PATH: 10-1 Valvular and Neoplastic Dz Flashcards
A: Valves are Lined by ______ with a ______ core made of what?
A2: What other 2 components make up Valves
B: Semilunar valves have ___ Cusps
A: Lined by endothelium with a Collagenous core made of [spongiosa/fibrosa/elastosa] + Connective tissue + Elastin Fibers
B: Semilunar valves (aortic and pulmonic) have 3 Cusps
A:[Bicuspid Aortic Valve] is a ______ malformation in which Aortic Valve ______
A2: Symptoms (2)
B: Pts with [Bicuspid Aortic Valve] are predisposed to what 3 pathologies?
A:[Bicuspid Aortic Valve] is a congenital malformation in which Aortic Valve only has [2 asymmetrical cusps + midline raphe] (instead of normal 3).
A2: Can be
- asymptomatic
- Aortic Stenosis (later in age due to degenerative calcification)
B:
[Infective Endocarditis] / [Aortic Dilatation] / [Aortic Dissection]
A: How is calcification related to Valve Disease? What is this process called?
B: Calcification of [structurally normal valves] clinically manifest during what age?
C: Calcification of Bicuspid valves clinically manifest during what age?
D: How does Aortic valve calcification related to Heart Failure?
A: [Calcium phosphate minerals] deposit onto valves that have incurred Chronic cumulative damage (such as from hyperlipidemia and HTN). = dystrophic calcification
B: If calcification affects structurally normal valves -Stenosis manifests clinically in age 70’s and 80’s
C:-If calcification affects Bicuspid Valves Stenosis manifests in 50’s and 60’s since bicuspid valves incur greater mechanical stress
D: Heaped up calcified masses within aortic cusps protrude through outflow surfaces and prevent cusp opening —> Diastolic Heart Failure
A1: Describe [MVPmd- Mitral Valve Prolapse Myxomatous Degeneration]
A2: Demographic affected most
B: Histological findings in the Mitral Valve (2)
C: Etiology (2)
D: Symptoms (3)
A: 1 or both mitral valve leaflets are enlarged and rubbery and will balloon upwards into the L atrium during systole. Mostly affects young women
B:
- Deposition of mucoid/myxomatous material
- chordae tendinae are elongated and thinned
C: Etiology:
a) myxomatous degeneration results from developmental defect of connective tissue
b) destruction and remodeling of valvular connective tissue is induced by hemodynamic abnormalities
D:
1) MOSTLY Asymptomatic but with [Characteristic Mid-Systolic Click]
2) Non-specific sx (anxiety / cp / SOB)
3) Embolism of leaflet Thrombus
A: Describe Infective Endocarditis
A2: Most common pathogen? Which causes [Acute Infective Endocarditis]?
B: Which subtype of Infective Endocarditis does [low virulent Virdians Strep] cause? Describe this process
C: What are Vegetations? Composition?(3) Chracteristics (3)
A: Destructive inflammation of cardiac valves and endocardium
A2: Bacteria (Staph Aureus causes Acute Infective Endocarditis= 50% Mortality )
B: [SubAcute Infective Endocarditis] - affects previously deformed valves and pts typically recover with [IV abx]
C: Vegetations can develop during Infective Endocarditis. Vegetations are made of [(thrombotic debis)/fibrin/inflammatory cells] and are large, friable and erosive –> Embolic Phenomena
A: Risk Factors for Infective Endocarditis (6)
B: If Vegetations from Infective Endocarditis develop into Thromboemboli–> System: what are 4 Embolic complications?
A: “the iDi APP”
- Preexisting Valve Dz
- Prosthetic Valves
- Immune Deficiency
- DM
- IV Drug Abuse
- Alcoholism
B: If Vegetations develop into Thromboemboli–> Peripheral System:
- [Subungual Splinter Hemorrhages]
- [Retinal Roth Spot Hemorrhages]
- Janeway lesions (nontender on palms/soles)
- [SubQ Osler Nodes on digit pulp]
A: Describe [MNTe - Marantic’s Nonbacterial Thrombotic Endocarditis]
B: How is MNTe pathogenic for the pt?
C: What Hypercoagulable demographics are at risk for MNTe?
A: Small, Sterile cardiac valve vegetations made of fibrin and platelets.
