Lec 11 Valvular Heart Disease I Flashcards
What is rheumatic fever?
- immuno response to group A strep pharyngitis 2-3 wks after initial infection
- cross-reactivity between strep antigen and structural glycoprotein
- leads to chronic rheumatic valvular heart disease = usually 10-30 yrs after ARF
What are the jones criteria for rheumatic fever?
- J= joints [polyarthritis]
- Heart =carditis
- N = Nodules [subcutaneous]
- E = erythema marginatum
- S = sydenham chorea
What is erythema marginatum?
pink rings on trunks and inner surfaces of limbs that come and go
What is sydenham chorea?
disorder of rapid uncoordinated jerking movements primarily of face, hands, feet
What heart signs associated with acute rheumatic fever?
- tachycardia
- decreased LV contractility
- pericardial friction rub
- transient murmur of mitral or aortic regurgitation
- mid-diastolic murmur at cardiac apex
What is treatment for acute rheumatic fever?
- penicillin
- aspirin/corticosteroids to reduce inflammation
What is prophylaxis for pts with previous ARF?
low dose penicillin through early adulthood
b/c once you have ARF you are more susceptible to getting it again
What valve is most commonly affected in rheumatic fever?
mitral –> mitral stenosis
What kinds of valve disease can you get from rheumatic fever?
- most common mitral stenosis
- some get mitral stenosis + aortic stenosis or regurgitation
What is most common cause of mitral stenosis? less common?
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rheumatic fever
other: congenital, infective endocarditis, mitral annular calcification
What is molecular mimicry?
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mechanism by which antibodies to M protein of strep attack own human tissue in acute rheumatic fever
Which valves get affected preferentially in rheumatic fever?
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mitral > aortic»_space; tricuspid
most common is mitral or mitral + aortic
What is early valve problem in rheumatic fever? later on?
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early = mitral valve regurgitation
late = mitral stenosis
What is aschoff body?
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sign of myocarditis in rheumatic fever = focus of chronic inflammation with fibrinoid material and giant cells and containing anitschkow cells
What are anitschkow cells?
macrophages with wavy caterpillar nuclei located in aschoff bodies = sign of myocarditis in rheumatic fever
What causes early death in acute rheumatic fever?
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myocarditis
What causes friction rub in acute rheumatic fever?
pericarditis
How do you distinguish atrial stenosis from wear and tear vs atrial stenosis from rheumatic valve disease?
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if from rheumatic valve disease will also have mitral stenosis + aorta will have fusion of commissures in rheumatic heart disease = fish mouth appearance
stenosis of just aorta without mitral involvement and no fusion = wear and tear
What are complications of aortic stenosis?
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- concentric left ventricular hypertrophy
- angina and syncope with exercise
- microangiopathic hemolytic anemia
What kind of murmur with mitral stenosis?
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- follows opening snap
- ## have delayed rumbling late diastolic murmur
What is significance of interval between S2 and opening snap?
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shorter interval = more severe stenosis
What is opening snap?
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after S2 loud sound of mitral opening due to initial rapid opening followed by abrupt stop in leaflet motion in diastole b/c of stenosis
What happens in mitral stenosis?
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- obstruction of blood flow across mitral valve
- difficult to empty from LA to LV
- end up with high left atrial pressure [P in LA»_space; LV]
- valve area reduced from 4 in normal to 2 in MS
What are clinical manifestations of mitral stenosis?
- can be asymptomatic if less severe
- can have: dyspnea, reduced exercise tolerance, fatigue, signs of pulmonary congestion [b/c high LA pressure transmitted back to lungs]
