Cardiology: 8.4: Valvular Disorders

Question 1

What happens to the myocardium in acute rheumatic fever?

Answer 1

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

Question 2

What is a complication of a damaged valve?

Answer 2

endocarditis

Question 3

What does mitral valve stenosis lead to?

Answer 3

thickening of the chordae tendinae and cusps

Question 4

What is the most common cause of mitral stenosis?

Answer 4

chronic rheumatic heart dz

Question 5

Mitral regurg is usually 2a to?

Answer 5

mitral valve prolapse

Question 6

What is the tx for aortic stenosis?

Answer 6

valve replacements

Question 7

How is acute rheumatic fever diagnosed?

Answer 7

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

Question 8

Describe the murmur in mitral valve prolapse.

Answer 8

mid-systolic click followed by regurg

Question 9

What is stenosis?

Answer 9

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

Question 10

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

Answer 10

a focus of chronic inflammation with giant cells and fibrinoid material

Question 11

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

Answer 11

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

Question 12

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

Answer 12

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

Question 13

What is chronic rheumatic valve disease?

Answer 13

scarring, stenosis from repeated bouts of acute rheumatic fever

Question 14

What is the mechanism by which acute rheumatic fever occurs?

Answer 14

molecular mimicry- bacterial M protein resembles human tissues

Question 15

Describe the murmur in mitral stenosis.

Answer 15

opening snap followed by a diastolic rumble

Question 16

What is the tx for mitral valve prolapse?

Answer 16

valve replacement

Question 17

What organism causes acute rheumatic fever?

Answer 17

group A beta-hemolytic strep

Question 18

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

Answer 18

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

Question 19

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

Answer 19

Aschoff bodies

Question 20

Who gets acute rheumatic fever?

Answer 20

children 2-3 weeks after strep throat

Question 21

What are the complications of aortic stenosis?

Answer 21

• LVH angina
• syncope with exercise
• microangiopathic hemolytic anemia

Question 22

What is the tx for aortic regurg?

Answer 22

valve replacement

Question 23

What are the complications of mitral valve prolapse?

Answer 23

• infectious endocardidits
• arrhythmia
• severe mitral regurg

Question 24

What do mitral valve vegetations cause?

Answer 24

mitral valve regurg

Question 25

What is regurg?

Answer 25

backflow across the valve

Question 26

What can the pericarditis in acute rheumatic fever cause?

Answer 26

a friction rub

Question 27

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

Answer 27

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

Question 28

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

Answer 28

bicuspid aortic valve

Question 29

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

Answer 29

Anitschkow cells

Question 30

Name the JONES criteria for acute rheumatic fever.

Answer 30

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

Question 31

What causes mitral valve prolapse?

Answer 31

myxoid degeneration --\> floppy valve

Question 32

Describe the murmur in aortic regurg.

Answer 32

early, blowing diastolic murmur

Question 33

How does aortic stenosis present?

Answer 33

systolic ejection click followed by a crescendo-decrescendo murmur

Question 34

What are the consequences of mitral regurg?

Answer 34

* volume overload * L-sided heart failure

Question 35

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

Answer 35

* most affected = the mitral valve * 2nd most = the aortic valve

Question 36

Who most often gets aortic stenosis?

Answer 36

older adults (\> 60 yo)

Question 37

What is mitral stenosis?

Answer 37

narrowing of the mitral valve orifice

Question 38

What does aortic valve stenosis lead to?

Answer 38

fusion of commissures

Question 39

Name a complication of mitral stenosis.

Answer 39

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

Question 40

What are the clinical s/s of aortic regurg?

Answer 40

* 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)

Question 41

How could you distinguish the cause of aortic stenosis?

Answer 41

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

Question 42

Describe the murmur in mitral regurg.

Answer 42

a holosystolic, blowing murmur

Question 43

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

Answer 43

myocarditis

Question 44

What is aortic regurg?

Answer 44

backflow of blood from the aorta to the LV during DIASTOLE

Question 45

What is mitral regurg?

Answer 45

reflux of blood from the LV to the LA during SYSTOLE

Question 46

What is mitral valve prolapse?

Answer 46

ballooning of the mitral valve into the LA during SYSTOLE

Question 47

Chronic rheumatic disease creates \_\_\_\_\_\_, while acute rheumatic disease causes \_\_\_\_\_\_.

Answer 47

* chronic = stenosis * acute = regurg

Question 48

What causes aortic regurg?

Answer 48

* aortic root dilation (syphilis) * valve damage (infectious endocarditis)

Question 49

What does a fishmouth aortic valve indicate?

Answer 49

fusion of the commissures - aortic stenosis

Question 50

What does pancarditis mean?

Answer 50

all 3 layers of the heart are inflamed

Question 51

What makes the mitral regurg murmur worse?

Answer 51

* squatting * expiration