Cardiac-valvular disorders

Question 1

what pathogen causes acute rheumatic fever?

Answer 1

pharyngitis due to group A B-hemolytic steptococci

Question 2

when does someone get acute rheumatic fever?

Answer 2

2-3 weeks after an episode of strep throat

Question 3

why does strep go onto cause acute rheumatic fever?

Answer 3

molecular mimicry

bacterial M protein resembles proteins in human tissue

Question 4

what are the minor criteria for acute rheumatic fever?

Answer 4

fever and elevated ESR

Question 5

what are the 5 major criteria of acute rheumatic fever?

Answer 5

1. migratory polyarthritis (J=joint)
2. pancarditis (O looks like a heart)
3. subcutaneous nodules (N=nodules)
4. erythema marginatum (E=erythema)
5. syndenham chorea (S=syndenham)

Question 6

what characterizes the endocarditis (part of pancarditis) seen in acute rheumatic fever?

Answer 6

small vegetations along the lines of closure that lead to regurg

Question 7

in what disease do you see anitschkow cells

Answer 7

in myocarditis due to acute rheumatic fever

Question 8

what is the most common cause of death during the acute phase of rheumatic fever?

Answer 8

myocarditis

Question 9

what does pericarditis cause (symptoms) in a person with acute rheumatic fever?

Answer 9

friction rub and chest pain

Question 10

what is the following describing? when is this seen?

“annular, non-puritic rash with erythematous borders commonly seen on trunk and limbs”

Answer 10

erythema marginatum seen in acute rheumatic fever

Question 11

what is syndenham chorea that is seen in acute rheumatic fever

Answer 11

rapid, involuntary muscle movements

Question 12

what is chronic rheumatic HD

Answer 12

valve scarring that arises due to rheumatic fever

Question 13

what characterizes the valvular scarring in chronic rheumatic HD

Answer 13

stenosis with classic “fish mouth” apperance

Question 14

what is the most common valve that is affected in chronic rheumatic HD

Answer 14

mitral (2nd valve would be aortic where you see fusion of commissures)

Question 15

what classically causes aortic stenosis

Answer 15

wear and tear

Question 16

what congenital issue puts a person at higher risk for aortic stenosis

Answer 16

a bicuspid aortic valve

Question 17

how can you separate chronic rheumatic HD vs “wear and tear” as the cause of aortic stenosis?

Answer 17

chronic rheumatic HD- coexisting mitral stenosis and fusion of aortic valve comissures

Question 18

wha sounds are heard in aortic stenosis

Answer 18

systolic ejection click followed by crescendo-decrescendo murmur

Question 19

what are 2 causes of aortic regurg? what is most common?

Answer 19

aortic root dilation (most common) or valve damage

Question 20

what are 2 causes of aortic root dilation

Answer 20

syphilitic aneurysm and aortic dissection

Question 21

what is 1 example of what could cause valve damage

Answer 21

infectious endocarditis

Question 22

what is heard with aortic regurg

Answer 22

early, blowing diastolic mumur

Question 23

what is “hyperdynamic circulation” that is seen in aortic regurg?

Answer 23

increased pulse pressure

diastolic pressure decreased and systolic pressure increased (due to increased SV)

Question 24

what is mitral valve prolapse

Answer 24

ballooning of mitral valve into L. atrium during systole

Question 25

what causes a mitral valve prolapse?

Answer 25

``` myxoid degeneration (accumulation of ground substance) of the valve making it floppy could be due to marfans or Ehlers-Danlos but usually unknown ```

Question 26

what is heard in mitral valve prolapse

Answer 26

incidental mid-systolic click followed by regurg murmur

Question 27

what action makes the mitral valve prolapse click and murmer softer? why?

Answer 27

squatting bc it increases systemic resistance will decrease L. ventricular emptying

Question 28

what are the rare complications seen with mitral valve prolapse? (3)

Answer 28

1. infectious endocarditis 2. arrhythmia 3. severe mitral regurg

Question 29

when do you hear this type of murmur: | "holosystolic blowing murmur"

Answer 29

mitral regurg

Question 30

what 2 things make a mitral regurg murmur louder? give reasons for both

Answer 30

1. squatting-increased systemic resistance will decrease L ventricular emptying 2. expiration-increases return to L. atrium

Question 31

what is most common cause of mitral stenosis

Answer 31

chronic rheumatic valve disease

Question 32

what is heard with mitral stenosis

Answer 32

opening snap followed by diastolic murmur

Question 33

what 3 things occur due to L. atrium dilation secondary to mitral stenosis

Answer 33

1. pulmonary congestion and edema 2. pulmonary HTN and R. sided HF 3. atrial fibrillation & mural thrombus risk

Question 34

what are some causes of mitral regurg?

Answer 34

1. mitral valve prolapse (usually) 2. LV dilation 3. infective endocarditis 4. acute rheumatic HD 5. papillary muscle rupture after MI

Question 35

what are 3 complications of aortic stenosis

Answer 35

1. concentric LV hypertrophy 2. angina and syncope with exercise 3. microangiopathic hemolytic anemia

Question 36

in what valvular defect do you see the following water hammer pulse pulsating nail bed- quincke pulse head bobbing

Answer 36

aortic regurg