Heart Failures + Valvular Diseases

Question 1

LVF Causes

Answer 1

Muscle:

• Myocarditis
• Myo infract

Filling
- Restricted by Pericardial Effusion

Rhythm
- Arrhythmia

Volume Overload/ Pressure Overload

• Regurg, high output state eg Anaemia (requiring high output)
• Hypertensioin

Question 2

LHF Effects

RHF Effects

Answer 2

Forward

• Hypoperfusion
• Kidney failure - RAS stimulated
• Brain

Backward

• Pulmonary Edema, Hypertension
• Presenting as Dyspnea, SOB,

RHF:

• Peripheral Edema - Nocturia
• Raised JVP
• Portal Hypertension
• • Ascites, Hepatosplenomegaly

Question 3

When can both Stenosis and Regurgitation take place?

Answer 3

Fibrosis

Question 4

Stenosis causes

Regurg causes

Answer 4

Stenosis:
Post-inflammation scarring - fibrosis from IE, RHD
Calcification - Calcific Aortic Stenosis
Congenital (bicuspid aortic valves)

Regurg:
Post-inflammation scarring - fibrosis, RHD can also
Developmental - Marfan
Degeneration - Myxoid degen - lead to Mitral Valve Prolapse - prolapse into atrium when systole - possible Regurg
Infections

Question 5

Give [4] important valvular diseases 2 + 2

Answer 5

Aortic Valve Calcification [MOST COMMON}
Mitral Valve Prolapse
Rheumatic HD
Infective EC

Question 6

Aortic Valve Calcification

Answer 6

Age-associated Degen

- Aortic Stenosis

Question 7

Aortic Stenosis causes [4] and effects

very important effect of aortic

Answer 7

Calcification
- RHD, IE
Congenital - bicuspid valves
– Stenosis confirm, narrow opening; can also lead to regurg if dont close properly

LHF
Coronary perfusion - ISCHEMIA - possible sudden death

Question 8

Mitral Valve Prolapse

• what is it
• what does it cause

Answer 8

Associated w Marfan

Ballooning of Valvular Cusps - thicken, rubbery
Myxoid degeneration of leaflets - replaced w mucoid substance
Regurg

Question 9

Rheumatic Fever

Pathophysiology
Acute
- Histologies
Chronic effects

Answer 9

Post Strep Pyogenes - GAS
Note Rheumatic Fever is systemic; RHD is a component

AB towards Streptolysin O - hence AntiSOT
- cross reactivity to heart valve proteins, cardiac myocytes

Effects

Acute:

• Pericarditis, Myocarditis - Pancarditis
• Fibrinoid Degeneration w lymphocytes
• • Aschoff bodies: Granulomatous bodies of: T cells, B cells, Aschoff giant cells (from macrophages fusing), activated macrophage (caterpillar cell) + central necrosis
• Vegetation at valves called verrucae - rheumatic depositions

Aschoff Bodies result of inflammation from heart muscle,

• Macrophages forming MGC, or caterpillar cells
• granulomatous inflammation w central necrosis

Chronic:

• inflammation, fibrosis - most at Mitral
• Note mitral problems predisposes to arrhythmia, IE, thromboembolism

Question 10

IE

What isit + Which valves more prone

Answer 10

Microbial infection of valves, endocardium

Left valves more prone

Question 11

What’s acute vs subacute IE

Answer 11

Acute means fresh Subacute means on preexisting abnormal valves - most common S. Viridians ( alpha hemolytic Optochin RESISTANT)
- note HACEK group

Question 12

Causes of acute IE

Answer 12

IV drug use, Open heart surgery, Septicemia (hematogenous spread)

Question 13

Local and Distant Cx of IE [3+3]

Answer 13

• Valve rupture (after necrosis)
• Myocardial ring abscess
• Pericarditis
• Septic Emboli
• Immune complex - GRN
• Infection - anaemia of chronic disease; Splenomegaly

Question 14

Give 2 examples of non infection vegetations

Answer 14

Non-bacterial Thrombotic Endocarditis: platelet rich vegetations - in the absence of vegetation

Lupus - antibody-antigen complex

Question 15

Cx of Valvular Heart Disease [4]

Answer 15

LVH, LHF

MI

Arrhythmia

IE predisposition