Cardio III - Q2,2 Flashcards
myocarditis is what
inflammation of the heart muscle itself, not just the lining
Who mostly has Rheumatic heart disease
those over 50 or those from other countries.
what causes Rheumatic heart disease
its an autoimmune reaction fo an infection, americans rarely get it because we use lots of antibiotics.
what autoimmune things can cause myocarditis
Rheumatic heart disease, Lupis, rheumatoid arthritis, transplant rejection and Drugs
what infectious agents can cause myocartditis
Borrelia burgdorferi, coxsackie virus, CMV, toxoplasmisis, trichinosis, chagas
what is the number one virus/infectious agent to cause myocarditis***
coxsackie virus**
what toxins could cause myocarditis
alcohol, chemo
what is the primary WBC if the problem is a virus
lymphocyte
what two things can valvular disease cause
stenosis and or insufficiency
why are valves so subjective to problems
they do not have their own blood supply so they don’t get as much benefit from the immune system.
what is stenosis
failure to open completely, it impedes flow foreward
sound of stenosis
woshing sound, either diastolic or systolic.
what can cause stenosis
hardening or stiffening of the valve with possible calcificationa
what is valve insufficiency
failure of the valve to close
what does valve insufficiency cause
regurgitation of blood, it flows backwards
what are the sounds associated with insufficiency?
murmurs and clicks
what is severity of stenosis and insuficiency dependiend on?
- degree of impairment, 2. which valve(s), 3. rate of involvement, 4. compensation
Compare valvular disease from infection to mitral stentosis due to RHD
sudden destruction of aortic valve can cause rapidly fatal cardiac failure from regurg while long developing mitral stensosis if remarkeabley well tolerated
What are the most frequently noted valvular abnormalities?
aquired stenosis of aortic and mitral valves - 2/3 of vavlular disease
When do mitral regurg sounds happen
systole
When do mitral stenosis sounds often happen
diastole
when do murmurs show
may or may not have symptoms,
what is the most common cause of stenosis or insufficiency in the USA
ageing
which valve is most likely to have a problem?
the aortic valve, its under the greatest stress and pressure
what is the order from most likely to least likely valve to have a problem
aortic, mitrial, pulmonary, tricuspid.
what is the most common valvular disease?
aortic stenosis, unless you concider mitral valve prolaps a disease
which side of the heart is most likely to have valve problems?
the left side - more pressure
What is the number one cause of valve disease in the world (not USA)
Rheumatic heart disease,
what is the likely reason Rheumatic heart disease doesn’t cause as much valve disease in the USA/
because strep viridans seems to be less virulent in our part of the world.
what is more serious quick or slow progression of valve disease
the same amount of valve damage over days to weeks is more dangerous than the same amount of damage that happened over 30 years. Compensations happen.
is Rheumatic heart disease ususally acute or chronic?
RHD is ususally chronic developing over years.
what would cause a pan systolic murmer?**
patentent ductus arterious - murmer over the entire heart sounds, S1 and S2
Patent ductus arterious is what***
when the lung bipass in a baby doesn?t close upon birth.
what is a congenital cause of stenosis?
When the 3 valve flaps are only two (aortic)
three main reasions for valve disease
- infection, autoimmune (RH), cancer
what does holosystolic mean
over entire systolic time
Aortic stenosis is the most common valvular disease, What are the two main types?
Aquired aortic stenosis(infection, autoimmune, cancer etc) , then congenital 3 flaps is 2.
why is a bicuspid valve where you should have a tricuspid valve bad
you get more wear and tear on the bicuspid valve
what is mitral annular calcification
calcified depositis around fibrous ring of mitral valve (left). May lead to stenosis but often doesn’t effect valvular function
mitral stenosis causes what sound
A mid systolic click ususally found incidentally on physical exam
what % of the US population has mitral valve prolapse, gender and age
3 %, the cause is unknown., mostly women between 20-40
what is mitral valve prolapse?
when one or both mitral leaflets are floppy and they prolapse and balloon back into left atrium during systole.
what is one of the most common forms of vascular disease
myxomatous degeneration of the mitral valve ( mitral valve prolapse)
what is a possible cause of MVP
cellular defect in connective tissue
sequelle of MVP
may lead to serious complacations.
how is mitral valve prolapse identified?
echocardiogram.
are people with MVP symptomatic?
mostly a symptomatic but have SOB or easy fatiguability
name 4 complications of MVP
infective endocarditis, mitral insufficiency, stroke/systemic infarct, arrhythemas
what is the most common valvular disease?
aortic stenosis
when do people get rheumatic fever acutely
between 5-17
what causes Rheumatic fever
an acute immun-modulated multi system inflammatory disease that usually happens withing a few weeks following and episode of Group A strep pharyngitis
what is the bacteria that causes the immume response that causes Rheumatic fever
Group A beta hemolytic strep
can any group A beta hemolytic strep cause Rheumatic fever
nope, only the throat kind, not the skin type.
why are antibiotics used for strep throat?
because the quicker the infection is cleared up, the least likely to have an immune response.
what are the odds of getting Rheumatic heart disease
Very few get the rheumatic fever from untreated strep throat3%, and even fewer of those go on to get rheumatic heart disease, its pretty rare.
What is the antibody that causes the immune respones in RF***
anti-streptococcal M proteins anticbodies that cross react with myosin
what is the pathoneumonic feature of pan-carditis in the case of Rheumatic heart disease
aschoff bodies.
what are the cardiac manifestations of RF
focal inflammatory involvment of 3 layers of heart called Pan carditis.
How do antibiotic change the acute course of RF
Its doesn’t, the acute course of RF doesn’t change, its and immune response not infectin.
what is the group A beta hemolytic strep in the throat that causes RF***
Strep pyogenes***
how is strep spread
direct contact with oral or respiratory secretions, the bug attaches to epithelium of upper respiratory tract.
how is strep diagnoses
Rapid strep test, elevated antistreptolysin O titer.
what is pathoneumonic of rheumatic heart disease***
aschoff Bodies, nodules found in heart of individuals with RF, also in rest of body
what are are aschoff bodies?
pathoneumonic for RHD, granulomatous structures consisting of fibrinous material, lymphocytes, and occasional plasma cell and macrophage that surround necrotic tissue
aschoff bodies do they have infectious material in them
nope, just a collection of our own WBCs around enlarged cells or islands of collagen and lymphocytes withing surrounding myocytes
What valve issue is often found with Rheumatic heart disease
mitral stensosis in particular
What is the classic look of the mitral stenosis of RHD, if looking at disected heart
There is a typical fish mouth shape.
what is a leading cause of mitral valve stenosis and valve replacement in the US?
chronic RHD
effects of chronic RHD
valve stenosis (mitral mostly) regurg, atrial dilation, arrhythmias, ventricular dysfunction
how long after acute episode of RF does stenosis, valve fusion /damage happen
2-10 years after, and each episode of Actue RF after progressively damages valves
what is the most common sign and symptoms of acute rheumatic fever
polyarthritis
what are the common non cardiac manifestations of Rheumatic heart disease
polyarthritis* chorea, erythema marginatum* and subcutaneous nodules, (often diagnostic)
common non diagnostic non cardiac manifestations of RHD
abdominal pain, arthraligase, fever and penmonia
what is erythema marginatum (erythema annulare)
rash that occurs in 5-13% of patients with acute RF. Trunk and proximal limbs, serpiginous ring
