cardio 3 Flashcards
what is Acquired stenosis
failure of valve to open completely, resulting in blockage of forward flow
mitral valve stenosis is usually due to ________
chronic (recurrent) rheumatic valvular disease
what is the underlying systemic disease that causes this mitral valve stenosis?
Acute rheumatic fever
acute rheumatic fever is caused by what
group A beta-hemolytic streptococcal pharyngitis.
myocarditis, pericarditis, arthralgia or arthritis, and other manifestations are caused by what
acute rheumatic fever
The myocarditis is characterized microscopically by _______ which are
Aschoff bodies
Aschoff bodies
are collections of mononuclear inflammatory cells and fibroblasts (essentially granulomatous inflammation).
Recurrent bouts of RF eventually lead to….
severe FIBROSIS and CALCIFICATION of the mitral valve and possibly other heart valves.
The disease is thought to be due to the production of _______ against the streptococcal bacteria which cross react with various antigens in the heart, joints and other sites.
antibodies
Regurgitation (insufficiency) is what
refers to a valve that fails to close completely, allowing backflow of blood
what is Mitral valve prolapse
is a condition in which the leaflets balloon into the left atrium during left ventricular contraction (systole).
T/F Severe prolapse may be associated with valvular regurgitation
TRUE!!!!!!!!!
severe prolapse is also called what
floppy mitral valve
T/F patients usually dont experience chest pain and palpitations with mitral valve prolapse
false, they sometimes do
in severe prolapse the mitral valves are large and floppy because….
microscopically show 1) fragmentation,
2) separation and 3) loss of collagen (myxomatous degeneration).
T/F Floppy mitral valve may be an isolated abnormality or part of a systemic connective tissue disorder such as Marfan syndrome.
TRUE
what is a systemic CT disorder
marfan syndrome
T/F aortic valve stenosis is very similar to mitral valve stenosis
TRUE, Fibrosis and calcification reduce the valve cusp mobility.
causes of aortic valve stenosis?
- chronic rheumatic valvular disease
2. may occur with advanced age (over 65 years)
The mechanisms include valve cusp destruction (endocarditis), myxomatous
degeneration and dilation of the aortic root.
aortic valve regurgitation
Infective Endocarditis usually caused by what
bacterial infection in a heart valve, although it may also be caused by fungus or other unusual infections
The three factors that
have been identified as having importance in the pathogenesis of infective endocarditis include:
1 ) endocardial or endothelial injury due to abnormalities in blood flow;
2 ) fibrin thrombi; and
3 ) organisms in the blood.
Clinical manifestations of infective endocarditis include:
fever, heart murmur, fatigue, anemia,
arthralgia, myalgia, splinter hemorrhages (nail bed) and Roth spots (retinal) hemorrhages, not absolutely specific to IE)
complications of infective endocarditis
a. rupture of chordae tendineae
b. spread of infection into myocardium or aorta
c. thromboembolism with infarction
d. septic thrombi with metastatic abscesses
e. valvular dysfunction and CHF
Acute Endocarditis
short time and large destruction with highly virulent pathogen on normal valves
subacute endocarditis
long time and little destruction with low virulent pathogen on abnormal valves
Vasculitis
inflammation of the blood vessels, causes changes in the vessel wall, caused my infection of the endothelial cells usually
other causes of vasculitis
microorganisms and Other causes include mechanical trauma, toxins, caustic substances, radiation and immune complexes.
vasculitis classifications
large vessel
medium vessel
small vessel
large vessel
Giant cell (temporal) arteritis- vasculitis of vessels in the head. Takayasu arteritis- vasculitis of the aorta and sometimes pulmonary artery. affecting young and middle aged asian women.
medium vessels
Polyarteritis nodosa (classic)- ("vasculitis") causing injury to organ systems. The areas most commonly affected by PAN include the nerves, intestinal tract, heart, and joints
Kawasaki syndrome - includes coronary arteries.small vessels
Microscopic polyarteritis - affects mainly capillaries and arterioles
Wegener’s granulomatosis - generally affects your kidneys, lungs and upper respiratory tract.
anti-endothelial cell antibodies associated with…
kawasaki syndrome
Anti-proteinase-3 (anti-PR3) - diffuse cytoplasmic distribution (formerly known as cANCA) associated with….
Wegeners granulomatosis
Anti-myeloperoxidase (anti-MPO) - perinuclear localization (formerly known as pANCA) associated with…
Microscopic polyarteritis
Fever, weight loss, headache, visual problems (including blindness), claudication of jaw (weakness when chewing due to decreased blood supply), pain and tenderness over temporal artery, polymyalgia rheumatica. Rare under the age of 50 years.
Giant cell (temporal) arteritis
Giant cell arteritis pathology
giant cell involved in Granulomatous inflammation and fibrosis, leading to narrowing of vessels and decreased blood flow to affected areas
Thickening of the wall reduces blood flow in the major branches off the aortic arch (“pulseless disease” due to weak pulses in the arms). Usually affects young women. May be the same disease as temporal arteritis, but in a younger patient.
Takayasu Arteritis
Takayasu Arteritis pathology
Granulomatous inflammation with fibrosis involving the aortic arch and the arch branches.
Fever, weight loss, hematuria, renal failure, hypertension, abdominal pain, melena. Clinical presentation may be very confusing due to involvement of multiple organ systems.
Polyarteritis nodosa
Polyarteritis nodosa pathology
Acute lesions show fibrinoid necrosis, thrombosis, neutrophils, aneurysms. With healing there is predominance of macrophages and plasma cells; progressive fibrous scarring.
Polyarteritis nodosa usually occurs….
kidneys (85%), heart (75%), liver (65%), and GI tract (50%).
Affects infants and young children (80% of patients
Kawasaki Disease
Etiology- It is suspected that a viral infection triggers a hypersensitivity reaction. AKA: mucocutaneous lymph node syndrome
Kawasaki disease
Microscopic Polyangiitis etiology
Often due to antigen-antibody complexes.
Fever, rash, joint swelling, pleural effusion, pulmonary infiltrates, myocarditis, GI bleeding, renal failure, presence of circulating anti-neutrophilic cytoplasmic antibodies (MPO-ANCA). May be precipitated by drugs, microorganisms, foreign proteins or tumor proteins.
Microscopic Polyangiitis
Pathology: Involves arterioles, capillaries, venules. Fibrinoid necrosis, neutrophils (leukocytoclastic vasculitis).
Microscopic Polyangiitis
Involves sinuses, lungs and kidneys (glomerulonephritis). Associated with the presence of anti-neutrophilic cytoplasmic antibodies direct against proteinase 3 (PR3-ANCA).
Wegener Granulomatosis
Thromboangiitis obliterans (Buerger Disease)
Endothelial injury from a substance in cigarette smoke
Usually begins before age 35. Pain and ischemia in extremities
Thromboangiitis obliterans (Buerger Disease)
Thromboangiitis obliterans (Buerger Disease)
Segmental acute and chronic vasculitis mainly in extremities with thrombosis.
another name for DISSECTING AORTIC HEMATOMA
aneurysm
what is DISSECTING AORTIC HEMATOMA
Longitudinal tear of the aortic media which begins in the ascending aorta and extends variable distance proximal (toward the heart) and distal to the descending aorta.
complications with dissecting aortic hematoma
severe hemorrhage from rupture, organ ischemia due to luminal compression by the expanding hematoma.
predisposing factors for dissecting aortic hematoma
- hypertension,
2. inherited connective tissue disorders (i.e., Marfan’s syndrome) with medial degeneration.
