HEART 3 Flashcards
1
Q
is the failure of a valve to open completely, obstructing forward flow
A
stenosis
2
Q
calcification or valve scarring may lead to
A
chronic stenosis
3
Q
failure of valves to close completely
A
insuffiency
4
Q
result from intrinsic disease of the valve leaflet or disruption of supporting structures
A
insifficiency
5
Q
supporting structures
A
aorta mitral annulus tendinous cords papillary muscles ventricular free wall
6
Q
consequence of leaflet scarring and retraction
A
insidiously
7
Q
chest rising during the contraction of the heart
A
thrills
8
Q
exacerbate valve disease and lead to unfavorable maternal or fetal outcomes
A
pregnancy
9
Q
calcification and
sclerosis of aortic valves, when you say
calcification, it also includes aging, your
wear and tear
A
aortic stenosis
10
Q
dilation of the ascending aorta, the aortic valve cannot compensate to the increased diameter of the aorta, secondary to hypertension and/ or aging
A
aortic insufficiency
11
Q
rheumatic heart disease
A
mitral stenosis
12
Q
myxomatous
degeneration (MVP) or your mitral valve
prolapse, or left ventricular dilation due to
heart failure
A
mitral insufficiency
13
Q
Most common of all valvular abnormalities
A
calcific aortic stenosis
14
Q
clinically significant
one to two decades earlier.
A
stenotic bicuspid valve
15
Q
consequence of
recurrent chronic injury due to hyperlipidemia,
hypertension, inflammation, and atherosclerosis
A
aortic valve calcification
16
Q
T or F
Bicuspid valves incur greater mechanical stress
than normal tricuspid valves, which may explain
their accelerated stenosis
A
T
17
Q
clinical feature (aortic stenosis) Left ventricular pressures rise to
A
200mmHg or more
18
Q
die within __ years of developing angina
A
5
19
Q
die within _ years of developing syncope
A
3
20
Q
die within _ yrs of CHF onset
A
2
21
Q
Some with familial clustering, often with
associated aortic or left ventricular
outflow tract malformations
A
calcific stenosis of congenitally bicuspid aortic valve
22
Q
in BAV, there is loss-of-function mutations in
A
NOTCH1 (9q34.3)
23
Q
major site of calcific deposits
A
raphe
24
Q
in BAV:
larger cusp having a ________
A
midline raphe resulting from incomplete commissural separation during development
25
In mitral annular calcification, degenerative calcific deposits in the mitral valve develop in the ___________
fibrous annulus
26
appear as irregular stony hard ulcerated nodules at the base of the leaflets (2-5 mm)
mitral annular calcification
27
Mitral annular calcification can lead to the following
regurgitation
Stenosis
Arryhthmias
28
one or both mitral valve leaflets are floppy
mitral valve prolapse (protrusion of mitral valve into the left atrium)
29
MVP is associated with disorders of connective tissue including marfan syndrome caused by
fibrillin 1 mutations
30
mutated FBN1 develop a form of MVP that is prevented by
TGF B inhibitors
31
the characteristic anatomic change in MVP
ballooning of the mitral leaflets
32
key histologic change in the tissue (mvp)
myxomatous degeneration of the spongiosa layer
33
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
```
34
mocat pentachrome stain
collagen yellow
elastin black
proteoglycan blue
35
auscultation of mid-systolic clicks, caused by abrupt tension in the redundant valve leaflets and chordae tendinae as the valve attempts to close
MVP
36
MVP can be confirmed by
echocardiography
37
can be done for for symptomatic patients or those with increased risk for significant complications
valve repair or replacement surgery
38
is an acute, immunologically
| mediated, multisystem inflammatory disease classically occurring a few weeks after group A streptococcal pharyngitis.
Rheumatic fever
39
is a common
manifestation of active RF and may progress to
chronic Rheumatic heart disease.
acute rheumatic carditis
40
Rheumatic heart disease characterized by
deforming fibrotic valvular disease,
particularly involving
mitral valve
| only cause of mitral stenosis
41
are the predictable
| consequence of healing and scarring associated with the resolution of the acute inflammation.
chronic fibrotic lesions
42
in RHD, damage to heart tissue may thus be caused by a combination of
antibody and T cell-mediated rxns
43
composed of foci of
Tlymphocytes, plasma cells, and plump activated
macrophages called Anitschkow cells
aschoff bodies
44
During acute RF, diffuse inflammation and
Aschoff bodies may be found in three layers of
the heart, resulting in
pericarditis, myocarditis, or endocarditis
45
small vegetations, very typical and a feature where you can differentiate the other types if disease causing vegetation
verrucae
46
Subendocardial lesions, exacerbated by
regurgitant jets, can induce irregular thickenings
called
MacCallum plaques (left atrium)
47
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
48
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)
```
49
Diagnosis (RF)
presence of 2 major
| or 1 major and 2 minor manifestations (fever arthralgia, elevated blood levels of acute phase reactants)
50
antibodies to streptococcal enzymes
streptolysin O and DNAse B
51
pericardial friction rubs
| tachycardia, and arrhythmias
acute carditis
52
cause cardiac dilation that
culminates in functional mitral valve insufficiency
or heart failure.
myocarditis
53
T or F
Surgical repair or replacement of diseased valves
has greatly improved the outlook for persons with
RHD
T
54
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
55
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
56
Is characterized by organisms with lower
| virulence (viridans streptococci) that cause insidious infections of deformed valves with less destruction
subacute IE
57
major antecedent disorder (IE)
RHD with valvular scarring
58
Endocarditis of native but previously damaged or
otherwise abnormal valves is caused most
commonly by
Streptococcus viridans
59
minor causes of IE
```
Enterococci
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella
```
60
prosthetic valves (1-2 mts)
s. aureus, s. epidermidis
61
prosthetic valve (1 yr)
Streptococcis, s. aureus
62
classic hallmark of IE
Vegetations on heart valves
63
most common sites of infection in IE
aortic and mitral valves
64
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
65
present in the majority of patientswith left-sided IE
murmurs
66
cure rate for low-virulence organisms
98%
67
enterococci and s aureus cure rates
60-90%
68
erythematous or hemorrhagic nontender lesions on the palms or soles
Janeway lesions
69
subcutaneous nodules in the pulp of the digits
osler nodules
70
retinal hemorrhages in the eyes
roth spots
71
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
```
72
Characterized by the deposition of small (1 to 5 mm)
| sterile thrombi on the leaflets of the cardiac valve
NBTE
73
endocarditis due to sepsis
marantic endocarditis
74
likely related to the procoagulant effects of tumor-derived mucin of tissue factor that can also cause migratory thrombophlebitis
mucinous adenocarcinoma
75
consequence of immune complex deposition, with activation of complement and recruitment of Fc-receptor bearing cells
NBTE (SLE)
76
intense valvulitis and fibrinoid necrosis of valve substance
NBTE SLE
77
systemic disorder marked by flushing, diarrhea, dermatitis and bronchoconstriction that is caused by bioactive compounds such as serotonin released by carcinoid tumors
Carcinoid syndrome
78
primarily affected carcinoid syndrome
endocardium and valves of the right heart
79
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)
80
Distinctive, glistening white intimal plaque like
| thickenings of the endocardial surfaces of the cardiac chambers and valve leaflets
carcinoid heart disease
