Cardiovascular Path 3

Question 1

__________ is a valvular disease that is only associated with rheumatic heart disease

Answer 1

Mitral stenosis

Question 2

Dilated cardiomyopathy can cause what valvular disease?

Answer 2

Mitral regurgitation

Question 3

Late low pitched diastolic murmur and creptiations in the lung is indicative of what valvular heart disease

Answer 3

Mitral stenosis

Question 4

Pansystolic murmur radiation to axilla is a what type of valvular heart disease

Answer 4

Mitral regurgitation

Question 5

Ejection systolic murmur loudest at the base and radiates to the neck after S1 is indicative of what valvular heart disease?

Answer 5

Aortic stenosis

Question 6

Bounding pulses, early diastolic murmur and a displaced apex beat is indicative of what valvular heart disease?

Answer 6

Aortic regurgitation

Question 7

Rheumatic fever usually follows an episode of _______ after a few weeks

Answer 7

Group A streptococcal pharyngitis

Question 8

Rheumatic fevere is a type ____ HS reaction from antibodies directed against _________ of the group A strep cross reacting with normal proteins in the __________

Answer 8

Type 2 HS;

M proteins; heart, joints and other tissues

Question 9

Elevated _________ and _______ titers are seen in rheumatic fever

Answer 9

ASO and anti-DNAase titers

Question 10

_____________ are pathognomonic of myocarditis in rheumatic fever and what layers of the heart can it be seen?

Answer 10

Paravascular Aschoff Bodies; ALL 3 layers

Question 11

Aschoff bodies, seen in _________, has a central zone of _______ infirlated by T cells, plasma cells and activated macrophages called ______ within the connective tissue of the Herat

Answer 11

Rheumatic fever; eosinophilic matrix; anitschkow cells (caterpillar cells)

Question 12

In acute rheumatic fever, watch would you expect to see as a result of the endocarditis?

Answer 12

• edematous and thickened valves with foci of fibrinoid necrosis
• tiny wart like vegetations along the lines of closure of the mitral valve → no effect on cardiac function

Question 13

In rheumatic fever, the vegetations are formed along ___________

Answer 13

The line of closure of the mitral valve

Question 14

What are some cardiac features of chronic rheumatic carditis?

Answer 14

• valvulitis (M>A>T>P)
• cardiac hypertrophy and dilation
• CHF
• arrhythmias
• infective endocarditis

Question 15

What are the minor criteria for JONES criteria?

Answer 15

• fever, arthralgia and ↑ ESR

Question 16

What do you need for diagnosis of rheumatic fever?

Answer 16

2 major OR 1 major + 2 minor
AND
Evidence of preceding strep infection by sowing ↑ ASO titers or positive strep throat culture

Question 17

Calcified aortic stenosis most commonly occurs in (3)

Answer 17

• elderly patients
• congenital bicuspid aortic vale
• rheumatic heart disease

Question 18

____________ is a valvular disease that can be a complication of Marfan Syndrome

Answer 18

mitral valve prolapse

Question 19

What heart sound is indicative of mitral valve prolapse?

Answer 19

Mid systolic click due to the ballooning of the leaflets into the left atrium during systole

Question 20

In mitral valve prolapse there is ________ of the ___________ layer of the valve and ________ of the _________ layer

Answer 20

Thinning of the fibrosa layer and thickening/expansion of the spongiosa layer

Question 21

Which layers of the valve are affected in mitral valve prolapse?

Answer 21

Spongiosa: expansion (accumulation of CT)
Fibrosa: thinning

Question 22

The midsystolic click seen in________ is de to when _______

Answer 22

Mitral valve prolapse; due to the abrupt tension on the leaflets and chordae tendonae when the valve tries to close

Question 23

Typically in ________ endocarditis, there is infection of a normal valve

Answer 23

Acute;

Destructive and fulminant and caused by high virulent organisms

Question 24

Subacute endocarditis occurs in normal/abnormal valves

Answer 24

Abnormal

Less destruction and most patients recover with appropriate therapy

Question 25

Microorganisms in infective endocarditis adhere to the deposits of platelets an fibrin via _____ and ________

Answer 25

Fibronectin and adhesion factors such as polysaccharides

Question 26

describe the vegetations seen in acute IE

Answer 26

friable, bulky and potential destructive and contain fibrin

Question 27

how are the vegetations different in subacute IE vs acute IE

Answer 27

subacute: vegetations are less friable and have lesser degree of valve destruction. and ring abscesses are uncommon. will see chronic inflammatory infiltrate, granulation tissue, fibrosis and calcification

Question 28

what are clinical features of infective endocarditis?

Answer 28

• finger clubbing
• splinter hemorrhages under nail beds
• Osler nodes: tender subcutaneous nodules on finger tips
• Janeway lesions: non tender maculae on palms and soles
• Roth spots: retinal hemorrhages

Question 29

splenomegaly and weight loss are features seen in acute/subacute IE?

Answer 29

subacute;

other features of subacute: CHANGING murmurs and low grade fever w/ malaise

Question 30

the release of the bacterial antigen in IE lets to what host consequences

Answer 30

causes immune complex formation leading to: glomerulonephritis, Osler’s nodes, and Roth spots

Question 31

in addition to Duke’s criteria, what else is needed for diagnosis?

Answer 31

repeated blood cultures and echocardiography

Question 32

what is marantic endocarditis?

Answer 32

presence of STERILE thrombi on the leaflets of previously normal valves (seen in debilitated patients like those with cancer)

Question 33

marantic endocarditis / NBTE (non bacterial thrombotic endocarditis) is associated with:

Answer 33

• endothelial abnormalities
• hypercoagulable states
• adenocarcinomas

Question 34

sterile vegetation on cardiac valves in patients with SLE is known as what disease?

Answer 34

Libman Sacks endocarditis (LSE in SLE)

Question 35

what kind of vegetations are seen in Libman sacks endocarditis?

Answer 35

STERILE

Question 36

what are some clinical features of someone suffering from acute bacterial endocarditis?

Answer 36

• high grade fever w/ chills
• NEW cardiac murmur
• features of septicemia

Question 37

in calcific aortic stenosis, the calcium is deposited ____________ leading to ______

Answer 37

behind the valve cusps and thus extend into the sinus of valsalva → coronary ischemia

Question 38

_________ and _______ lesions are due to the fragmentation of the vegetations in IE

Answer 38

splinter hemorrhage and Janeway lesion

Question 39

life long anticoagulation and thus risk for hemorrhage is a complication of ______ type of prosthetic valve

Answer 39

mechanical;

Question 40

what are some complications of mechanic prosthetic valves?

Answer 40

• thrombo embolism
• life long anitcoagulation (risk for hemorrhage)
• hemolysis (RBC destruction)
• paravascular leak due to inadequate healing
• IE

Question 41

because tissue valves (bioprosthetic valves) are less durable, what are some possible complications?

Answer 41

• matrix deterioration → rigidity and calcification → stenosis and can perforate

Question 42

do you need anticoagulation for bioprosthetic valves?

Answer 42

NO (only with mechanical)