Cardiac: Vavlular Disorders

Question 1

valvular lesions generally result in either what 2 things

Answer 1

1. stenosis

2. regurgitation

Question 2

what causes acute rheumatic fever

Answer 2

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

Question 3

who usually gets acute rheumatic fever

Answer 3

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

Question 4

What are 3 categories for a diagnosis of acute rheumatic fever

Answer 4

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

Question 5

ESR

Answer 5

erythrocyte sedimentation rate

Question 6

what is the JONES criteria

Answer 6

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

Question 7

what is sydenham chorea

Answer 7

rapid, involuntary muscle movements

Question 8

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

Answer 8

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

Question 9

where can pancarditis occur

Answer 9

1. endocarditis
2. myocarditis
3. pericarditis

Question 10

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

Answer 10

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

Question 11

what characterizes myocarditis

Answer 11

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

Question 12

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

Answer 12

myocarditis

Question 13

how does pericarditis present clinically

Answer 13

friction rub and chest pain

Question 14

having relapse of acute rheumatic fever increases the chances of what

Answer 14

chronic rheumatic fever

Question 15

what is chronic rheumatic heart disease

Answer 15

valve scarring as a consequence of rheumatic fever

Question 16

chronic rheumatic heart disease results in what

Answer 16

stenosis with classic ‘fish-mouth’ apperance

Question 17

what valve is usually involved in chronic rheumatic fever

Answer 17

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

Question 18

what is a complication with chronic rheumatic heart disease

Answer 18

endocarditis

Question 19

what is aortic stenosis

Answer 19

narrowing of aortic valve oriface

Question 20

what can cause aortic stenosis

Answer 20

1. fibrosis and calcification “wear and tear”

2. chronic rheumatic valve disease

Question 21

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

Answer 21

late adulthood, greater than 60

Question 22

what type of valve can lead to aortic stenosis

Answer 22

bicuspid aortic valve

Question 23

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

Answer 23

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

Question 24

cardiac compensation from aortic stenosis leads to what

Answer 24

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

Question 25

what are 3 complications with aortic stenosis

Answer 25

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

Question 26

having concentric left ventricular hypertrophy can lead to what

Answer 26

cardiac failure

Question 27

why does angina and syncope with exercise occur with aortic stenosis

Answer 27

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

Question 28

what happens in microangiopathic hemolytic anemia

Answer 28

RBCs damaged producing schistocytes while crossing calcified valve

Question 29

what is the treatment for aortic stenosis

Answer 29

valve replacement after onset of complications

Question 30

what is aortic regurgitation

Answer 30

- backflow of blood from aorta into left ventricle during diastole

Question 31

what are causes of aortic regurgitation

Answer 31

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

Question 32

what is the most common cause of aortic regurgitation

Answer 32

isolated root dilation

Question 33

what are 3 clinical features of aortic regurgitation

Answer 33

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

Question 34

how does hyperdynamic circulation occur

Answer 34

- increase pulse pressure ( difference in systolic and diastolic pressure) - diastolic pressure decreases due to pressure regurgitation - systolic pressure increases due to increase stroke volume

Question 35

what clinical sytmptoms does hyperdynamic circulation occur in aortic regurgitiaton

Answer 35

- bounding pulse (water-hammer pulse) - pulsating nail bed (Quincke pulse) - head bobbing

Question 36

what is the treatment for aortic regurgitaion

Answer 36

valve replacement once LV dysfunction develops

Question 37

what is mitral valve prolapse

Answer 37

ballooning of mitral valve into left atrium during systole

Question 38

what specifically happens to the valve in mitral valve prolapse

Answer 38

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

Question 39

in what diseases can mitral valve prolapse occur in?

Answer 39

Marfan syndrome | Ehlers-Danlos syndrome

Question 40

clinically how does mitral valve prolapse show up as

Answer 40

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

Question 41

correlate click and murmurs with squatting

Answer 41

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

Question 42

What are complications of mitral valve prolapse complications

Answer 42

rare but can include - infectious endocarditis - acute rheumatic heart disease - papillary muscle rupture after a myocardial infarction

Question 43

what is the treatment for mitral valve prolapse

Answer 43

valve replacement

Question 44

what is mitral regurgitation

Answer 44

reflux of blood from left ventricle into left atrium during systole

Question 45

what complications can cause mitral regurgitation

Answer 45

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

Question 46

what are 2 clinical features of mitral regurgitation

Answer 46

1. Holosystoilc "blowing" murmur | 2. volume overload and left-sided heart failure

Question 47

how does squatting and expiration impact mitral regurgitation

Answer 47

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

Question 48

what is mitral stenosis

Answer 48

narrowing of mitral valve oriface

Question 49

clinical features of mitral stenosis

Answer 49

1. opening snap followed by diastolic rumble | 2. volume overload

Question 50

Volume overload from mitral stenosis causes what

Answer 50

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