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Block 10 > Hemodynamic Disorders 2 > Flashcards

Hemodynamic Disorders 2 Flashcards

1
Q

The second most common valvular disease in the US.

A

Calcific aortic stenosis

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2
Q

Calcific aortic stenosis epidemiology

A

Males (3:1)

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3
Q

3 main causes of calcific aortic stenosis

A
  1. congenitally anomalous bicuspid valve
  2. “senile” degeneration
  3. chronic rheumatic disease
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4
Q

Early pathology of the valve in aortic stenosis

A

thickening with lipid deposition and inflammation (with macrophages and lymphocytes), followed by fibrosis

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5
Q

Late pathology of the valve in aortic stenosis

A

nodular heaped-up calcifications in the mid-portion of each cusp protruding into the sinuses of the Valsalva

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6
Q

Symptoms of calcific aortic stenosis

A

angina pectoris
syncope
dyspnea

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7
Q

chest pain due to myocardial ischemia

A

angina pectoris

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8
Q

loss of consciousness

A

syncope

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9
Q

Signs of aortic stenosis

A

crescendo-decrescendo systolic murmur
a weak delayed pulse
atrial gallop

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10
Q

Prognosis of aortic stenosis

A

5 years without valve replacement

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11
Q

The ejection of a portion of the LV stoke volume backward into the left atrium due to insufficiency of the mitral valve.

A

Mitral regurgitation

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12
Q

First and second most common causes of mitral regurgitation in the US.

A 
#1: mitral valve prolapse
#2: ischemic heart disease
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13
Q

Epidemiology of mitral regurgitation

A

20 % of middle-aged whites (M=F)

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14
Q

If mitral regurgitation is acute, the left atrium _____.

A

Has elevated pressure.

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15
Q

If mitral regurgitation is chronic, the left atrium _____.

A

is dilated

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16
Q

The medical emergency of sudden mitral regurgitation resulting in increased left atrial pressure and flash pulmonary edema is caused by

A

Rupture of a papillary muscle (due to myocardial infarction or infective endocarditis)

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17
Q

The symptom of acute mitral regurgitation

A

dyspnea

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18
Q

The most common symptom of chromic mitral regurgitation

A

fatigue

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19
Q

Additional symptoms of severe chronic mitral regurgitation (and consequent heart failure)

A

paroxysmal nocturnal dyspnea and orthopnea

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20
Q

Sign of mitral regurgitation

A

apical holosystolic (pansystolic) murmur

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21
Q

The most common valvular disease

A

mitral valve prolapse

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22
Q

Epidemiology of MVP

A

Females (3:2)

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23
Q

The threshold for heart failure is a __% reduction in stroke volume.

A

25

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24
Q

Microscopic pathology of MVP is _____ of outer zona fibrosa and _____ of inner zona spongiosa.

A

degeneration; expansion

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25
Q

Inflammation of endocardium, myocardium and epicardium following GAS beta-hemolytic streptococcal pharyngitis.

A

Acute rheumatic heart disease

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26
Q

Jones criteria for the diagnosis of rheumatic fever.

A

Evidence of streptococcal infection AND either 2 major or 1 major and 2 minor criteria.

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27
Q

Major criteria for rheumatic fever.

A 
carditis
polyarthritis
Sydenham's chorea
erythema marginatum
subcutaneous nodules
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28
Q

Minor criteria for rheumatic fever

A

fever
migratory arthralgias
prolonged PR interval
high ESR or WBC count

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29
Q

Epidemiology of acute rheumatic fever

A

developing countries

children

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30
Q

Gross pathology of rheumatic heart disease

A

1-2mm verrucous vegetations lined up on valve closure

fubrinous pericarditis

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31
Q

Microscopic pathology of rheumatic heart disease

A 
fibrin and platelet thrombi on valves
Aschoff bodies (foci of fibrinoid necrosis with histiocytes and Anitschkow cells (clumped chromatin resembling a caterpillar))
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32
Q

Signs of acute rheumatic heart disease

A

various systolic and diastolic murmurs

pericardial friction rub

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33
Q

treatment for acute rheumatic heart disease

A

aspirin, penicillin, and supportive care

34
Q

acute rheumatic fever often progresses to

A

mitral stenosis

aortic regurgitation

35
Q

foci of fibrinoid necrosis with histiocytes and Anitschkow cells

A

Aschoff bodies

36
Q

cells with clumped chromatin resmbling a caterpillar

A

Anitschkow cells

37
Q

Symptoms usually occur an average of 20 years after carditis, but 50% have no history of it.

A

Chronic rheumatic heart disease

38
Q

mitral stenosis is almost always due to

A

rheumatic carditis

39
Q

Epidemiology of mitral stenosis

A

females (2:1)

40
Q

fibrous thickening of valves with or without calcification

A

rheumatic mitral stenosis

41
Q

MacCallum patches

A

map-like areas of atrial endocardial thickening and fibrosis; rheumatic mitral stenosis

42
Q

Common complications are left atrial hypertension, left atrial dilation, atrial fibrillation, left atrial thrombus formation, pulmonary hypertension, right ventricular hypertophy and right heart failure.

