morphology: Fish-mouth appearance comes from?

A

Mitral stenosis

Seen in chronic status

17
Q

Valvular Heart Disease: Rheumatic Heart Disease - Morphology: MacCallum plaques

A

Irregulary SUBENDOCARDIAL thickenings in the LEFT ATRIUM

Slide 65

18
Q

Jones Criteria: Major Criteria

A

Two criteria: Major and Minor

One needs two major or one major and two minor criteria to make the diagnosis of Rheumatic Fever – after excluding all other possibilities!

19
Q

Jones Criteria: Major Criteria

A

Mnemonic: “CANCER”

Carditis (Pan) 
Arthritis (migratory) 
Nodules (subcutaneous) 
Chorea (Sydenham's) 
Erythema (Marginatum) 
Rheumatic anamnesis
20
Q

Jones Criteria: Minor Criteria

A

Mnemonic: “CAFE PAL”

CRP increased
Arthralgia
Fever
Elevated ESR
Prolonged PR interval
Anamnesis of rheumatism
Leukocytosis
21
Q

Valvular Heart Disease: Mitral Valve Prolapse - Complications (4)

A
  1. Infective endocarditis
  2. Arrhythmias
  3. Stroke
  4. Mitral Insufficiency
22
Q

Jones Criteria: Minor Criteria

A

Mnemonic: “CAFE PAL”

CRP increased
Arthralgia
Fever
Elevated ESR
Prolonged PR interval
Anamnesis of rheumatism
Leukocytosis
23
Q

Infective Endocarditis: Defined (4)

A

Infectious agents invade heart valves and endocardium

A very common cause of cardiac complication among IV drug users

High virulent organisms
cause the acute IE

Low virulence organisms cause sub acute IE

24
Q

Infective Endocarditis also occurs when by what?

A

Occurs following prosthetic valve replacement by S. epidermidis

25
Q

Infective Endocarditis: Organisms

A

“HACEK”

H 
A 
C 
E 
K

Rarely enterococci

26
Q

Infective Endocarditis: Valvular Appearance

A

Show vegetations –> fibrin thrombi covered vy bacteria and cell debris

27
Q

Infective Endocarditis: Isolated bacteria (2)

A

Strep Viridans

S. Aureus

28
Q

Infective Endocarditis: Morphology (5)

A

Bulky, FRIABLE vegetations on valves

Multiple vegetations seen in IV abusers

Vegetations prone for embolization

Septic infarcts are seen

Erosion of the underlying endomyocardium leads to the formation of “Ring Abscess”

29
Q

Infective Endocarditis: Morphology (5)

A

Bulky, FRIABLE vegetations on valves

Multiple vegetations seen in IV abusers

Vegetations prone for embolization

Septic infarcts are seen

Erosion of the underlying endomyocardium leads to the formation of “Ring Abscess”

30
Q

IV Drugs on Heart Saying

A

Tricuspid valve involved in drug abusers ( Don’t tri drugs ) with S. aureus on right side of the body

31
Q

Infective Endocarditis: Duke Criteria - Major (3)

A

Positive Blood Culture

ECG Evidence of Damage

Valve Regurgitation

32
Q

Infective Endocarditis: Duke Criteria - Minor (5)

A

Fever

IV Drug Abuse

Janeway lesions

Roth Spots

Osler nodes

Slide 71

M3 Path Block 2 (10 decks)

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