Aortic/Mitral Valvular Disease

Question 1

What are the 2 criteria for Left sided Hypertensive Disease?

Answer 1

1. Concentric LV hypertrophy

2. Other evidence of hypertension

Question 2

With Left sided Hypertensive Disease, describe what can be seen with the diastolic and systolic dysfunctions

Answer 2

Diastolic dysfunction - atrial enlargement/fibrillation
= Thromboembolism risk
Systolic dysfunction - increased oxygen requirement

Question 3

Cor pulmonale

Answer 3

Right sided Hypertensive Disease

Question 4

Describe how Right sided Hypertensive Disease (cor pulmonale) arises

Answer 4

• Vasoconstriction in the lungs
• Increased Pulmonary A. Pressure
• Increased RV pressure
  = Right sided Heart Failure

Question 5

Left Sided Hypertensive Disease results in?

Answer 5

Congestive Heart Failure

Question 6

What are the risk factors for Calcific Aortic Stenosis?

Answer 6

Increasing age (60-80) with chronic HTN and hyperlipidemia

Question 7

Calcific Aortic Stenosis

Answer 7

Mounded calcifications in cusps of valve prevent complete opening

Question 8

All heart valves besides the mitral valve should have how many cusps?

Answer 8

3

Question 9

Congenital or acquired fusion can cause Bicuspid Aortic Valves…. what will this show an accelerated course of?

Answer 9

Calcific Aortic Stenosis 1-2 decades earlier than usually expected

Question 10

Congenital or acquired fusion can cause Bicuspid Aortic Valves… what will this show an accelerated course of?

Answer 10

Calcific Aortic Stenosis 1-2 decades earlier than usually expected

Question 11

What are the possible symptoms of Calcific Aortic Stenosis?

Answer 11

LV hypertrophy
Systolic murmur
Angina and syncope
Congestive Heart Failure

Question 12

What are the possible symptoms of Calcific Aortic Stenosis?

Answer 12

LV hypertrophy
Systolic murmur
Angina and syncope
Congestive Heart Failure

Question 13

Who/Where are Mitral Annular Calcifications?

Answer 13

• Females older than 60

= Calcific deposits in fibrous annulus (base of leaflets)

Question 14

Who/Where are Mitral Annular Calcifications?

Answer 14

• Females older than 60

= Calcific deposits in fibrous annulus (base of leaflets)

Question 15

What do Mitral Annular Calcifications lead to?

Answer 15

Arrhythmias –> heart block and sudden death

Question 16

Mitral Valve Prolapse

Answer 16

Valve leaflets prolapse back into left atrium during systole
– Hooding of the leaflets is seen

Question 17

What syndrome is Mitral Valve Prolapse common?

Answer 17

Marfan Syndrome

Question 18

What are the signs of Mitral Valve Prolapse?

Answer 18

Mid-systolic click

Dyspnea

Question 19

ALL valvular abnormalities seem to be associated with an increased risk for?

Answer 19

Infective Endocarditis

Question 20

ALL valvular abnormalities seem to be associated with an increased risk for?

Answer 20

Infective Endocarditis

Question 21

Describe how Rheumatic Fever arises

Answer 21

• Group A Streptococcus Pharyngitis
• Antibodies to M streptococcal protein
• Reactive to self antigens in body
  = Fever, large joints, subcutaneous nodules, erythema marginatum, syndenham chorea and heart disease

Question 22

What antibodies will be (+) with Rheumatic fever?

Answer 22

DNase B

Streptolysin B

Question 23

Rheumatic Heart Disease affects which valves in order from most often to least often?

Answer 23

MAT

• Mitral
• Aortic
• Tricuspid

Question 24

Findings of Acute Rheumatic Heart Disease?

Answer 24

• Peri/Myo/Endo (pan) - carditis
• Verrucae formation
• MacCallum Plaques

Question 25

Findings of Chronic Rheumatic Heart Disease?

Answer 25

- Valvular leaflet thickening | - Valvular stenosis

Question 26

Infective Endocarditis usually occurs where and is of what origin?

Answer 26

- BACTERIAL | - - usually occurs on abnormal or prosthetic heart valves

Question 27

Acute Infective Endocarditis symptoms

Answer 27

Rapid fever, chills and weakness

Question 28

What bacteria usually causes Acute Infective Endocarditis?

Answer 28

Staph. Aureus

Question 29

With IV drug use, where will the infective endocarditis be and what bacteria?

Answer 29

Right sided | - Staph. Aureus

Question 30

Subacute Infective Endocarditis Symptoms?

Answer 30

Low grade fever and fatigue

Question 31

What bacteria may cause Subacute Infective Endocarditis especially on prosthetic heart valves?

Answer 31

Staph. Epidermidis

Question 32

What bacteria may cause Subacute Infective Endocarditis, especially after dental procedures?

Answer 32

Strep. Viridans and HACEK group

Question 33

What other manifestations can be seen with Infective Endocarditis? (4)

Answer 33

Subungual splinter hemorrhages Janeway lesions Osler nodes Roth spots on eye

Question 34

What other manifestations can be seen with Infective Endocarditis? (4)

Answer 34

Subungual splinter hemorrhages Janeway lesions Osler nodes Roth spots on eye

Question 35

What are 3 possible causes of NONbacterial Thrombotic Endocarditis?

Answer 35

Cancer SLE Antiphospholipid Syndrome

Question 36

Symptoms of NONbacterial Thrombotic Endocarditis?

Answer 36

Asymptomatic --> Valvular thrombi

Question 37

How does Carcinoid Heart Disease arise?

Answer 37

- Carcinoid tumors secrete serotonin | - Plaque-like endocardial and valve thickening

Question 38

Symptoms and side of Carcinoid Heart Disease?

Answer 38

- RIGHT side | = Flushing, diarrhea and bronchospasm

Question 39

Asymptomatic --> valvular thrombi

Answer 39

NONbacterial thrombotic endocarditis

Question 40

Flushing, diarrhea and bronchospasm with the right side of the heart affected are seen with?

Answer 40

Carcinoid Heart Disease