B: Are non-destructivebut because of VERY loose attachment –> embolization –> Infarcts
C:
- “MNTe liked pancreatic CA pts with indwelling IV catheters and who’d been recently burned”*
- CA pts (especially mucin producing pancreatic CA)
- Pt with indwelling IV catheters
- Burn/Sepsis Pts
A: Where are vegetations from [Liebman - Sacks SLE Endocarditis] mostly found? (2)
B: Describe Vegetations from [Liebman - Sacks SLE Endocarditis] (4). What are they associated with? (2)
C: [Liebman - Sacks SLE Endocarditis] could result in _____ _______
A: Most commonly seen on mitral and tricuspid valve undersurfaces
B: [Small/ sterile / granular / eosinophilic] vegetations associated with [valve necrosis] and [marked inflammation]
C: Could result in Valve Fibrosis
Acute Rheumatic Fever
A: When does it Onset
B: Demographic most commonly affected
C: Etiology
A: Occurs few weeks (10 days to 6 weeks) after Group A (beta- hemolytic) streptococcal pharyngitis. Can Relapse!
B: Most commonly seen in children 5-15 years old, but certainly can affect adults
C: [Antibodies and (CD4 Helper T)] made against [Strep Pyogenes M Protein] ALSO attack the heart!
C: Chronic Rheumatic Heart Disease
C2: Characteristic Sign
C:
Clinical manifestations develop years to decades after episode of [acute rheumatic fever] ultimately manifesting as [mitral stenosis] (sometimes aortic)
C2: Valve leaflets become thickened and fused —> “fishmouth buttonhole stenosis “
A: What is the JONES Criteria?
B: List MAJOR Manifestations of the associated Disease (5)
C: List minor Manifestations of the associated Disease (3)
A: JONES Critera states that pt must have the criteria in order = Acute Rheumatic Fever
- Preceeding [Strep Pyogenes Group A Infection]
+
- [2 MAJOR Manifestations] OR [1 MAJOR / 1 minor]
B: List MAJOR Manifestations
J= joint (migratory polyarthritis of large joints)
O= Carditis
N= Nodules located SubQ
E= Erythema marginatum on skin
S= Sydenham Chorea
C:minor manifestations= Fever / Arthralgia/ [Elevated acute-phase reactants]
A: 2 Classical Findings for [Acute Rheumatic Fever-Carditis]
B: Describe [B and B Pericarditis] (2)
A:
- Pancarditis ([B and B Pericarditis] /Myocarditis/Endocarditis)
- Aschoff bodies = represents focal inflammatory lesions and is collection of ( Lymphocytes / Plasma cells/ [ACM -Anitschkow Caterpillar Macrophages] )
B: [B and B Pericarditis]
- Bread and Butter Pericarditis: Fibrinous pericardial exudates with friction rub
- Usually resolves without sequeale
A: 2 Classical Findings for [Acute Rheumatic Fever-Carditis]
B: Describe associated Myocarditis (4)
A:
- Pancarditis ([B and B Pericarditis] /Myocarditis/Endocarditis)
- Aschoff bodies = represents focal inflammatory lesions and is collection of ( Lymphocytes / Plasma cells/ [ACM -Anitschkow Caterpillar Macrophages] )
B: Myocarditis
- Scattered Aschoff bodies in myocardium
- Potential arrhythmias / Diltation / [functional mitral valve insufficiency]
A: 2 Classical Findings for [Acute Rheumatic Fever-Carditis]
B: Describe associated Endocarditis (3)
A:
- Pancarditis ([B and B Pericarditis] /Myocarditis/Endocarditis)
- Aschoff bodies = represents focal inflammatory lesions and is collection of ( Lymphocytes / Plasma cells/ [ACM -Anitschkow Caterpillar Macrophages] )
B: Endocarditis
- Inflammation and [foci of fibrinoid necrosis] on left-sided >right sided valve cusps
- Verrucae – Small sterile vegetations on valve cusps
- Clinical findings may be a new murmur
A: Carcinoid Tumors
B: What do they secrete (Name 3)?
C: Carcinoid Syndrome
C2: Sx (5)
Carcinoid tumors
A: Endocrine tumors most commonly involving gastrointestinal tract and lung
B: Secrete Serotonin/kallikrein/ bradykinin/histamine, prostaglandins/tachykinins
C:
occurs with carcinoid tumor metastatic to the liver
-[Episodic flushing], cramps, NVD
[ACM -Anitschkow Caterpillar Macrophages]
Myxoma