A

rheumatic mitral stenosis

43
Q

Aortic regurgitation can be due to 4 things.

A
  1. insufficiency of a congenitally anomalous bicuspid valve
  2. endocarditis
  3. chronic rheumatic valve deformation
  4. dilation of the aortic valve ring by aortic aneurysm or dissection
44
Q

decreased diastolic pressure (due to aortic regurgitation) can be a problem because

A

you might get decreased coronary artery perfusion

45
Q

symptoms of decompensated aortic regurgitation

A

fatigue
decreased exercise tolerance
dyspnea

46
Q

signs of decompensated aortic regurgitation

A

diastolic decrescendo murmur
hyperdynamic bounding
rapidly collapsing pulse (Corrigan pulse)
head-bobbing with each pulse (de Musset sign)

47
Q

characteristic pulse pressure of aortic regurgitation

A

wide pulse pressure due to increased systolic and decreased diastolic pressure

48
Q

autoimmune inflammation of heart valves that occurs as part of systemic lupus erythematosus

A

Libman-Sacks endocarditis

49
Q

Lupus epidemiology

A

females (9:1)
15-45 years old
AA (3:1)

50
Q

Gross pathology of Libman-Sacks endocarditis

A

small to medium verrucous, berry-like or flat vegetations, commonly on multiple valves

51
Q

Microscopic pathology of Libman-Sacks endocarditis

A 
necrotic debris
fibrinoid material
degenerating leukocytes
fibroblasts
hematoxylin bodies
52
Q

hematoxylin bodies

A

condensed naked nuclei of dead degenerated cells ingested by phagocytes

53
Q

Complications of Libman-Sacks endocarditis

A

chronic adhesive pericarditis

NOT emboli from the vegetations

54
Q

Nonbacterial thrombotic endocarditis

A

marantic endocarditis

55
Q

occurs in 75% of patients with malignant tumors

A

marantic endocarditis

56
Q

Prevalent in pts with DIC, chronic sepsis, and Swan-Ganz right heart catheterization

A

marantic endocarditis

57
Q

small (1 to 5 mm) fibrin and platelet thrombi, most commonly on the atrial side of the mitral valve, usually on the line of valve closure

A

Marantic endocarditis

58
Q

Uncommon disease that causes vegetations

A

infective endocarditis

59
Q

Pathogenesis of _____ is

  1. valvular endothelial injury
  2. platelet and fivrin deposition
  3. microbial seeding
  4. microbial multiplication
A

Infective endocarditis

60
Q

Infective carditis is ____% fatal if undiagnosed and untreated.

A

100

61
Q

Infective carditis is __% fatal if diagnosed and treated appropriately.

A

20

62
Q

Fulminant and due to highly virulent organisms (such as S. aureus).

A

Acute bacterial endocarditis (ABE)

63
Q

Insidious onset over weeks and due to less virulent organisms (such as viridans streptococci).

A

Subacute bacterial endocarditis (SBE)

64
Q

Commonly due to coagulase-negative Stapjulococcus epidermis, which is rare in NVE.

A

Prosthetic valve endocarditis (PVE)

65
Q

Commonly acute and commonly on the tricuspid valve

A

Endocarditis in injecting drug users

66
Q

A cell wall component that facilitates adherence of some streptococci to blood clot (esp. Streptococci mutans, a viridans)

A

dextran

67
Q

Up to 3cm, friable vegetations, combination of tan, gray, red or brown, usually on the line of valve closure.

A

Infective endocarditis

68
Q

Fibrin, platelets and masses of organisms, sometimes with necrosis and neutrophils.

A

Infective endocarditis

69
Q

Later microscopic pathology of infective endocarditis.

A

Lymphocytes, macrophages and fibroblasts may infiltrate and fibrosis may occur.

70
Q

Common symptoms of infective endocarditis

A

fever
chills
weakness
dyspnea

71
Q

Common physical signs of infective endocarditis.

A

Fever
heart murmur
splenomegaly
petechiae

72
Q 
Uncommon signs include:
Osler nodes
subungual splinter hemorrhages
changing heart murmur
Janeway lesions
new heart murmur
Roth spots
A

Infective endocarditis

73
Q

pea-sized tender finger/toe nodules

A

Osler nodes

74
Q

small palm/sole hemorrhages

A

Janeway lesions

75
Q

white dots with surrounding hemorrhage in the retina

A

Roth spots

76
Q 
Common laboratory findings are:
elevated ESR
circulating immune complexes
anemia
proteinuria
A

infective endocarditis

77
Q

continuous low-grade bacteremia is characteristic of

A

endocarditis

78
Q

Methods of visualizing vegetations

A 
transthoracic echocardiography
transesophageal echocardiography (>90% sensitivity)
79
Q

Complications of infective endocarditis

A

heart failure

septic emboli

80
Q

Emboli locations in infective endocarditis

A

kidneys
heart
spleen
brain

Block 10 (16 decks)

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