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MHD1/Pharm1 Exam 4 > (MHD) Valvular Heart Disease > Flashcards

(MHD) Valvular Heart Disease Flashcards

1
Q

Describe the basics of valve histology. What components make it up?

A

The valve is lined by endothelium and has a connective tissue core which is composed of spongiosa, fibrosa and reticularis, as well as collagen and elastic fibers.

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2
Q

Mitral insufficeincy is also known as…

A

Mitral regurgitation.

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3
Q

Often, patients with a bicuspid aortic valve also have underlying…

A

Aortopathy. They are therefore at increased risk for dissections, aneurysms and other aorta related issues. They are also at greater risk for an aortic stenosis earlier in life.

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4
Q

What is the most common valvular abnormality?

A

Valvular degeneration due to calcification.

Occurs due to normal wear and tear on the heart.

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5
Q

Pts with aortic stenosis are often the same pts who have a higher likelihood of what other cardiovascular disease?

A

Atherosclerosis

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6
Q

What are the symptoms or Calcific Aortic Stenosis (3)?

A
  1. CHF
  2. MI
  3. Syncope (not enough blood is getting to the brain)
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7
Q

What is Mitral Valve Prolapse?

A

Ballooning of the mitral valve into the atrium during systole. The MV has enlarged, redudant, floppy leaflets.

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8
Q

What syndrome is mitral valve prolapse often associated with?

A

Marfan

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9
Q

Name the (4) rare, serious complications associated with mitral valve prolapse

A
  1. Arrhythmias
  2. Infective endocarditis (due to leaflet rubbing the endocardium)
  3. Mitral insufficiency
  4. Stroke/systemic infarct from embolism (leaflet can break off of atrial thrombi can form)

A.I.M.S. of prolapse

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10
Q

What is the hallmark finding associated with Infective Endocarditis? Describe it.

A

VEGETATION

This is an abnormal outgrowth upon the valves of the heart, composed of various tissue elements. They can be bulky, thrombotic, and destructive.

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11
Q

Describe Acute Infective Endocarditis

(what is the condition of the valve prior to this disease state? how high is mortality? what is the micro-organism most associated with it?)

A

Occurs in valves which were usually normal previously. It is a rapid destruction with a high (50%) mortality. Staph aureus is the most common bug associated with it.

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12
Q

Describe Subacute Infective Endocarditis

(what is the condition of the valve prior to this disease state? how high is mortality? what is the micro-organism most associated with it?)

A

Affects previously deformed valves. Usually there is recovery if the treatment is appropriate. Most commonly associated with Strep viridans.

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13
Q

Why are IV drug users at increased risk for IE?

A

They directly introduce bugs into their vessels via puncturing of their own non-steril skin with a non-steril needle.

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14
Q

Complications associated with Infective Endocarditis (4)

A
  1. Valve insufficiency or stenosis
  2. Abscess
  3. Emboli
  4. Glomerulonephritis

You G.A.V.E. me IE!

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15
Q

Treatment for IE

A
  1. IV antibiotics
  2. Surgery
  3. Prophylaxis w/ antibiotics for high risk Pts
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16
Q

Name the (3) types of noninfected vegetations

A
  1. Nonbacterial Thrombotic Endocarditis (Marantic Endocarditis)
  2. Endocarditis of System Lupus Erythematosus (Liebman-Sacks Endocarditis)
  3. Acute Rheumatic Fever
17
Q

Describe Marantic Endocarditis

A
  • Small, sterile, non-destructive vegetations (thrombi)
  • Loosely attached so can easily embolize
18
Q

In what kind of Pts is Marantic Endocarditis most likely?

A

Patients prone to hypercoagulable states (Sepsis, cancer, burns, indwelling catheters, etc.)

19
Q

Describe Endocarditis of System Lupus Erthematosus (Libman-Sacks Endocarditis).

What happens and what can it lead to?

A

Small Sterile vegetations which are the consequence of immune complex deposition and associated inflammation. This valvulitis leads to subsequent fibrosis and valve deformity.

20
Q

What causes rheumatic fever?

A

It is an immune response to group A Strep (pyogenes). Antibodies directed against M proteins of strep cross-react with self-antigens in the heart, activating macrophages and causing an autoimmune response.

21
Q

Name the Jones criteria for acute RA

A
  • Joints (polyarthritis)
  • Carditis
  • Subcutaneous nodules
  • Erythema marginatum of skin
  • Sydenham chorea (involuntary pruposless, rapid movements)

Pt must have had Group A Strep and 2 major manifestations ( or 1 major and 2 minor)

22
Q

Describe Aschoff Bodies. What disease are they associated with?

A

They are tiny granulomas associated with acute rheumatic fever.

They are made from T lymphocytes, plasma cells and a special form of macrophage (Anitschkow cell aka caterpillar)

PAL

23
Q

Name the particular type of Macrophage associated with Aschoff Bodies

A

Anitschkow cells aka caterpillar cells.

24
Q

Describe the cycle of fibrosis associated with RA

A

Inflammation causes fibrosis which obliterates the normal leaflet structure. Turbulence induced by this obliteration causes additional fibrosis.

25
Q

What occurs in Chronic Rheumatic Valvular Disease? Which valve is most commonly effected?

A

Fibrosed valves leads to stenosis (fish mouth/ buttonhole) and the cards of the valves become short, thick and fused. Usually effects the MITRAL VALVE only.

26
Q

What is a carcinoid? What does it secrete?

A

A neuroendocrine tumor which secretes bioactive products, particularly serotonin.

27
Q

What effect can Serotonin from Carcinoid Heart disease have on the heart?

A

It can cause plaque-like thickening of the endocardium and valves, ultimately leading to right sided heart disease.

28
Q

What is the most common primary tumor of the heart in adults?

A

Myxoma

29
Q

Where does a Myxoma most frequently occur?

A

Left Atria

90% occur in the atria and it occurs in the left atria at a ratio of 4:1

30
Q

Describe the Myxoma (clinical manifestations?)

A

It is a tumor with a gelatinous appearance. It can present in form of a ball-valve obstruction in which, during systole, it can move into or through the AV valves. This can lead to syncope depending on the positioning. They can also embolize.

31
Q

What 2 clinical features are associated with rheumatic fever?

A

Aschoff bodies + Pancarditis

32
Q

What clinical associations are associated with pancarditis

A
  1. Bread and Butter pericarditis
  2. Myocarditis
  3. Endocarditis

MHD1/Pharm1 Exam 4 (26 decks)

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