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SP16- Gen Path Exam 1 > Cardiac Valvular Disease and Vasculitis > Flashcards

Cardiac Valvular Disease and Vasculitis Flashcards

1
Q

What are the five discussed valvular heart diseases?

A
  • Mitral Valve Stenosis
  • Mitral Valve Regurgitation
  • Aortic Valve Stenosis
  • Aortic Valve Regurgitation
  • Infective Endocarditis
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2
Q

What is Mitral Valve Stenosis?

A

failure of a valve to open completely, obstructing forward flow

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3
Q

Mitral valve stenosis is usually due to ________.

A

Chronic (recurrent) Rheumatic Valvular Disease

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4
Q

What is Acute Rheumatic Fever?

A

a systemic disease, usually in children, which follows a group A beta-hemolytic streptococcal pharyngitis

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5
Q

True or False: Rheumatic Fever (RF) produces myocarditis, pericarditis, arthralgia, or arthritis.

A

True

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6
Q

Myocarditis associated with RF is characterized microscopically by ______ bodies which are collections of _________ and ________.

A

Aschoff
mononuclear inflammatory cells
fibroblasts

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7
Q

What will recurrent bouts of RF eventually lead to?

A

severe fibrosis and calcification of the mitral valve (and possibly other valves)

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8
Q

True or False: RF is thought to be due to the production of antibodies against the streptococcal bacteria that cross react with various antigens in the heart, joints and other sites.

A

True

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9
Q

What is “regurgitation?”

A

insufficiency

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10
Q

What is valve regurgitation?

A

a valve that fails to close completely, allowing backflow of blow

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11
Q

Mitral Valve Regurgitation may be caused by a variety of conditions including ______ and ______.

A

IHD

endocarditis

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12
Q

What is Mitral Valve Prolapse?

A

a condition in which the leaflets balloon into the left atrium during left ventricular contraction (systole)

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13
Q

Mild prolapse occurs in _____ % of the general population.

A

5-10

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14
Q

True or False: Mild Mitral Valve Prolapse is very common.

A

True

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15
Q

True or False: Mitral Valve Prolapse usually progresses to valvular regurgitation.

A

False, it usually does not. “Severe Prolapse” may be associated with regurgitation

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16
Q

True or False: Some Mitral Valve patients also experience chest pain and palpitations.

A

True

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17
Q

Severe Mitral Valve Prolapse is also called _______

A

Floppy Mitral Valve

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18
Q

Describe the valve cusps in severe mitral valve prolapse.

A

-the valve cusps are large and microscopically show fragmentation, separation and loss of collagen (Myxomatous Degeneration)

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19
Q

Floppy mitral valve may be part of a systemic connective tissue disorder, such as ______.

A

Marfan Syndrome

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20
Q

In Aortic Valve Stenosis, _____ and ______ reduce the valve cusp mobility.

A

fibrosis

calcification

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21
Q

Bicuspid aortic valve is a common congenital malformation and these valves are predisposed to calcification and fibrosis, starting at about ______ of age.

A

40 years

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22
Q

What are the mechanisms of Aortic Valve Regurgitation?

A
  • valve cusp destruction (endocarditis)
  • myxomatous degeneration
  • dilation of the aortic root
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23
Q

Infective endocarditis is usually caused by _____.

A

a BACTERIAL infection of the heart valve

*may also be fungus or unusual infections

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24
Q

What are predisposing factors of infective endocarditis?

A
  • abnormal heart valves
  • prosthetic valves
  • intravenous drug use
  • intracardiac shunts
  • diabetes
  • immunosuppression
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25
Q

What are the three factors that have been identified as having importance in the pathogenesis?

A
  1. endocardial or endothelial injury due to abnormalities in blood flow
  2. fibrin thrombi
  3. organisms in the blood
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26
Q

What are the clinical manifestations of Infective endocarditis?

A 
fever
heart murmur
fatigue
anemia
arthralgia
myalgia
splinter hemorrhages
Roth spots
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27
Q

What are Roth Spots?

A

retinal hemorrhages (not absolutely specific to IE)

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28
Q

True or False: Chordae tendineae could rupture due to complications with Infective Endocarditis.

29
Q

What is the difference between acute and subacute endocarditis?

A

Acute: short duration, virulant organism, large vegetations, previously normal valve, prominent tissue destruction

Subacute: Longer duration, low virulence, small vegetations, previously abnormal valve, less tissue destruction

30
Q

Vasculitis may be caused by ________, mechanical trauma, toxins, caustic substances, radiation, or immune complexes.

31
Q

What are the three classifications of vasculitis?

A

Large vessel
medium vessel
small vessel

32
Q

What are the two forms of Large Vessel Vasculitis?

A 
Giant Cell (temporal) Arteritis
Takayasu Arteritis
33
Q

What are the two forms of Medium Vessel Vasculitis?

A

Polyarteritis Nodosa

Kawasaki Disease

34
Q

What are the two forms of Small Vessel Vasculitis?

A

Microscopic Polyangiitis

Wegener Granulomatosis

35
Q

True or False: The etiology of Giant Cell Arteritis is unknown.

36
Q

Giant Cell is rare at what age?

A

before age 50

37
Q

What are the two key characteristics regarding the pathology of Giant Cell?

