CSIM 1.63: Cardiovascular Disease 2 Flashcards
Recall which atrioventricular valve is on the:
1) Left side of the heart
2) Right side of the heart
1) Bicuspid mitral valve
2) Tricuspid valve
What do valvular defects result in?
Either:
• Stenosis - failure to fully open impairing forward flow
• Insufficiency/incompetence - failure to fully close causing reversed flow
E.g. ‘mitral stenosis’, ‘aortic stenosis’ are valvular conditions
What are the clinical signs/effects of cardiac valve diseases?
- Murmur
- AF
- Syncope
- Heart failure
What are the commonest causes of:
1) Mitral stenosis?
2) Aortic valve stenosis?
3) Mitral regurgitation?
4) Aortic valve regurgitation?
1)
• Rheumatic heart disease
2)
• Rheumatic heart disease
• Congenital bicuspid aortic valve
• Senile calcific aortic stenosis
3)
• Infective endocarditis
• Connective tissue disorders
• Mitral valve prolapse (mitral degeneration)
• Rupture of papillary muscle and chordae tendinae
4)
• Infective endocarditis
• Connective tissue disorders (Marfan syndrome)
• Aortic root dilatation
What is Rheumatic fever? What causes it?
What does it cause if it progresses? How is this diagnosed
Acute fever marked by inflammation and pain in the joints
• Develops 2 weeks after a strep A sore throat
• M proteins produced by group A strep are similar to many glycoproteins found in CT
• Anti-streptococcal antibodies have an autoimmune cross-reaction with connective tissue components
Causes acute rheumatic carditis, diagnosed with JONES’ CRITERIA:
• Carditis and chronic valve damage
• Fever and recent sore throat (strep A)
• Erythema margintum
• Polyarthritis of large joints
• Sydenham’s chorea
• Abdominal pain
What is sydenham chorea?
A neurological disorder with involuntary rapid movements
What is CHRONIC rheumatic heart disease?
Organisation of the inflammation seen in acute rheumatic carditis with fibrosis (IMG 154)
What proportion of mitral stenoses are caused by rheumatic carditis?
99%
What valvular changes are seen in stenosis caused by:
1) Rheumatic heart disease?
2) Calcific aortic stenosis?
1) Commisural fusion, leaflet thickening
2) NO commisural fusion (free edges not involved), calcific masses on AORTIC side of cusps
Describe the pathogenesis of aortic stenosis?
Similar to atherosclerosis - deposition of lipids, inflammation and calcification
How is calcific aortic stenosis treated?
- Classical aortic valve replacement (AVR)
* Stented AVR
Describe the types of mitral degeneration which lead to prolapse and mitral regurgitation.
Fibroelastic degeneration
• Not genetic
• In over 60 year-olds
• Due to thinning of leaflets
Barlow’s degeneration
• Genetic
• In under 60s
• Due to thickening of the leaflets
How is mitral degeneration treated?
Mitral valve reconstruction
What are the clinical features of infective endocarditis? and how is it diagnosed?
What are the indications for surgery?
VEGETATIONS WITH: • Fibrin • Inflammatory cells • Granulation tissue • Microorganisms CAUSES • Murmurs • Immune-mediated glomerulonephritis • Emboli-mediated secondary features (Osler nodes, Janeway lesions, Roth spots, splinter haemorrhages) • Regurgitation of valves (due to vegetations) • Fever and chills
DIAGNOSED USING Duke Criteria:
Definite diagnosis
• Pathological criteria
• Clinical criteria (major and minor)
• Two major/one major and three minor/five minor criteria for definite diagnosis
Possible diagnosis
• One major criteria and one minor/three minor criteria
Rejected diagnosis
• Alternate diagnosis confirmed
• Resolution wth 4 days antibiotics
• Possible diagnosis criteria not met
INDICATIONS FOR SURGERY:
• Heart failure
• Uncontrolled infection
• Prevention of embolism
What can microemboli from endocarditis cause?
- Janeway lesions on palms and soles
- Osler nodes on digits
- Roth spots on retina
- Subungal splinter haemorrhage
