Acquired Valvular and Endocardial Disease Flashcards
What are other terms for retrograde blood flow through a valve?
Valvular regurgitation/insufficiency
What does stenosis of a cardiac valve generally lead to?
Pressure overload hypertrophy of the myocardium proximal to the obstruction. Once compensatory mechanisms are exhausted, dilation and fialure of the chamber proximal to the valve occurs
What does valvular regurgitation lead to?
Hypertrophy and dilation of the chamber proximal to the valve
What is the common infecting agent in rheumatic fever?
Streptococcus pyogenes (group A Beta-hemolytic Streptococcus)
What is the pathogenesis triad of rheumatic fever?
- genetically susceptible host
- rheumatogenic strain of of GAS
- abnormal host immune response
What regions of the heart are affected in acute rheumatic heart disease?
Endocardium, myocardium, pericardium (pancarditis);
What are changes that occur in the myocardium in rheumatic heart disease?
Aschoff bodies, Anitschkow cells
What are Aschoff bodies? What are Anitschkow cells?
- AB - Characteristic granulomatous lesion of rheumatic myocarditis
- AC - Cells w/i the Aschoff bodies whose nuclei have an “owl eye” appearance in cross section and appear as caterpillars in longitudinal cuts
What are the characteristic changes that occur in the pericardium during Rheumatic Fever?
Pericarditis with fibrin deposits between parietal and visceral pericardium (“Bread and butter pericarditis”)
The biopsy of a heart is shown. What are the distinct findings in this biopsy? What is your Dx?
Anitschkow cells within Aschoff bodies; Rheumatic Fever
What are the criteria to Dx Rheumatic Fever?
The Jones Criteria
Either two major criteria or one major and two minor criteria
- Major criteria - carditis (murmurs, cardiomeg., pericarditis, CHF), polyarthritis, chorea, erythema marginatum, subcutaneous nodules
- Minor criteria - Previous Hx of RF, arthralgia, fever, certain lab tests indicating inflamm process, EKG changes
What tests are indicative of a Streptococcus infection?
Serum Abs to:
- Streptolysin O
- DNAase B
- hyaluronidase
What are recurrent attacks of Rheumatic Fever associated with?
Different types of GAS to which the patient has not yet been exposed
What is the most commonly and severely affected valve in chronic rheumatic disease?
Mitral
Which valve is second most commonly involved in rheumatic heart disease?
The aortic valve
What are 4 major complications of rheumatic heart disease?
- Bacterial endocarditis
- Mural thrombi
- Congestive HF
- Adhesion Pericarditis
Why is there an increased risk of bacterial endocarditis in patient swith chronic RHD?
Scarred valves of rheumatic hear disease provide an attractive envrionment for bacteria
A patient expires and their mitral valve is shown at autopsy. Verrucous vegetations are shown on the leaflets of the mitral valve. What is you Dx? What other conditions did the patient likely have? What is the most common lesion associated in this scenario?
Libman-Sacks Endocarditis; SLE; Fibrinous pericarditis
In patients with Ankylosing Spondylitis, what is the primary pathology that occurs?
Inflammation particularly near the vavle ring resulting in aortic regurgitation
What is the general cardiac pathogenesis that occurs in scleroderma (progressive systemic sclerosis)?
Intimal sclerosis of small arteries -> small infarcts -> patchy fibrosis -> CHF, arrhythmias
What are the complications of polyarteritis nodosa?
Necrotizing lesions in the branches of the coronaries resulting in MI, arrhythmias, and HB
What bugs generally cause acute bac endocarditis? Subacute bac endocarditis?
S. aureus/S. pyogenes; S. viridans/S. epidermidis
What is the most common predisposing condition for bac endocarditis in children?
Congenital heart disease
What are the most common predisposing bases for bac endocarditis in adults?
Mitral valve prolapse and congenital heart disease
