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gen-path 2 > CV lecture 3- Cardiac Valvular Disease and Vasculitis > Flashcards

CV lecture 3- Cardiac Valvular Disease and Vasculitis Flashcards

1
Q

Acquired mitral valve stenosis is usually caused by what?

A

usually due to chronic (recurrent) rheumatic valvular disease

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2
Q

what is mitral valve stenosis?

A

failure of a valve to open completely, obstructing forward flow

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3
Q

what strain of bacteria is usually responsible for acquired stenosis?

A

Group A β-hemolytic Streptoccocal pharyngitis

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4
Q

mitral valve stenosis usually effects what group of people?

A

children

only 20% of cases are in adults

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5
Q

what are the clinical features of Acute rheumatic fever (ARF)?

A

arthritis (often polyarthritis)
carditis
erythema marginatum (skin rash)
subcutaneous nodules

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6
Q

The myocarditis caused by ARF is characterized microscopically by _______ bodies

A

Aschoff

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7
Q

what are the 3 types of Rheumatic Carditis?

A

Pericarditis – fibrinous

Endocarditis – sterile vegetations

Myocarditis – Aschoff bodies

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8
Q

what are the microscopic characteristics of Aschoff bodies?

A
  • mononuclear cells and fibroblasts

- form of granulomatous inflammation

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9
Q

Recurrent bouts of acute rheumatic fever lead to __________ and ____________

A

fibrosis

and

mitral valve stenosis

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10
Q

______________ refers to a valve that fails to close completely, allowing backflow of blood

A

Regurgitation (insufficiency)

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11
Q

what is Mitral valve prolapse?

A

a condition in which the leaflets balloon into the left atrium during left ventricular contraction (systole)

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12
Q

what are the THREE causes of mitral valve regurgitation?

A

1) Ischemic heart disease
2) Infective endocarditis
3) Floppy mitral valve (severe MV prolapse)

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13
Q

floppy mitral valve (sever MV prolapse) can be isolated or part of ___________ syndrome

A

Marfan syndrome

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14
Q

what are the characteristics of floppy mitral valve (Sever MV prolapse)?

A
  • the valve cusps are large and microscopically show fragmentation
  • separation and loss of collagen
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15
Q

_____________ degeneration is the name given when mitral valves separate and lose collagen

A

myxomatous degeneration

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16
Q

what are the possible complications of floppy mitral valve syndrome?

A
  • MV regurgitation
  • endocarditis
  • thromboemboli
  • sudden death (rare)
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17
Q

_____________ Stenosis is caused by fibrosis and calcification

A

Aortic Valve Stenosis

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18
Q

what is the effect on the heart from fibrosis and calcification during aortic valve stenosis?

A

reduce the valve cusp mobility

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19
Q

what are the 3 types/causes of Aortic valve stenosis?

A
  • Chronic rheumatic valvular disease
  • Degenerative (senile)
  • Congenital bicuspid valve
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20
Q

which form of Aortic valve stenosis is more common in younger people?

A

Congenital bicuspid valve

  • much younger initial onset (40-50 years)
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21
Q

what are the 3 causes of Aortic Valve Regurgitation?

A
  • Valve cusp destruction
  • Weakened valve cusps
  • Dilation of the aortic root
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22
Q

what 2 conditions can cause valve cusp destruction (and lead to Aortic valve regurgitation)?

A

infectious endocarditis

rheumatic heart disease

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23
Q

myxomatous degeneration (from Marfan syndrome) will lead to the weakening of what structure?

(causes aortic valve regurgitation)

A

Weakened valve cusps

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24
Q

A Dilation of the ________ can occur as a result of degeneration of the media of the aorta

