Lecture 11+12 Flashcards

Question

morphology of RHD

Answer 1

deforming fibrotic valvular disease favors the mitral valve leading to mitral stenosis Chronic rheumatic heart disease = mostly valvular; fibrosis and calcification

Answer 2

focal lesions will be found in all three layers (pancarditis) will have distinct lesions in the heart - Aschoff bodies composed of immune cells = Anitschkow cells chromatin condenses into a central, slender, wavy ribbon (caterpillar cell)

Answer 3

most frequent Conspicuous irregular fibrous thickening (neovascularized) and calcification of the leaflets Fusion of the commissures and shortening of the chordae tendineae Fixed narrow opening (fish mouth, button hole) Mitral stenosis

Answer 4

Cusps are thickened, firm and adherent to each other Valve orifice is reduced to rigid, triangular channel

Answer 5

1. Migratory polyarthritis of the large joints 2. Pancarditis (myocarditis, pericarditis, or endocarditis) 3. Subcutaneous nodules (typically on extensor surfaces of extremities) 4. Erythema marginatum, an irregular circinate skin rash 5. Syndenham chorea, a neurologic disorder with involuntary rapid movements Pharyngeal cultures for streptococci are negative by the time the illness begins Antibodies to one or more streptococcal enzymes, such as streptolysin O and DNase B, can be detected in the sera Predominant clinical manifestations are carditis and arthritis, the latter more common in adults than in children

Answer 6

Valvulitis murmurs Left atrium progressively dilates → mural thrombi → embolus congestive heart failure Arrhythmias Infective endocarditis

Answer 7

Evidence of a preceding group A streptococcal infection Presence of two major manifestations OR One major and two minor manifestations (nonspecific signs and symptoms that include: fever, arthralgia, or elevated blood levels of acute-phase reactants)

Answer 8

age-associated “wear and tear” of either anatomically normal valves or congenitally bicuspid valves epi: elderly population if congenital then middle aged etiopath: Likely a consequence of recurrent chronic injury due to hyperlipidemia, hypertension, inflammation, and other factors similar to those implicated in atherosclerosis Chronic progressive injury leads to valvular degeneration and incites the deposition of hydroxyapatite (the same calcium salt found in bone) Aortic valve scarred as a result of rheumatic heart disease

Answer 9

Mounded calcified masses on the outflow surfaces of the cusps that ultimately prevent cuspal opening Free edges of the cusps are usually not involved

Answer 10

Dystrophic calcification Functional valve area is decreased by large nodular calcific deposits → causes measurable outflow obstruction Subjects the left ventricular myocardium to progressively increasing pressure overload

Answer 11

Angina pectoris – increased requirement of hypertrophied myocardium Syncope – poor perfusion of the brain Death usually occurs due to congestive heart failure or arrhythmias

Answer 12

one or both mitral leaflets are “floppy” and prolapse—they balloon back into the left atrium during systole; also called Mitral valve prolapse (MVP) epi: usually women between 20-40 ``` etiopath: an underlying (possibly systemic) intrinsic defect of connective tissue like in Marfan syndrome ```

Answer 13

most are asymptomatic Palpitations, fatigue or atypical chest pain Mid systolic click Severe complications in about 3% of cases: • Mitral regurgitation and congestive heart failure • Infective endocarditis • Ventricular arrhythmias (may lead to →SCD) • Thromboembolic- stroke

Answer 14

gross: Soft puffed up rubbery mitral valve cusps Ballooning of the valve leaflets into the left atrium during systole (mid-systolic click) Chordae tendineae which are often elongated and fragile → may rupture in severe cases Mitral annulus may be dilated (regurgitation) micro: Thinning of fibrosa layer of valve, expansion of spongiosa layer Excessive amounts of loose, edematous, faintly basophilic ground substance within the middle layer of the valve leaflets and chordae (myxomatous degeneration)

Answer 15

Strept. viridans

Answer 16

``` valves were previously normal staph aureus involved (highly virulent) rapid progression lots of destruction difficult to cure and surgery is needed ```

Answer 17

previously deformed valves less virulent like viridans streptococci insidious speed.. not so much destruction antibiotics are helpful; no surgery needed

Answer 18

Most common valves involved- mitral and aortic valves IV drug abuse = tricuspid valve Classic hallmark of IE: Vegetations on heart valves ➔ friable, bulky, potentially destructive lesions containing fibrin, inflammatory cells, and bacteria or other organisms can have a ring abscess

Answer 19

Associated with less valvular destruction Microscopically: • Granulation tissue at their bases (indicative of healing) With time, fibrosis, calcification Chronic inflammatory infiltrate

Answer 20

fever clubbing of the fingers splinter hemorrhage's under nailbeds systematic embolization ``` osler nodes (tender subcutaneous nodules) janeway lesions (nontender macule on palms and soles) roth spots (retinal hemorrhages) ```

Answer 21

High grade fever with chills New cardiac murmur Features of septicemia

Answer 22

Low grade fever; malaise Changing cardiac murmurs Weight loss and splenomegaly

Answer 23

Modified Duke criteria Repeated blood cultures (for aerobic and anaerobic organisms) Echocardiography

Answer 24

presence of sterile thrombi on the leaflets of previously normal valves epi: seen in debilitated patients (cancer) ``` patho: Associated with endothelial abnormalities, hypercoagulable states, adenocarcinomas Usually asymptomatic not really known ``` complications: emboli and IE

Answer 25

gross: most commonly seen in the mitral valve multiple small nodules vegetations are non-invasive micro: Nodules composed of eosinophilic material (fibrin) and a delicate layer of aggregated platelets No inflammation or fibrosis Loosely attached to the cusps

Answer 26

small (1 to 4 mm), sterile vegetations in the setting of systemic lupus erythematosus (SLE) patho: Consequence of immune complex deposition + activation of complement and recruitment of Fc-receptor–bearing cells histo: Intense valvulitis and fibrinoid necrosis of the valve substance location: Vegetations can occur anywhere on the valve surface, on the chordae, or even on the atrial or ventricular endocardium

Answer 27

``` mechanical valves: Thrombo-embolism Life-long anticoagulation (hemorrhage) Infective endocarditis RBC destruction (hemolysis) Inadequate healing → Paravalvular leak ``` Tissue valves (Bioprostheses): Complications less durable: matrix deterioration, rigidity, calcification→ stenosis, can perforate Infective endocarditis Inadequate healing → Paravalvular leak

Answer 28

RHD = small, warty vegetations along the lines of closure of the valve leaflets IE = by large, irregular masses on the valve cusps that can extend onto the chordae

Answer 29

NBTE = exhibits small, bland vegetations, usually attached at the line of closure LSE = small- or medium-sized vegetations on either or both sides of the valve leaflets