Lecture/Tute - Path CVS - Valvular Heart Disease

Question 1

As an overview, what are the 4 types of valve diseases and what goes under each of them?

What’s a prolapse?

Answer 1

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Question 2

So an abnormal valve may be what 2 things? What happens with these 2 things?

What will the change in fucntion of the valve lead to? Why?

Answer 2

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Question 3

Changes related to abnormal valves:

1. What are the 2 most common valves affected? Why is it those two?
2. What will each valve lead to? Like what sorta changes will you see and in which chamber?

Answer 3

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Question 4

Ageing/wear and tear: Calcific Aortic Sclerosis

1. What decades does it usually ocur in? What group may it be earlier in?
2. What’re the risk factors comparable to for this? What about the pathogenesis?
3. What does the calcified material do?
4. So what two things does the valves becoming rigid result in?
5. Are commisures involved with calcific aortic sclerosis?
6. What’s a murmur?
7. Wht does the vlave look like?
8. The effect of this is a production of what sort of murmur and eventually what to the myocardium?

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Ageing/wearing and tear #2: Mitral valve calcification

1. Ageing and wear lead to calcification of what feature? Whereabouts is this feature in the heart?
2. What may this cause? Does it have a big effect?

Question 5

Acquired #1: Rheumatic Heart Disease

1. What age group does it mostly affect?
2. What sorta of socioeconomic group is it mostly associated with?
3. What’s the generic difference between acute rheumatic fever and chronic rheumatic heart disease?
4. What is acute rheumatic fever? What does it invovle?
5. What does chronic RHD result from? So you get changes in what? What happens overtime?
6. Exlain the scienfitic proces of rheumatic fever brielfy
7. Pathogenesis: RF afer how many weeks of infection by ____ _____ ____ ______ ______ pharyngitis? Why so long?
8. So the antibodies to streptococcal ____ ____ produced in approx ___% individuals, will cross react with ____ ____ and other antigens in various organs especaiifly the ____, ____, and _____. In addition, the CD4+ T cells specific for Streptococcal peptides react with ____ ____ in the heart producing ____ and activating ____. The damage is a combination of what? What response follows?
9. Okay so what 5 things do you see clinically in ARF?
10. ARF Endocarditis: What occurs in the CT beneath the endocaridum throughout the heart? What does this result in? Whose endothelium is damaged? So what forms in the areas of te damage along the lines of closure of valves and along the chordae tendineae? What’re they called? Are they sterile?
11. ARF Pericarditis: infalmmation of what (within what?) leads to sterile fibrinous exudate? This presents as what?
12. ARF Myocarditis: Is the most serious and can be life threatening because affects what? Most deaths are due to this. In thie myocarditis, what three things do you have?
13. So carrying on from question 11, you first have aschoff bodies: what’re they a collection of? (3 things). Why is the last one called what it is called? These bodies tend t be around what?
14. ARF healing (no sequale!): following abtament of the acute inflammation the leisons resulting from the immune reactions heal. What is the healing by and why? Scarring will occur where? What does the scarring in the endocardium result in?
15. Go carefully read the sidagram on slide 28
16. Chronic Rheumatic valvular disease: Mitral valve -scarring of the endocardium leads to what 4 things? Recall back and think how these changes of the mitral valve are different to the calfified annular ring. What is the mitral valve formity known as? Small thrombi are present on upper surface- why? So you get stenosis and regurgitation. What can you say about the haemodynaic flow through the valve?
17. What’re the cardiac changes that follow witha stenotic mitral valve? What about severe stenotic aortic valve?
18. Summary!
    - ARF results from what?
    - ARF is assocoaied with foci of ____, paarticularly muscles and on ___, which heal by scarring
    - Scarred valves graduually become what? Leading to what? Characerised by wht?

Answer 5

3. Fever precedes the disease?
4. So you have the infection of a strep and the antibodies against that will travel in blood and cross react with the endocardium, most damage in the valve (endocardidtis) and also inflammation of peri and myocardium. With the deposition of cross-reactive AB, you’ll get vegetations, myocardial aschoff bodies and fibrous pericadritis
5. So you get swelling of cusps bc of the inflammation subendocardially - will result in damage of endothelium where they rub agaisnt eashother but also in chordae teninaea when blood passes through the valve and there’s turbilence - tubrulence will damage that endothelium too

Question 6

Infective Endocarditis:

1. What is this the infection of?
2. What two things is it classified as? What sorta does the classification depend on?
3. So what does the two types of endocarditis involve?
4. Pathogenesis: Need occurence of what? How can you get this?
5. The recognition of the predisposing valve pathology and risky clinical situations allows prevention of bacterial endocarditis by use of what?

Answer 6

2. On the type of organism involved

Question 7

Acute bacterial endocarditis

1. Occurs on what type of valve?
2. So you have bacteraemia of virulent organisms - what two are ones you should know?
3. So you have binding of bacteria to endocardium - what results from this?
4. You then get rapid growth with valvular damage, spread to what? Possible formation of what?
5. What sort of onset?
6. So you get cardiac murmur and what signs? (considering it’s acute inflammation……)

Answer 7

6. Systemic

Question 8

Subacute bacterial endocarditis

1. The valve involved in this is ususally what?
   - blood flow through the damaged valve leads to what where?
   - __ ______ ____ ____ form and ____ virulence organisms circulating as a bacteraemia infect the thrombi. What follows?
2. What does a vegetation comprise of?
3. What’re the sources of bacteraemia?
4. What sort of onset?
5. What sort of infection? So what sort of symptoms? (be specific - look on sticky notes). What can you see in nails?
6. If you get left ventricular hypertrophy - what does this usually indicate?

Answer 8

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Question 9

Complications with infective endocarditis:

1. What do you see clinically (like what symptoms - that you discussed in question 5)
2. What three things will you see in the blood test
3. Embolism of what? What can this cause/ (slide 42)
4. Rupture of what? Usually happens in acute endocardiits though

Question 10

Summary

1. Infective endocarditis is (usually) a what sort of infection (like is it viral or fungi or what?) of cardiac valves?
2. Either you can get ____ virulent organsism which can attack valves - can they attack the abnormal valves?
3. Or you can get ____ virulence oragnisms whcih target what?

Answer 10

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