A
  1. Granulomatous Inflammation with giant cells
  2. Intimal Proliferation and fibrosis (destruction of elastic fibers)
    =narrowing of the lumen
38
Q

True or False: Takayasu Arteritis affects large vessels and is more common in females.

A

True and True!

39
Q

True or False: Takayasu may be the same disease as Giant Cell but in a younger patient.

A

True

(think of a Kayak (taKAYAsu)…you need a BIG river to paddle down, so it is going to occur in big vessels like the aorta)

40
Q

What is another name given to Takayasu? Why?

A

“Pulseless Disease”

causes weak pulses in the arms due to reduced bloodflow from major aortic branches

41
Q

__________ is a medium vessel vasculitis that was once associated with Hepatitis B because _____% of patients had both conditions

A

Polyarteritis Nodosa

30

42
Q

Why would clinical presentation of Polyarteritis Nodosa be confusing?

A

due to involvement of multiple organ systems
(Known this)

*sites most commonly involved:
Kidneys 85%
Heart 75%
Liver 65%
GI Tract 50%
43
Q

__________ Disease is a medium vessel vasculitis that is also known as Mucocutatneous Lymph Node Syndrome.

44
Q

______% of patients with Kawasaki Disease are under the age of 4 yrs.

45
Q

A child with Kawasaki will usually present with what symptoms?

A

skin rash*
fever
mucous membrane erythema

46
Q

What is the etiology of kawasaki disease?

A

anti-endothelial antibody (?) triggered by viral infection

47
Q

What are the two small vessel vasculitis diseases?

A

Microscopic Polyangiitis

Wegener Granulomatosis

48
Q

Etiology of Microscopic Polyangiitis is mediated by ________ Ag-Ab Complex; whereas, Wegener is mediated by __________.

A

MPO- ANCA (M-icroscopic PO-lyarteritis “MPO”)

PR3- ANCA (“PR3” stands for proteinase 3)

49
Q

True or False: Microscopic Polyangiitis involves fibrinoid necrosis and leukocytoclastic vasculitis.

50
Q

What is leukocytoclastic vasculitits?

A

breakdown of PMN nuclei

51
Q

Wegener Granulomatosis affects _________ and kidneys.

A

upper/lower respiratory tract

52
Q

Damage associated with Wegener is due to an abnormal expression of ______ on endothelial cell surfaces which bind to ANCA and activates _____ which will cause endothelial damage.

A

proteinase 3

neutrophils

53
Q

What is the pathology of Wegener Granulomatosis?

A

(Known this)

  • Necrotizing Granulomas
  • Vasculitis with fibrinoid necrosis (this is how it affects the respiratory tract…the air space fills with fibinoid tissue)
54
Q

What is a distinguishing oral characteristic/sign of Wegener Granulomatosis?

A

Strawberry Gingivitis

55
Q

________ is an endothelial injury from a substance in cigarette smoke.

A

Thromboangiitis Obliterans (Buerger Disease)

56
Q

True or False: Thromboangiitis Obliterans (Buerger Disease) usually begins before age 65.

A

False, BEFORE AGE 35!

57
Q

Thromboangiitis Obliterans causes segmental acute and chronic vasculitis mainly in _______ and with ______. What is the other name for this condition?

A

extremities
thrombosis
“Buerger Disease)

58
Q

________ syndrome is a connective tissue disorder that is related to Mitral Valve Prolapse and Dissecting Aortic Hematoma.

59
Q

What is a Dissecting Aortic Hematoma?

A

aneurysm
-longitudinal tear of the aortic media which begins in the ascending aorta and extends a variable distance proximal (toward the heart) and distal to the descending aorta

60
Q

What are complications associated with Dissecting Aortic Hematoma?

A

severe hemorrhage from rupture (death)

branch obstruction and organ ischemia (luminal compression by the expanding hematoma)

61
Q

Serious complications of Dissecting Aortic Hematomas predominately occur in _____ dissections, which therefore mandate surgical intervention.

62
Q

What is the difference between Type A and Type B dissections?

A

Type A = proximal, ascending aorta

Type B = distal, after take-off of the great arteries

63
Q

What is the difference between Pericarditis, Endocarditis, and Myocarditis?

A 
Peri = fibrinous
Endo = sterile vegetations
Myo = Aschoff bodies (mononuclear cells and fibroblasts)
64
Q

What is the difference between degenerative and congenital aortic valve stenosis?

A

Degenerative (senile) = advanced age

Congenital Bicuspid Valve = much younger onset, ~40

65
Q

Mitral Valve fibrosis and calcification with valvular stenosis could be a result of __________ with Group A beta-hemolytic ________.

A

acute rheumatic fever (ARF)

streptococcal pharyngitis

66
Q

What is the histopathological feature common with Mitral Valve Prolapse?

A

myxomatous degeneration

67
Q

Aortic valve stenosis is caused by _____ and _____.

A

fibrosis and calcification

68
Q

Dissecting Aortic Hematoma occurs in which layer of the vessel wall?

A

between the middle and outer third of the MEDIA

69
Q

What does ANCA stand for?

A

antineutrophilic cytoplasmic antibodies

SP16- Gen Path Exam 1 (10 decks)

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