Hemodynamic Disorders II

Question 1

second most common valvular disease causing hemodynamic disorder

Answer 1

Calcific aortic stenosis

Question 2

Three main causes of Calcific aortic stenosis

Answer 2

congenitally anomalous bicusid valve
Senile degeneration
Chronic rheumatic disease

Question 3

The cause of CAS in most patients under 65 is:

Answer 3

bicuspid valve

Question 4

The cause of CAS in most patients over 65 is:

Answer 4

senile degeneration

Question 5

Symptoms of CAS

Answer 5

Angina pectoris (chest pain due to myocardial ischemia), syncope, dyspnea
Symptoms usually occur with exertion.

Question 6

Surgical valve replacement improves survival

Answer 6

truth

Question 7

Early pathology of CAS

Answer 7

Thickening with lipid deposition and inflammation (macrophages and lymphocytes) followed by some fibrosis.

Question 8

Late pathology of CAS

Answer 8

Nodular heaped up calcifications

Question 9

What is mitral valve regurgitation.

Answer 9

Well, the mitral valve is between the left atrium and left ventricle so Mitral regurgitation is when , during systolic contraction, some of the blood from the left ventricle goes back into the left atrium when the valve doesn’t work properly.

Question 10

Most common cause of mitral regurgitation

Answer 10

Mitral valve prlapse….followed by ischemic heart disease.

Question 11

Pathophys consequences of mitral regurgitation are?

Answer 11

Decreased forward stroke volume
Increased left atrium volume and pressure
Volume related stress on the left ventricle because the added left atrial volume is returned to it along with the normal left atrial volume during diastole

Question 12

Flash pulmonary edema

Answer 12

When rupture of a papillary muscle due to an MI or IE causes sudden mitral regurgitation, increasing left atrial pressure which is then transmitted backwards to the pulmonary circulation, may cause rapid pulmonary edema which is called flash pulmonary edema. MEDICAL EMERGENCY

Question 13

Acute mitral regurg symptom

Answer 13

dyspnea

Question 14

Chronic mitral regurg symptom

Answer 14

fatigue

Question 15

Forward stroke volume from normal of 100ml down to 75 is what

Answer 15

Heart failure

Question 16

Mitral valve prolapse maybe associated with connective tissue disorders like Marfans

Answer 16

True

Question 17

Most common valvular disease?

Answer 17

MVP

Question 18

Rheumatic Heart DIsease

Answer 18

A “pancarditic” (endo, myo, and epi cardium) disease of inflammation following pharyngitis caused by group A Beta hemolytic strep.

Question 19

Gross pathology of ARF

Answer 19

Tiny vegetations lined up where the valves close

Question 20

Microscopic pathology

Answer 20

Fibrin and platelett thrombi on valves, and aschoff bodies

Question 21

Whats an Aschoff Body

Answer 21

foci of fibrinoid necrosis with histocytes anitschkow cells.

Question 22

Chronic Rheumatic Heart Disease is more common with:

Answer 22

Recurrent carditis, carditis at an early age, or severe carditis

Question 23

Surgical valve replacement leads to the requirement of lifelong anti-coagulants

Answer 23

True

Question 24

Libman-Sacks Endocarditis

Answer 24

Associated with Lupus. 50% of pts. Usually occurs simultaneously with pericarditis. Can feature vegetations (flat or berrylike) on all valves though mitral and tricuspid are most common.

Question 25

Marantic Endocarditis

Answer 25

Nonbacterial thrombotic endocarditis. Its common and occurs in 75% of patients with malignant tumors. Its basically the deposition of blood clot on heart valves and can be a PRECURSOR TO IE.

Question 26

Marantic endocarditis is also prevalent in pts with what?

Answer 26

DIC, sepsis, and swan-ganz heart catheterization

Question 27

Pathology of Marantic Endocarditis

Answer 27

small fibrin and platelet thrombi most commonly on the atrial side of the mitral valve.

Question 28

Pathogeneisis of Infective endocaditis

Answer 28

valvular injury, platelet and fibrin deposition, microbial seeding, microbial multiplication

Question 29

Three classifications of IE

Answer 29

Acute bacterial vs. subacute bacterial (Acute = Aureus, subacute= viridians streptococci),

Question 30

Prosthetic valve endocarditis is commonly due to what organism

Answer 30

Staph epidermis

Question 31

Pathology of IE

Answer 31

Large friable vegetations that are some combination or tan, red, gray, brown.

Question 32

Common physical signs of IE

Answer 32

fever, heart murmur,petechiae, splenomegaly

Question 33

Common symptoms:

Answer 33

Fever, weakness dyspnea

Question 34

Common lab findings in IE

Answer 34

elevated ESR, circulating immune complexes, anemia, proteinura.