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Pathoma > Cardiac: Vavlular Disorders > Flashcards

Cardiac: Vavlular Disorders Flashcards

1
Q

valvular lesions generally result in either what 2 things

A
  1. stenosis

2. regurgitation

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2
Q

what causes acute rheumatic fever

A
  • systemic complication of pharyngitis due to group A beta-hemolytic streptococci
  • step bacteria M protein resembles human tissue
  • molecular mimicry
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3
Q

who usually gets acute rheumatic fever

A

children 2-3 weeks after an episode of streptococcal pharyngitis (“strep throat”)

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4
Q

What are 3 categories for a diagnosis of acute rheumatic fever

A
  1. prior group A beta-hemolytic strep infection
  2. fever and elevated ESR
  3. JONES criteria
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5
Q

ESR

A

erythrocyte sedimentation rate

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6
Q

what is the JONES criteria

A 
Joints: migratory polyarthritis 
Heart: panarditis ( all 3 layers of heart)
Subcutaneous Nodules
Erythema marginatum 
Sydenham chorea
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7
Q

what is sydenham chorea

A

rapid, involuntary muscle movements

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8
Q

what is erythema marginatum? what area of the body does this usually impact?

A

annular, nonpruritic rash with erythematous borders, commonly involving trunk and limbs

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9
Q

where can pancarditis occur

A
  1. endocarditis
  2. myocarditis
  3. pericarditis
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10
Q

what characterizes the endocarditis? what does it lead to? what valves are involved?

A
  • small vegetations along lines of closure that lead to regurgitation
  • mitral more commonly involved than aortic
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11
Q

what characterizes myocarditis

A

Aschoff bodies with foci of chronic inflammation, reactive histocytes with slender, wavy nuclei ( Anitschkow cells) , giant cells, fibrinoid material

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12
Q

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

A

myocarditis

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13
Q

how does pericarditis present clinically

A

friction rub and chest pain

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14
Q

having relapse of acute rheumatic fever increases the chances of what

A

chronic rheumatic fever

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15
Q

what is chronic rheumatic heart disease

A

valve scarring as a consequence of rheumatic fever

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16
Q

chronic rheumatic heart disease results in what

A

stenosis with classic ‘fish-mouth’ apperance

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17
Q

what valve is usually involved in chronic rheumatic fever

A
  • most common is mitral valve: thickening of chordae tendineae and cusps
  • occasionally aortic valve: fusion of commissures
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18
Q

what is a complication with chronic rheumatic heart disease

A

endocarditis

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19
Q

what is aortic stenosis

A

narrowing of aortic valve oriface

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20
Q

what can cause aortic stenosis

A
  1. fibrosis and calcification “wear and tear”

2. chronic rheumatic valve disease

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21
Q

who does ‘wear and tear’ aortic stenosis usually occur in?

A

late adulthood, greater than 60

22
Q

what type of valve can lead to aortic stenosis

A

bicuspid aortic valve

23
Q

what distinguishes ‘wear and tear’ aortic stenosis from chronic rheumatic valve aortic stenosis

A
  • coexisting mitral stenosis and fusion of aortic valve commissures distinguish rheumatic disease from ‘wear and tear’
24
Q

cardiac compensation from aortic stenosis leads to what

A

prolonged asymptomatic stage: systolic ejection click followed by crescendo-decrescendo murmur is heard

25
Q

what are 3 complications with aortic stenosis

A
  1. concentric left ventricular hypertrophy
  2. angina and syncope with exercise
  3. microangiopathic hemolytic anemia
26
Q

having concentric left ventricular hypertrophy can lead to what

A

cardiac failure

27
Q

why does angina and syncope with exercise occur with aortic stenosis

A

limited ability to increase blood flow across the stenotic valve leads to decreased perfusion of the myocardium and brain

28
Q

what happens in microangiopathic hemolytic anemia

A

RBCs damaged producing schistocytes while crossing calcified valve

29
Q

what is the treatment for aortic stenosis

A

valve replacement after onset of complications

30
Q

what is aortic regurgitation

A
  • backflow of blood from aorta into left ventricle during diastole
31
Q

what are causes of aortic regurgitation

A
  1. aortic root dilation - syphilitic aneurysm and aortic dissection
  2. valve damage - infectious endocarditis
32
Q

what is the most common cause of aortic regurgitation

A

isolated root dilation

33
Q

what are 3 clinical features of aortic regurgitation

A
  1. early, blowing diastolic murmur
  2. hyperdynamic ciruclation
  3. LV dilation and eccentric hypertrophy (increase preload)
34
Q

how does hyperdynamic circulation occur

A
  • increase pulse pressure ( difference in systolic and diastolic pressure)
  • diastolic pressure decreases due to pressure regurgitation
  • systolic pressure increases due to increase stroke volume
35
Q

what clinical sytmptoms does hyperdynamic circulation occur in aortic regurgitiaton

A
  • bounding pulse (water-hammer pulse)
  • pulsating nail bed (Quincke pulse)
  • head bobbing
36
Q

what is the treatment for aortic regurgitaion

A

valve replacement once LV dysfunction develops

37
Q

what is mitral valve prolapse

A

ballooning of mitral valve into left atrium during systole

38
Q

what specifically happens to the valve in mitral valve prolapse

A

myxoid degeneration (accumulation of ground substance) , makeing valve floppy

39
Q

in what diseases can mitral valve prolapse occur in?

A

Marfan syndrome

Ehlers-Danlos syndrome

40
Q

clinically how does mitral valve prolapse show up as

A

incidental mid-systolic click (followed by a regurgitation murmur; usually asymptomatic)

41
Q

correlate click and murmurs with squatting

A

click and murmur become softer with squatting ( increased systemic resistance decreases left ventricular emptying)

42
Q

What are complications of mitral valve prolapse complications

A

rare but can include

  • infectious endocarditis
  • acute rheumatic heart disease
  • papillary muscle rupture after a myocardial infarction
43
Q

what is the treatment for mitral valve prolapse

A

valve replacement

44
Q

what is mitral regurgitation

A

reflux of blood from left ventricle into left atrium during systole

45
Q

what complications can cause mitral regurgitation

A
  • mitral valve prolapse
  • LV dilation (Left-sided cardiac failure)
  • infective endocarditis
  • acute rheumatic heart disease
  • papillary muscle rupture after myocardial infarction
46
Q

what are 2 clinical features of mitral regurgitation

A
  1. Holosystoilc “blowing” murmur

2. volume overload and left-sided heart failure

47
Q

how does squatting and expiration impact mitral regurgitation

A

squatting: increased systemic resistance decreases left ventricular emptying
expiration: increased return to left atrium

48
Q

what is mitral stenosis

A

narrowing of mitral valve oriface

49
Q

clinical features of mitral stenosis

A
  1. opening snap followed by diastolic rumble

2. volume overload

50
Q

Volume overload from mitral stenosis causes what

A

dilatation of left atrium resulting in

  1. pulmonary congestion with edema and alveolar hemorrhage
  2. pulmonary hypertension and eventual right-sided heart failure
  3. atrial fibrillation with associated risk for mural thrombi

Pathoma (38 decks)

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