Cardiology: 8.4: Valvular Disorders Flashcards
What happens to the myocardium in acute rheumatic fever?
Aschoff bodies (a focus of chronic inflammation with giant cells and fibrinoid material) containing Anitschkow cells
What is a complication of a damaged valve?
endocarditis
What does mitral valve stenosis lead to?
thickening of the chordae tendinae and cusps
What is the most common cause of mitral stenosis?
chronic rheumatic heart dz
Mitral regurg is usually 2a to?
mitral valve prolapse
What is the tx for aortic stenosis?
valve replacements
How is acute rheumatic fever diagnosed?
- evidence of a prior infection = ASO or anti-DNase B titer
- minor criteria = fever + elevated ESR
- major criteria = the JONES criteria
Describe the murmur in mitral valve prolapse.
mid-systolic click followed by regurg
What is stenosis?
narrowing of the opening of the valve –> harder to push blood through
What are Aschoff bodies? What are they assoc. with?
a focus of chronic inflammation with giant cells and fibrinoid material
What most often causes aortic stenosis? Name one other cause, too.
- most common = fibrosis and calcifications from normal wear and tear
- other = chronic rheumatic valve disease
What are Anitschkow cells? What are they assoc. with?
cells with a slender, wavy (caterpillar) found in the myocardium
What is chronic rheumatic valve disease?
scarring, stenosis from repeated bouts of acute rheumatic fever
What is the mechanism by which acute rheumatic fever occurs?
molecular mimicry- bacterial M protein resembles human tissues
Describe the murmur in mitral stenosis.
opening snap followed by a diastolic rumble
What is the tx for mitral valve prolapse?
valve replacement
What organism causes acute rheumatic fever?
group A beta-hemolytic strep
Other than mitral valve prolapse, name some other causes of mitral regurg.
- LV dilation
- infective endocarditis
- acute rheumatic heart dz
- papillary muscle rupture post-MI
This is a focus of chronic inflammation with giant cells and fibrinoid material found in the myocardium during acute rheumatic fever.
Aschoff bodies
Who gets acute rheumatic fever?
children 2-3 weeks after strep throat
What are the complications of aortic stenosis?
- LVH angina
- syncope with exercise
- microangiopathic hemolytic anemia
What is the tx for aortic regurg?
valve replacement
What are the complications of mitral valve prolapse?
- infectious endocardidits
- arrhythmia
- severe mitral regurg
What do mitral valve vegetations cause?
mitral valve regurg
What is regurg?
backflow across the valve
What can the pericarditis in acute rheumatic fever cause?
a friction rub
Why do pts with aortic stenosis get angina, syncope with exercise?
there’s limited ability to increase the amount of blood across the valve
What increases the risk of and speeds the process of aortic stenosis?
bicuspid aortic valve
These are cells with a slender, wavy (caterpillar) found in the myocardium during acute rheumatic fever.
Anitschkow cells
Name the JONES criteria for acute rheumatic fever.
- J = joints (migratory polyarthritis of large joints)
- O = heart (pancarditis)
- N = nodules (subcutaneous of the skin)
- E = erythema marginatum (annular rash)
- S = Syndenham chorea
What causes mitral valve prolapse?
myxoid degeneration –> floppy valve
Describe the murmur in aortic regurg.
early, blowing diastolic murmur
How does aortic stenosis present?
systolic ejection click followed by a crescendo-decrescendo murmur
What are the consequences of mitral regurg?
- volume overload
- L-sided heart failure
What valve is most likely to be affected by endocarditis in acute rheumatic fever? Which is 2nd most likely?
- most affected = the mitral valve
- 2nd most = the aortic valve
Who most often gets aortic stenosis?
older adults (> 60 yo)
What is mitral stenosis?
narrowing of the mitral valve orifice
What does aortic valve stenosis lead to?
fusion of commissures
Name a complication of mitral stenosis.
volume overload –> dilation of LA –> pulm problems, A-fib
What are the clinical s/s of aortic regurg?
- 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)
How could you distinguish the cause of aortic stenosis?
mitral stenosis + fusion of aortic valve commissures = rheumatic disease, NOT wear and tear
Describe the murmur in mitral regurg.
a holosystolic, blowing murmur
What is the most common cause of death during the acute phase of rheumatic fever?
myocarditis
What is aortic regurg?
backflow of blood from the aorta to the LV during DIASTOLE
What is mitral regurg?
reflux of blood from the LV to the LA during SYSTOLE
What is mitral valve prolapse?
ballooning of the mitral valve into the LA during SYSTOLE
Chronic rheumatic disease creates ______, while acute rheumatic disease causes ______.
- chronic = stenosis
- acute = regurg
What causes aortic regurg?
- aortic root dilation (syphilis)
- valve damage (infectious endocarditis)
What does a fishmouth aortic valve indicate?
fusion of the commissures - aortic stenosis
What does pancarditis mean?
all 3 layers of the heart are inflamed
What makes the mitral regurg murmur worse?
- squatting
- expiration
