HEART 3 Flashcards
is the failure of a valve to open completely, obstructing forward flow
stenosis
calcification or valve scarring may lead to
chronic stenosis
failure of valves to close completely
insuffiency
result from intrinsic disease of the valve leaflet or disruption of supporting structures
insifficiency
supporting structures
aorta mitral annulus tendinous cords papillary muscles ventricular free wall
consequence of leaflet scarring and retraction
insidiously
chest rising during the contraction of the heart
thrills
exacerbate valve disease and lead to unfavorable maternal or fetal outcomes
pregnancy
calcification and
sclerosis of aortic valves, when you say
calcification, it also includes aging, your
wear and tear
aortic stenosis
dilation of the ascending aorta, the aortic valve cannot compensate to the increased diameter of the aorta, secondary to hypertension and/ or aging
aortic insufficiency
rheumatic heart disease
mitral stenosis
myxomatous
degeneration (MVP) or your mitral valve
prolapse, or left ventricular dilation due to
heart failure
mitral insufficiency
Most common of all valvular abnormalities
calcific aortic stenosis
clinically significant
one to two decades earlier.
stenotic bicuspid valve
consequence of
recurrent chronic injury due to hyperlipidemia,
hypertension, inflammation, and atherosclerosis
aortic valve calcification
T or F
Bicuspid valves incur greater mechanical stress
than normal tricuspid valves, which may explain
their accelerated stenosis
T
clinical feature (aortic stenosis) Left ventricular pressures rise to
200mmHg or more
die within __ years of developing angina
5
die within _ years of developing syncope
3
die within _ yrs of CHF onset
2
Some with familial clustering, often with
associated aortic or left ventricular
outflow tract malformations
calcific stenosis of congenitally bicuspid aortic valve
in BAV, there is loss-of-function mutations in
NOTCH1 (9q34.3)
major site of calcific deposits
raphe
in BAV:
larger cusp having a ________
midline raphe resulting from incomplete commissural separation during development
In mitral annular calcification, degenerative calcific deposits in the mitral valve develop in the ___________
fibrous annulus
appear as irregular stony hard ulcerated nodules at the base of the leaflets (2-5 mm)
mitral annular calcification
Mitral annular calcification can lead to the following
regurgitation
Stenosis
Arryhthmias
one or both mitral valve leaflets are floppy
mitral valve prolapse (protrusion of mitral valve into the left atrium)
MVP is associated with disorders of connective tissue including marfan syndrome caused by
fibrillin 1 mutations
mutated FBN1 develop a form of MVP that is prevented by
TGF B inhibitors
the characteristic anatomic change in MVP
ballooning of the mitral leaflets
key histologic change in the tissue (mvp)
myxomatous degeneration of the spongiosa layer
secondary changes (mvp)
fibrous thickening of the valve leaflets Linear fibrous thickening of the left ventricular endocardial surface Thickening of the mural endocardium Thrombi Focal calcifications
mocat pentachrome stain
collagen yellow
elastin black
proteoglycan blue
auscultation of mid-systolic clicks, caused by abrupt tension in the redundant valve leaflets and chordae tendinae as the valve attempts to close
MVP
MVP can be confirmed by
echocardiography
can be done for for symptomatic patients or those with increased risk for significant complications
valve repair or replacement surgery
is an acute, immunologically
mediated, multisystem inflammatory disease classically occurring a few weeks after group A streptococcal pharyngitis.
Rheumatic fever
is a common
manifestation of active RF and may progress to
chronic Rheumatic heart disease.
acute rheumatic carditis
Rheumatic heart disease characterized by
deforming fibrotic valvular disease,
particularly involving
mitral valve
only cause of mitral stenosis
are the predictable
consequence of healing and scarring associated with the resolution of the acute inflammation.
