9 - The Heart: Valvular Heart Disease Flashcards by G V

Valvular Heart Disease: Defined

Congenital or acquired

Stenosis usually - failure of valve to open completely

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Valvular Heart Disease: Types (3)

Aortic Stenosis - Aging
Mitral stenosis: Rheumatic Heart Disease
Mitral insufficiency: Mitral Valve Prolapse

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Valvular Heart Disease: Aortic Stenosis (3)

Age Related

Seen in bicuspid valves

*Deposition of hydroxyapatite in elastic layer of valve

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Valvular Heart Disease: Aortic Stenosis - Gross (3)

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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Valvular Heart Disease: Mitral Valve Prolapse (4)

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

Marfan’s
Ehler-Danlos
Klinefelter’s Syndrome
Detective embryogenesis in cells of mesenchyme origin

Hint: Billowing of valve at postmortem

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

Deposition of MUCUS material in spongiosa layer (Myxamatous degeneration)

Attenuation of collagenous layer

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

Asymptomatic

**MID-SYSTOLIC CLICK - sudden collapse

Angina on exertion

Detected by ECHO cardiography

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

Infective endocarditis
Arrhythmias
Stroke
Mitral Insufficiency

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Valvular Heart Disease: Rheumatic Heart Disease - Defined

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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Valvular Heart Disease: Rheumatic Heart Disease - Defined

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

Age group: 5-15 years

Asia, Sri Lanka

Cardiac problems preceding throat infection history for about 2 weeks

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Valvular Heart Disease: Rheumatic Heart Disease - Pathogenesis

Molecular mimicry between M protein of strep and the heart

Slide 63

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

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

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

A few show wavy chromatin

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

Mitral stenosis

Seen in chronic status

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

Irregulary SUBENDOCARDIAL thickenings in the LEFT ATRIUM

Slide 65

Jones Criteria: Major Criteria

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!

Jones Criteria: Major Criteria

Mnemonic: “CANCER”

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

Jones Criteria: Minor Criteria

Mnemonic: “CAFE PAL”

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

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

Infective endocarditis
Arrhythmias
Stroke
Mitral Insufficiency

Jones Criteria: Minor Criteria

Mnemonic: “CAFE PAL”

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

Infective Endocarditis: Defined (4)

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

Infective Endocarditis also occurs when by what?

Occurs following prosthetic valve replacement by S. epidermidis

Infective Endocarditis: Organisms

"HACEK" ``` H A C E K ``` Rarely enterococci

Infective Endocarditis: Valvular Appearance

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

Infective Endocarditis: Isolated bacteria (2)

Strep Viridans S. Aureus

Infective Endocarditis: Morphology (5)

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"

Infective Endocarditis: Morphology (5)

IV Drugs on Heart Saying

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

Infective Endocarditis: Duke Criteria - Major (3)

Positive Blood Culture ECG Evidence of Damage Valve Regurgitation

Infective Endocarditis: Duke Criteria - Minor (5)

Fever IV Drug Abuse Janeway lesions Roth Spots Osler nodes Slide 71