A

dilation of the aortic root

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25
name the predisposing factors for infective endocarditis:
- intracardiac shunts - valvular disease - prosthetic valves (10-20% of all IE cases) - IV drug abuse - immune suppression - diabetes mellitus
26
what 3 factors have been identified in the pathogenesis of infective endocarditis?
1) endocardial/endothelial injury (blood flow) 2) fibrin thrombi 3) organisms in the blood (sepsis)
27
list the clinical signs of infective endocarditis:
Fever Fatigue Anemia Myalgia/arthralgia Splinter hemorrhages; Roth spots (retinal hemorrhages) Heart murmur
28
where are "splinter hemorrhages" found in patients with infective endocarditis?
in the nail beds
29
which form of infective endocarditis affects previously normal heart valves? which form effects previously abnormal valves?
normal valves- ACUTE infective endocarditis previously abnormal valves- SUBacute infective endocarditis
30
what are some complications of infective endocarditis?
1) valvular regurgitation 2) rupture of chordae tendineae 3) contiguous spread of infection 4) thromboembolism – “splinter hemorrhages” of fingernails 5) septic emboli with abscesses
31
what are the causes of vasculitis?
``` ***Infection*** Immunologic mechanisms Radiation Trauma Caustic substances Unknown ```
32
what are the 2 diseases that lead to "large vessel" vasculitis?
``` Giant cell (temporal) Takayasu arteritis ```
33
_________________ and ____________ are both diseases that cause "medium vessel" vasculitis
Polyarteritis nodosa and Kawasaki disease
34
name the 2 diseases that result in small vessel vasculitis
Microscopic polyarteritis Wegener granulomatosis
35
what are the 4 factors involved in the pathogenesis of vasculitis?
1) Immune complexes; circulating or may form in-situ 2) Antineutrophilic cytoplasmic antibodies (ANCA) 3) Anti-endothelial cell antibodies 4) Cell-mediated immune mechanisms
36
which Antineutrophilic cytoplasmic antibody (ANCA) is associated with microscopic polyarteritis?
Anti-myeloperoxidase (anti-MPO) - perinuclear localization
37
which Antineutrophilic cytoplasmic antibody (ANCA) is associated with Wegener granulomatosis?
Anti-proteinase-3 (anti-PR3) - diffuse cytoplasmic distribution
38
anti-endothelial cell antibodies are important in the pathogenesis of what disease?
Kawasaki disease | a medium vessel vasculitis
39
what are the clinical characteristics of Giant Cell (temporal) arteriosis?
``` rare before age 50 fever weight loss headache visual disturbances ``` pain and tenderness over temporal artery polymyalgia rheumatica
40
what are the pathological characteristics of Giant cell arteriosis?
Granulomatous inflammation Intimal proliferation / fibrosis
41
T/F: the etiology (cause) of both Giant cell, and Takayasu arteriosis have both been identified
FALSE the etiology of both is unknown
42
________________ is also called the "pulseless disease".... what causes this?
Takayasu Arteritis - patients have weak arm pulses
43
what is the pathology of Takayasu arteritis?
1) Involves aortic arch and branches 2) Intimal fibrosis 3) Granulomatous inflammation with fibrosis (NOTE: numbers 2 & 3 are the same as giant cell vasculitis)
44
what are the clinical manifestations of Polyarteritis Nodosa?
1) acute-relapsing-chronic progression 2) fever 3) weight loss 4) hematuria 5) renal failure 6) hypertension 7) abdominal pain 8) melena
45
describe the pathology for Polyarteritis Nodosa
- Haphazard and segmental involvement of medium and small muscular arteries - Kidney > liver > heart > GI - Fibrinoid necrosis, PMN’s - Thrombosis, aneurysms - Heal by fibrosis
46
what sites in the body are usually involved with Polyarteritis Nodosa?
Usual sites of involvement are: kidneys (85%), heart (75%), liver (65%), GI tract (50%).
47
________________ is also known as mucocutaneous lymph node syndrome
Kawasaki disease
48
what is the etiology of Kawasaki disease?
anti-endothelial antibody triggered by viral infection | It is suspected that a viral infection triggers a hypersensitivity reaction. AKA: mucocutaneous lymph node syndrome
49
what age group is effected by Kawasaki disease?
Infants & young children
50
name the clinical features of Kawasaki disease:
fever mucous membrane erythema (eyes/mouth) skin rash cervical lymphadenopathy usually self-limited
51
1-2% of patients with Kawasaki disease will die due to __________________
coronary artery vasculitis
52
what is the etiology/cause of Microscopic Polyangiitis?
antigen-antibody complexes Ag-Ab complexes/MPO-ANCA
53
what are the clinical signs for microscopic polyangiitis?
skin rash, other organs
54
microscopic polyangiitis may be caused by what "precipitating" conditions?
May be precipitated by: drugs microorganisms foreign proteins or tumor proteins.
55
what is the pathology of microscopic polyangiitis?
Involves arterioles, capillaries, venules. Fibrinoid necrosis * small vessel vasculitis WITHOUT necrotizing granulomatous inflammation
56
what is the etiology, and the clinical signs, for Wegener's Granulomatosis?
Etiology: neutrophil-related endothelial damage mediated by PR3-ANCA Clinical – sinusitis, pneumonitis, renal failure, glomerulonephritis
57
what is the pathology of Wegener's Granulomatosis?
- Affects kidneys, upper and lower respiratory tract - Necrotizing granulomas - Vasculitis with fibrinoid necrosis
58
give the etiology and clinical signs for Thromboangiitis Obliterans (Buerger Disease):
Etiology – endothelial injury from substance in cigarette smoke Clinical – cigarette smoking, < 35 years, pain of extremities, ischemic ulcers, gangrene
59
what are the pathological characteristics of Thromboangiitis Obliterans (Buerger Disease)?
Vasculitis with thrombosis
60
what are the pathological characteristics for Dissecting Aortic Hematomas?
A) intimal tear - split between mid & outer third of the media B) media may be normal or have degeneration
61
what are the complications AND predisposing factors for Dissecting aortic hematomas?
Complications: 1) rupture – hemorrhage 2) branch obstruction Predisposing factors: 1) hypertension 2) connective tissue disorders (Marfan’s)
62
which form of vasculitits is MUCH more common in women than in men?
Takayasu arteriosis - most common in women under 40 yrs old

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