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Pathoma LAH > Cardiology: 8.4: Valvular Disorders > Flashcards

Cardiology: 8.4: Valvular Disorders Flashcards

1
Q

What happens to the myocardium in acute rheumatic fever?

A

Aschoff bodies (a focus of chronic inflammation with giant cells and fibrinoid material) containing Anitschkow cells

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2
Q

What is a complication of a damaged valve?

A

endocarditis

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3
Q

What does mitral valve stenosis lead to?

A

thickening of the chordae tendinae and cusps

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4
Q

What is the most common cause of mitral stenosis?

A

chronic rheumatic heart dz

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5
Q

Mitral regurg is usually 2a to?

A

mitral valve prolapse

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6
Q

What is the tx for aortic stenosis?

A

valve replacements

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7
Q

How is acute rheumatic fever diagnosed?

A
  • evidence of a prior infection = ASO or anti-DNase B titer
  • minor criteria = fever + elevated ESR
  • major criteria = the JONES criteria
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8
Q

Describe the murmur in mitral valve prolapse.

A

mid-systolic click followed by regurg

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9
Q

What is stenosis?

A

narrowing of the opening of the valve –> harder to push blood through

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10
Q

What are Aschoff bodies? What are they assoc. with?

A

a focus of chronic inflammation with giant cells and fibrinoid material

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11
Q

What most often causes aortic stenosis? Name one other cause, too.

A
  • most common = fibrosis and calcifications from normal wear and tear
  • other = chronic rheumatic valve disease
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12
Q

What are Anitschkow cells? What are they assoc. with?

A

cells with a slender, wavy (caterpillar) found in the myocardium

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13
Q

What is chronic rheumatic valve disease?

A

scarring, stenosis from repeated bouts of acute rheumatic fever

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14
Q

What is the mechanism by which acute rheumatic fever occurs?

A

molecular mimicry- bacterial M protein resembles human tissues

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15
Q

Describe the murmur in mitral stenosis.

A

opening snap followed by a diastolic rumble

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16
Q

What is the tx for mitral valve prolapse?

A

valve replacement

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17
Q

What organism causes acute rheumatic fever?

A

group A beta-hemolytic strep

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18
Q

Other than mitral valve prolapse, name some other causes of mitral regurg.

A
  • LV dilation
  • infective endocarditis
  • acute rheumatic heart dz
  • papillary muscle rupture post-MI
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19
Q

This is a focus of chronic inflammation with giant cells and fibrinoid material found in the myocardium during acute rheumatic fever.

A

Aschoff bodies

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20
Q

Who gets acute rheumatic fever?

A

children 2-3 weeks after strep throat

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21
Q

What are the complications of aortic stenosis?

A
  • LVH angina
  • syncope with exercise
  • microangiopathic hemolytic anemia
22
Q

What is the tx for aortic regurg?

A

valve replacement

23
Q

What are the complications of mitral valve prolapse?

A
  • infectious endocardidits
  • arrhythmia
  • severe mitral regurg
24
Q

What do mitral valve vegetations cause?

A

mitral valve regurg

25
Q

What is regurg?

A

backflow across the valve

26
Q

What can the pericarditis in acute rheumatic fever cause?

A

a friction rub

27
Q

Why do pts with aortic stenosis get angina, syncope with exercise?

A

there’s limited ability to increase the amount of blood across the valve

28
Q

What increases the risk of and speeds the process of aortic stenosis?

A

bicuspid aortic valve

29
Q

These are cells with a slender, wavy (caterpillar) found in the myocardium during acute rheumatic fever.

A

Anitschkow cells

30
Q

Name the JONES criteria for acute rheumatic fever.

A
  • J = joints (migratory polyarthritis of large joints)
  • O = heart (pancarditis)
  • N = nodules (subcutaneous of the skin)
  • E = erythema marginatum (annular rash)
  • S = Syndenham chorea
31
Q

What causes mitral valve prolapse?

A

myxoid degeneration –> floppy valve

32
Q

Describe the murmur in aortic regurg.

A

early, blowing diastolic murmur

33
Q

How does aortic stenosis present?

A

systolic ejection click followed by a crescendo-decrescendo murmur

34
Q

What are the consequences of mitral regurg?

A
  • volume overload
  • L-sided heart failure
35
Q

What valve is most likely to be affected by endocarditis in acute rheumatic fever? Which is 2nd most likely?

A
  • most affected = the mitral valve
  • 2nd most = the aortic valve
36
Q

Who most often gets aortic stenosis?

A

older adults (> 60 yo)

37
Q

What is mitral stenosis?

A

narrowing of the mitral valve orifice

38
Q

What does aortic valve stenosis lead to?

A

fusion of commissures

39
Q

Name a complication of mitral stenosis.

A

volume overload –> dilation of LA –> pulm problems, A-fib

40
Q

What are the clinical s/s of aortic regurg?

A
  • bounding pulses
  • pulsating nail beds
  • head bobbing
  • increased systolic pressure
  • decreased diastolic pressure
  • widened pulse pressure
  • LV dilation w/ eccentric hypertrophy (only one aspect of ventricle, not whole thing)
41
Q

How could you distinguish the cause of aortic stenosis?

A

mitral stenosis + fusion of aortic valve commissures = rheumatic disease, NOT wear and tear

42
Q

Describe the murmur in mitral regurg.

A

a holosystolic, blowing murmur

43
Q

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

A

myocarditis

44
Q

What is aortic regurg?

A

backflow of blood from the aorta to the LV during DIASTOLE

45
Q

What is mitral regurg?

A

reflux of blood from the LV to the LA during SYSTOLE

46
Q

What is mitral valve prolapse?

A

ballooning of the mitral valve into the LA during SYSTOLE

47
Q

Chronic rheumatic disease creates ______, while acute rheumatic disease causes ______.

A
  • chronic = stenosis
  • acute = regurg
48
Q

What causes aortic regurg?

A
  • aortic root dilation (syphilis)
  • valve damage (infectious endocarditis)
49
Q

What does a fishmouth aortic valve indicate?

A

fusion of the commissures - aortic stenosis

50
Q

What does pancarditis mean?

A

all 3 layers of the heart are inflamed

51
Q

What makes the mitral regurg murmur worse?

A
  • squatting
  • expiration

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