Ch 11: HTN, Cor Pulmonale & Valvular Disease Flashcards
What part of the heart compensates for chronic HTN?
Left Ventricle
Hypertrophy occurs due to the volume overload
True or false. The left ventricular free walls and interventricular septum become thickened uniformly & concentrically.
True
There is also an increase in heart weight with hypertrophy
What is the appearance of the hypertrophic myocytes?
Increased diameter, hyperchromatic & rectangular “box car” nuclei
60 year old Miley Cyrus had a smoking hx of 20 pack/year and 5 year history of chronic bronchitis that really ended her singing career. She expired from congestive heart failure and autopsy of the heart showed hypertrophy of the right ventricle. What was the most likely cause of the right ventricular hypertrophy?
Pulmonary HTN
Cor pulmonale is defined as right ventricular hypertrophy and dilation second to pulmonary HTN.
COPD & pulmonary fibrosis are the most common causes
Old St. Nick has come to you because he is worried that he will not be able to deliver all the Christmas presents to the good girls and boys this year. He has been dypsneic in the workshop and has had to use 3 pillows to breathe while he sleeps. When you measure his vitals signs you notice that his heart rate is 115 bpm, bp 173/102. From indulging in too many Christmas cookies he has become obese and you also notice pitting edema, hepatosplenomegaly & rales at the bases of both lungs. ECG reveals left ventricular hypertrophy & CXR shows an enlarged heart. What is likely wrong with Old St. Nick?
Hypertensive Heart Disease
Intracerebral hemorrhage is often a frequent & fatal complication, so be sure to treat Old St. Nick!
- Valvular stenosis is due to _____ overload
2. Valvular insufficiency is due to _____ overload
- Pressure
2. Volume
12 year old boy in Uganda presents in the ED w/ tachycardia, chest pain, respiratory distress, pericarditis, increased CRP & increased ESR. CXR is significant for cardiomegaly. After he expires an autopsy was performed aschoff bodies anitschkow cells were found. What is the appropriate diagnosis?
Acute Rheumatic fever
Microscopic examination most often reveals aggregates of mononuclear cells arranged around centrally located deposits of eosinophilic collagen (inflammatory lesions).
Exposure to what pathogen can cause rheumatic fever?
Group A Beta Hemolytic stretococcus
Surface antigens cross react w/ similar antigens found in the heart, joints & connective tissue of the skin
What is the most common life threatening complication of rheumatic fever?
CHF
This is secondary to valvular stenosis/insufficiency
This is usually only in non-developed countires
What are the 4 complications of Chronic Rheumatic fever?
- Bacterial Endocarditis
(Scarred valves provide attractive environment for bacteria—> murmor; common in IV Drug user) - Mural Thrombi
(form in atrial & ventricular chambers—>thromboemboli—> infarcts) - CHF
(assoc. w/ rheumatic disease of both mitral & aortic valves) - Adhesive Pericarditis
(follows fibrinous pericarditis of acute attack)
True or false? RA compromises cardiac function
False
RA does NOT compromise cardiac function
Michelle Obama decided that she wanted to come to Syracuse for some dinosaur BBQ, but at dinner she noticed a concerning heart murmur. So she decides to come to Upstate and lucky you get to see her. She has a history of skin rashes & recurrent arthritis. She is positive for ant-dsDNA antibodies. Because you want to impress her so much you tell her right on the spot that her murmur is caused by what?
Libman-Sacks Endocarditis
This is the most striking cardiac lesion in SLE pts
Non-bacterial vegetations are seen on the mitral valve.
Fibrinoid necrosis is present in the small vessels w/ focal degeneration of interstitial tissue
Ankylosing Spondylitis principally causes regurgitation of what valve?
Aortic Valve
Congenital heart disease is a predisposing factor for ______ endocarditis in children
Bacterial endocarditis
A 63 year old man w/ a prosthetic valves presents with a 6 week history of fever, fatigue, a murmor, splenomegaly, petechiae & clubbing of his fingers. While in the ICU he develops neurologic dysfunction owing to what disease?
Bacterial endocarditis (in majority of cases there will be no predisposing cardiac lesion)
Vegetation of bacterial endocarditis are on what side of the atrioventricular valves and on what side for the semilunar valves?
AV Valves- atrial side
Semilunar Valves- ventricular side
Chonic (recurrent) episodes of rheumatic fever cause diffuse fibrosis of valve leaflets. They also become thickened, shrunken and less pliable leading to stenosis. Which valves are the most commonly severely affected valves?
Mitral valve then Aortic valve
MacCallum Patch can form due to chronic regurgitation from the stenotic mitral valve, produces “jet” of blood directed at the post. aspect of the left atrium, which damages the atrial endocardium—> discrete focus of rough, wrinkled endocardium
IV drug abusers most commonly develop insufficiency of what valve, leading to right sided heart failure?
Tricuspid Insufficiency
Most cases are cause by S. aureus from the skin
45 year old woman w/ a hx of adenocarcinoma of the lung is likely to have which of the following
a) Inflammatory valvular disease
b) Marantic Endocarditis
c) Emobilization of destructive valve vegetations to the brain
b) Marantic Endocarditis
Presence of sterile vegetations (non-destructive, non-inflammatory) on apparently normal cardiac valves, almost always associated w/ cancer (adenocarcinoma of pancreas or lung is common) or other wasting disease.
This disease is attributed to increased blood coagulability & immune complex deposition
DANGER of emobilization to distant organs.
What feature can distinguish Rheumatic Aortic Valve Disease from Degenerative (senile) calcific stenosis?
Commissural fusion (3 distinct cusps are not evident) & accompanied mitral valve disease are seen in rheumatic aortic valve disease
Both present w/ rigidly calcified valve cusps
Dystrophic calcification is due to the modulation of valvular interstitial cells to an osteoblastic phenotype
Calcification of the mitral valve annulus is aggravated by the presence of what 3 disorders?
Aortic Stenosis
HTN
Diabetes
A 23 year old male with a hx of Ehlers-Danlos Syndrome presents w/ a late systolic murmur. The murmur is due to what disorder, causing regurgitation of what valve and he is also at greater risk of sudden cardiac death due to what type of arrhythmia?
Mitral Valve Prolapse causing mitral regurgitation
Greater risk for sudden cardiac death from ventricular tachyarrhythmias.
Pulmonary edema in a patients with rheumatic fever is due to what complication?
Stenosis of the mitral valve (most commonly & severely affected valve in chronic rheumatic disease). Irregular thickening & calcification of the leaflets w/ fusion of the commissures & chrodae tendinae—> “fish mouth” appearance of orifice of valve
Left ventricular papillary muscles are susceptible to ischemic injury b/c of their blood supply. Angina can lead to transient ischemia leading to transient regurgitation of what valve?
What can lead to permanent regurgitation of this valve?
Mitral valve
Myocardial Infarction can lead to permanent mitral regurgitation
This heart defect is seen in patients who have a hx of jejunal carcinoid tumors that have metastasized to their liver. It is thought that valvular & cardiac lesions are caused by production of what from the tumor in the liver? What is the heart defect?
High concentrations of serotonin (other vasoactive amines & peptides)
Right sided heart disease leading to tricuspid regurgitation.
The lesions are plaque-like, deposits of dense, pearly gray fibrous tissue on the tricuspid valve (assoc. w/ inflammation)
