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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
Inflammation of endocardium, myocardium and epicardium following GAS beta-hemolytic streptococcal pharyngitis.
Acute rheumatic heart disease
26
Jones criteria for the diagnosis of rheumatic fever.
Evidence of streptococcal infection AND either 2 major or 1 major and 2 minor criteria.
27
Major criteria for rheumatic fever.
``` carditis polyarthritis Sydenham's chorea erythema marginatum subcutaneous nodules ```
28
Minor criteria for rheumatic fever
fever migratory arthralgias prolonged PR interval high ESR or WBC count
29
Epidemiology of acute rheumatic fever
developing countries | children
30
Gross pathology of rheumatic heart disease
1-2mm verrucous vegetations lined up on valve closure | fubrinous pericarditis
31
Microscopic pathology of rheumatic heart disease
``` fibrin and platelet thrombi on valves Aschoff bodies (foci of fibrinoid necrosis with histiocytes and Anitschkow cells (clumped chromatin resembling a caterpillar)) ```
32
Signs of acute rheumatic heart disease
various systolic and diastolic murmurs | pericardial friction rub
33
treatment for acute rheumatic heart disease
aspirin, penicillin, and supportive care
34
acute rheumatic fever often progresses to
mitral stenosis | aortic regurgitation
35
foci of fibrinoid necrosis with histiocytes and Anitschkow cells
Aschoff bodies
36
cells with clumped chromatin resmbling a caterpillar
Anitschkow cells
37
Symptoms usually occur an average of 20 years after carditis, but 50% have no history of it.
Chronic rheumatic heart disease
38
mitral stenosis is almost always due to
rheumatic carditis
39
Epidemiology of mitral stenosis
females (2:1)
40
fibrous thickening of valves with or without calcification
rheumatic mitral stenosis
41
MacCallum patches
map-like areas of atrial endocardial thickening and fibrosis; rheumatic mitral stenosis
42
Common complications are left atrial hypertension, left atrial dilation, atrial fibrillation, left atrial thrombus formation, pulmonary hypertension, right ventricular hypertophy and right heart failure.
rheumatic mitral stenosis
43
Aortic regurgitation can be due to 4 things.
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
decreased diastolic pressure (due to aortic regurgitation) can be a problem because
you might get decreased coronary artery perfusion
45
symptoms of decompensated aortic regurgitation
fatigue decreased exercise tolerance dyspnea
46
signs of decompensated aortic regurgitation
diastolic decrescendo murmur hyperdynamic bounding rapidly collapsing pulse (Corrigan pulse) head-bobbing with each pulse (de Musset sign)
47
characteristic pulse pressure of aortic regurgitation
wide pulse pressure due to increased systolic and decreased diastolic pressure
48
autoimmune inflammation of heart valves that occurs as part of systemic lupus erythematosus
Libman-Sacks endocarditis
49
Lupus epidemiology
females (9:1) 15-45 years old AA (3:1)
50
Gross pathology of Libman-Sacks endocarditis
small to medium verrucous, berry-like or flat vegetations, commonly on multiple valves
51
Microscopic pathology of Libman-Sacks endocarditis
``` necrotic debris fibrinoid material degenerating leukocytes fibroblasts hematoxylin bodies ```
52
hematoxylin bodies
condensed naked nuclei of dead degenerated cells ingested by phagocytes
53
Complications of Libman-Sacks endocarditis
chronic adhesive pericarditis | NOT emboli from the vegetations
54
Nonbacterial thrombotic endocarditis
marantic endocarditis
55
occurs in 75% of patients with malignant tumors
marantic endocarditis
56
Prevalent in pts with DIC, chronic sepsis, and Swan-Ganz right heart catheterization
marantic endocarditis
57
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
Marantic endocarditis
58
Uncommon disease that causes vegetations
infective endocarditis
59
Pathogenesis of _____ is 1. valvular endothelial injury 2. platelet and fivrin deposition 3. microbial seeding 4. microbial multiplication
Infective endocarditis
60
Infective carditis is ____% fatal if undiagnosed and untreated.
100
61
Infective carditis is __% fatal if diagnosed and treated appropriately.
20
62
Fulminant and due to highly virulent organisms (such as S. aureus).
Acute bacterial endocarditis (ABE)
63
Insidious onset over weeks and due to less virulent organisms (such as viridans streptococci).
Subacute bacterial endocarditis (SBE)
64
Commonly due to coagulase-negative Stapjulococcus epidermis, which is rare in NVE.
Prosthetic valve endocarditis (PVE)
65
Commonly acute and commonly on the tricuspid valve
Endocarditis in injecting drug users
66
A cell wall component that facilitates adherence of some streptococci to blood clot (esp. Streptococci mutans, a viridans)
dextran
67
Up to 3cm, friable vegetations, combination of tan, gray, red or brown, usually on the line of valve closure.
Infective endocarditis
68
Fibrin, platelets and masses of organisms, sometimes with necrosis and neutrophils.
Infective endocarditis
69
Later microscopic pathology of infective endocarditis.
Lymphocytes, macrophages and fibroblasts may infiltrate and fibrosis may occur.
70
Common symptoms of infective endocarditis
fever chills weakness dyspnea
71
Common physical signs of infective endocarditis.
Fever heart murmur splenomegaly petechiae
72
``` Uncommon signs include: Osler nodes subungual splinter hemorrhages changing heart murmur Janeway lesions new heart murmur Roth spots ```
Infective endocarditis
73
pea-sized tender finger/toe nodules
Osler nodes
74
small palm/sole hemorrhages
Janeway lesions
75
white dots with surrounding hemorrhage in the retina
Roth spots
76
``` Common laboratory findings are: elevated ESR circulating immune complexes anemia proteinuria ```
infective endocarditis
77
continuous low-grade bacteremia is characteristic of
endocarditis
78
Methods of visualizing vegetations
``` transthoracic echocardiography transesophageal echocardiography (>90% sensitivity) ```
79
Complications of infective endocarditis
heart failure | septic emboli
80
Emboli locations in infective endocarditis
kidneys heart spleen brain

Block 10 (16 decks)

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