Cardiovascular Path 3 Flashcards
__________ is a valvular disease that is only associated with rheumatic heart disease
Mitral stenosis
Dilated cardiomyopathy can cause what valvular disease?
Mitral regurgitation
Late low pitched diastolic murmur and creptiations in the lung is indicative of what valvular heart disease
Mitral stenosis
Pansystolic murmur radiation to axilla is a what type of valvular heart disease
Mitral regurgitation
Ejection systolic murmur loudest at the base and radiates to the neck after S1 is indicative of what valvular heart disease?
Aortic stenosis
Bounding pulses, early diastolic murmur and a displaced apex beat is indicative of what valvular heart disease?
Aortic regurgitation
Rheumatic fever usually follows an episode of _______ after a few weeks
Group A streptococcal pharyngitis
Rheumatic fevere is a type ____ HS reaction from antibodies directed against _________ of the group A strep cross reacting with normal proteins in the __________
Type 2 HS;
M proteins; heart, joints and other tissues
Elevated _________ and _______ titers are seen in rheumatic fever
ASO and anti-DNAase titers
_____________ are pathognomonic of myocarditis in rheumatic fever and what layers of the heart can it be seen?
Paravascular Aschoff Bodies; ALL 3 layers
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
Rheumatic fever; eosinophilic matrix; anitschkow cells (caterpillar cells)
In acute rheumatic fever, watch would you expect to see as a result of the endocarditis?
- 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
In rheumatic fever, the vegetations are formed along ___________
The line of closure of the mitral valve
What are some cardiac features of chronic rheumatic carditis?
- valvulitis (M>A>T>P)
- cardiac hypertrophy and dilation
- CHF
- arrhythmias
- infective endocarditis
What are the minor criteria for JONES criteria?
- fever, arthralgia and ↑ ESR
What do you need for diagnosis of rheumatic fever?
2 major OR 1 major + 2 minor
AND
Evidence of preceding strep infection by sowing ↑ ASO titers or positive strep throat culture
Calcified aortic stenosis most commonly occurs in (3)
- elderly patients
- congenital bicuspid aortic vale
- rheumatic heart disease
____________ is a valvular disease that can be a complication of Marfan Syndrome
mitral valve prolapse
What heart sound is indicative of mitral valve prolapse?
Mid systolic click due to the ballooning of the leaflets into the left atrium during systole
In mitral valve prolapse there is ________ of the ___________ layer of the valve and ________ of the _________ layer
Thinning of the fibrosa layer and thickening/expansion of the spongiosa layer
Which layers of the valve are affected in mitral valve prolapse?
Spongiosa: expansion (accumulation of CT)
Fibrosa: thinning
The midsystolic click seen in________ is de to when _______
Mitral valve prolapse; due to the abrupt tension on the leaflets and chordae tendonae when the valve tries to close
Typically in ________ endocarditis, there is infection of a normal valve
Acute;
Destructive and fulminant and caused by high virulent organisms
Subacute endocarditis occurs in normal/abnormal valves
Abnormal
Less destruction and most patients recover with appropriate therapy
Microorganisms in infective endocarditis adhere to the deposits of platelets an fibrin via _____ and ________
Fibronectin and adhesion factors such as polysaccharides
describe the vegetations seen in acute IE
friable, bulky and potential destructive and contain fibrin
how are the vegetations different in subacute IE vs acute IE
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
what are clinical features of infective endocarditis?
- 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
splenomegaly and weight loss are features seen in acute/subacute IE?
subacute;
other features of subacute: CHANGING murmurs and low grade fever w/ malaise
the release of the bacterial antigen in IE lets to what host consequences
causes immune complex formation leading to: glomerulonephritis, Osler’s nodes, and Roth spots
in addition to Duke’s criteria, what else is needed for diagnosis?
repeated blood cultures and echocardiography
what is marantic endocarditis?
presence of STERILE thrombi on the leaflets of previously normal valves (seen in debilitated patients like those with cancer)
marantic endocarditis / NBTE (non bacterial thrombotic endocarditis) is associated with:
- endothelial abnormalities
- hypercoagulable states
- adenocarcinomas
sterile vegetation on cardiac valves in patients with SLE is known as what disease?
Libman Sacks endocarditis (LSE in SLE)
what kind of vegetations are seen in Libman sacks endocarditis?
STERILE
what are some clinical features of someone suffering from acute bacterial endocarditis?
- high grade fever w/ chills
- NEW cardiac murmur
- features of septicemia
in calcific aortic stenosis, the calcium is deposited ____________ leading to ______
behind the valve cusps and thus extend into the sinus of valsalva → coronary ischemia
_________ and _______ lesions are due to the fragmentation of the vegetations in IE
splinter hemorrhage and Janeway lesion
life long anticoagulation and thus risk for hemorrhage is a complication of ______ type of prosthetic valve
mechanical;
what are some complications of mechanic prosthetic valves?
- thrombo embolism
- life long anitcoagulation (risk for hemorrhage)
- hemolysis (RBC destruction)
- paravascular leak due to inadequate healing
- IE
because tissue valves (bioprosthetic valves) are less durable, what are some possible complications?
- matrix deterioration → rigidity and calcification → stenosis and can perforate
do you need anticoagulation for bioprosthetic valves?
NO (only with mechanical)
