Lecture 29: Valvular heart disease

Question 1

What is stenosis?

Answer 1

Impaired forward flow

Question 2

What is regurgitation/incompetance?

Answer 2

Allows reverse flow

Question 3

Can you have stenosis and regurgitation?

Answer 3

Yes can be pure or mixed

Question 4

What are six types of heart valve disease?

Answer 4

• Mitral stenosis
• Mitral regurgitation
• Aortic stenosis
• Aortic regurgitation
• Ventricular cavity abnormalities
• Pathologies involving heart valaves

Question 5

What are systolic murmurs?

Answer 5

Mitral or tricus = Strong at start and reduced over time from S1-S2 (murmur caused by the incompetance of closure and thus blood flowing out during the systolic window)

Aortic or pul:
Murmur increases from S1 peaks and then decreases to S2. i.e loudest at the highest flow point / peak pressure

Question 6

What are diastolic murmurs?

Answer 6

AV stenosis: Loud after S2 and decreases to near 0, then increases to S1. I.e Passive filling (starts fast then diastasis, then loud again at atrial systole)

Semilunar regurg: Loud from S2 and decreases to none

Question 7

What are the common pathogenic causes in valvular disease?

Answer 7

• CT defects
• Calcification
• Infection
• Post-infection i.e rhuematic fever
• Hypercoaguable states
• Carcinoid tumours

Question 8

Describe how developmental defects in connective tissue can lead to valvular disease?

Answer 8

• Stenosis of pulmonary or aortic valve
• Leaflet abnormalities
• Myxomatous degeneration of mitral valve i.e maarfan syndrome

Question 9

What can be observed on valves with developmental CT defects?

Answer 9

Vegetations on the valves

Question 10

Whats an example of developmental CT defects in relation to maarfan syndrome?

Answer 10

Myxomatous mitral valve degeneration

• Mitral valve prolapse
• ‘Floppy’ mitral valve
• Often asymptomatic

Question 11

What is dystrophic calcification?

Answer 11

• Can occur at local areas after extensive cell injury

i. e Annular calcification of mitral valve or stenosis of aortic valve

Question 12

How does calcification result?

Answer 12

• Initiated when dead or dying cells accumulate Ca
  + Mitochondria
  + Membrane-bound vesicles

(Delicate heart valves can suffer cumulative damage which may lead to cell injury and calcification)

Question 13

What is it called when heart valves are invaded and or colonised by microbes?

Answer 13

Infective endocarditis

• After seeding of blood with microbes i.e surgery

Question 14

What lesions from infective endocarditis called?

Answer 14

Vegetations

Question 15

How can infective endocarditis be clinically divided?

Answer 15

• Acute = High virulence, prev. normal valve, high mortality i.e staph auerus
• Sub-acute = Low virulence, previously abnormal heart valve i.e strep viridans

Question 16

What sort of auto-immune reaction is rheumatic heart disease?

Answer 16

Type 2 hypersensitivity reaction

Question 17

What can rhuematic fever lead to?

Answer 17

• Chronic valve deformities i.e mitral stenosis

Question 18

How is histologically found with rheumatic fever?

Answer 18

Aschoff bodies = foci of oedematous connective tissue surrounded by lymphocytes, plasma cells and enlarged macrophages

Question 19

What does damage from rhuematic fever predispose someone to?

Answer 19

Infective endocarditis

Question 20

Whats an example of hypercoaguable states and valve disease?

Answer 20

Non-bacterial thromotic endocarditis

• Deposition of fibrin/platelets on valves
• Can also occur from other drivers of hyper-coagulation i.e cancer or sepsis or artificial heart valves

Question 21

What are carcinoid tumours?

Answer 21

Range of neoplasms arising from neuroendocrine cells or their precurosrs

Question 22

How can carcinoid tumours cause valve disease?

Answer 22

Carcinoid tumours secrete a variety of bioactive products i.e serotonin - appear to cause plaque like thickenings

• Thickenings largely SM
• Impacts tricuspid or pulm valves