chronic fibrotic lesions
in RHD, damage to heart tissue may thus be caused by a combination of
antibody and T cell-mediated rxns
composed of foci of
Tlymphocytes, plasma cells, and plump activated
macrophages called Anitschkow cells
aschoff bodies
During acute RF, diffuse inflammation and
Aschoff bodies may be found in three layers of
the heart, resulting in
pericarditis, myocarditis, or endocarditis
small vegetations, very typical and a feature where you can differentiate the other types if disease causing vegetation
verrucae
Subendocardial lesions, exacerbated by
regurgitant jets, can induce irregular thickenings
called
MacCallum plaques (left atrium)
Changes of the mitral valve in chronic RHD are
leaflet thickening, commissural fusion and
shortening, and thickening of the tendinous
cords. This will add to severity of the patients
symptoms. This is now you call
fish-mouth stenosis
Rheumatic fever is characterized by a constellation of major manifestations:
Migratory polyarthritis of large joints Pancarditis Subcutaneous nodules Erytheme marginatum Sydenham chorea (involuntary rapid movements)
Diagnosis (RF)
presence of 2 major
or 1 major and 2 minor manifestations (fever arthralgia, elevated blood levels of acute phase reactants)
antibodies to streptococcal enzymes
streptolysin O and DNAse B
pericardial friction rubs
tachycardia, and arrhythmias
acute carditis
cause cardiac dilation that
culminates in functional mitral valve insufficiency
or heart failure.
myocarditis
T or F
Surgical repair or replacement of diseased valves
has greatly improved the outlook for persons with
RHD
T
Is a microbial infection of the heart valves or the
mural endocardium that leads to the formation of vegetation composed of thrombotic debris and organisms, associated with destruction of the underlying cardiac tissues.
Infective endocarditis
is typically caused by infection of a
previously normal heart valve by a highly
virulent organism (e.g. Staphylococcus aureus)
that rapidly produces destructive lesions
Acute IE
Is characterized by organisms with lower
virulence (viridans streptococci) that cause insidious infections of deformed valves with less destruction
subacute IE
major antecedent disorder (IE)
RHD with valvular scarring
Endocarditis of native but previously damaged or
otherwise abnormal valves is caused most
commonly by
Streptococcus viridans
minor causes of IE
Enterococci Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella
prosthetic valves (1-2 mts)
s. aureus, s. epidermidis
prosthetic valve (1 yr)
Streptococcis, s. aureus
classic hallmark of IE
Vegetations on heart valves
most common sites of infection in IE
aortic and mitral valves
typically exhibit granulation tissue at their bases indicative of healing
o With time, fibrosis, calcification, and
chronic inflammatory infiltrate can develop
vegetations of subacute IE
present in the majority of patientswith left-sided IE
murmurs
cure rate for low-virulence organisms
98%
enterococci and s aureus cure rates
60-90%
erythematous or hemorrhagic nontender lesions on the palms or soles
Janeway lesions
subcutaneous nodules in the pulp of the digits
osler nodules
retinal hemorrhages in the eyes
roth spots
When you say non-infective endocarditis, we think of two:
o Noninfected (sterile) vegetations occur in nonbacterial thrombotic endocarditis (NBTE) o Endocarditis of systemic lupus erythematosus (SLE)/ Libman-sacks endocarditis
Characterized by the deposition of small (1 to 5 mm)
sterile thrombi on the leaflets of the cardiac valve
NBTE
endocarditis due to sepsis
marantic endocarditis
likely related to the procoagulant effects of tumor-derived mucin of tissue factor that can also cause migratory thrombophlebitis
mucinous adenocarcinoma
consequence of immune complex deposition, with activation of complement and recruitment of Fc-receptor bearing cells
NBTE (SLE)
intense valvulitis and fibrinoid necrosis of valve substance
NBTE SLE
systemic disorder marked by flushing, diarrhea, dermatitis and bronchoconstriction that is caused by bioactive compounds such as serotonin released by carcinoid tumors
Carcinoid syndrome
primarily affected carcinoid syndrome
endocardium and valves of the right heart
Valvular plaques in carcinoid syndrome are also
similar to lesions that occurred in patients taking
fenfluramine (an appetite suppressant) or ergot
alkaloids (for migraine headaches)
Distinctive, glistening white intimal plaque like
thickenings of the endocardial surfaces of the cardiac chambers and valve leaflets
carcinoid heart disease
