Path: diseases of endocardium and valves Flashcards
1
Q
Rheumatic fever
A
- A sequelae to strep throat, inflammation due to M protein (on capsule) that causes multi-systemic inflammatory disease
- Causes: acute rheumatism, rheumatic heart disease, polyartheritis rheumatica
- Can lead to chronic rheumatic heart disease (mostly affecting mitral valve, but also can affect Ao valve)
- Incidence is 5-15 yrs, and increases w/ poor nutrition, high density population, large families, developing countries
2
Q
Clinical features of rheumatic fever
A
- Sore throat followed by 2-4 wk latent period followed by signs/Sx of rheumatic fever
- Blood cultures during rheumatic fever will usually be negative
- Sx: polyartheritis, chorea, carditis, subcutaneous nodules, erythema marginatum
3
Q
Heart pathology of rheumatic fever
A
- Most serious effect, usually a pancarditis
- Endocarditis: vegetations (platelet, RBC, fibrin) on valves or chordae
- Myocarditis (interstitial): lymphocytes and Aschoff bodies (cigar shaped)
- Aschoff bodies are small granulomas with anitschkow myocytes (owl eyes), can cause arrhythmias
- Pericarditis (fibrinous): fibrosis can be a problem if it affects the valves
4
Q
Sequelae of rheumatic fever
A
- ASO (anti-streptolysin O) titer used to Dx
- Sequellae: majority recover in 6 wks, but recurrence does increase risk for chronic valvular disease
- Chronic valvular disease can lead to cardiac failure
- Sub-acute endocarditis also a complication of valvular disease
- Rx: bed rest and high doses of salicylates (also antibios during strep laryngitis will decrease chance of rheumatic fever)
5
Q
Rheumatic valvulitis
A
- Following recurrent rheumatic fever, leads to progressive scarring, stenosis, incompetence, or both
- Especially affects mitral (and Ao) valve
- May take years of Sx to arise (usually adults)
6
Q
SLE valvulitis
A
- Multiple small vegetations on both surfaces on valves
- Sx may mimic rheumatic fever (pericarditis and myocarditis may be present)
7
Q
Carcinoid syndrome
A
- Affects R side of heart (pulm and tricuspid valves)
- Due to biogenic amines (5HT, histamine) released by carcinoid tumors
8
Q
Noninfective vs infective endocarditis (EC)
A
- Noninfective: seen in advanced cancer, wasting disease
- Infective: predisposition of valves that are damaged (Rh fever)
9
Q
Infective EC
A
- Usually due to S aureus (more acute) or strep viridans (sub-acute/chronic)
- Acute: usually highly virulent and affecting normal valves (staph, IVDU)
- Sub-acute: low virulence on damaged valves (strep viridans)
- Damaged valves: RF, congenital heart disease, degenerative heart disease, prosthetics
- Infective thrombi develop and can embolize (L: brain, kidney, gut; R: lungs)
- M > A > T > P
10
Q
Consequences of EC
A
- Bacteremia: splenomegaly, splinter hemorrhages, roth spots (eye hemorrhages)
- Immune complexes: osler nodes, janeway lesions, glomerulonephritis
- Valve dysfxn: changing murmur, perforation
- Embolism
- Local infected (mycotic) aneurysm
11
Q
Mitral stenosis
A
- Due to rheumatic heart disease, usually female
- Causes diastolic rumble murmur, LAE, L sided HF and pulmonary edema
- Leads to interstitial fibrosis, pulmonary artery HTN, RVH
12
Q
Mitral regurg
A
- Due to degenerative valve disease (myxomatous degeneration- floppy valve, CT d/os, fibroelastic deficiency), rheumatic fever, chronic LV failure (dilation of annulus), ischemia/infarction
- Pathophysiology: holosystolic murmur w/ dilation of LV and LA and L sided HF (may lead to RVH)
13
Q
Ao stenosis
A
- Etiology: usually degenerative valve disease (includes congenital bicuspid), from fibrosis/calcification of valve from aging (and congenital bicuspid), can be rheumatic
- There is a crescendo-decrescendo systolic murmur, hypotention and syncopal attacks, angina (decreased coronary perfusion)
- LVH and L sided heart failure common
14
Q
Ao regurg
A
- Usually due to degenerative and/or congenital bicuspid, possibly rheumatic (rheumatic often involves multiple valves)
- Leads to decrescendo early diastolic murmur, wide pulse pressure, bounding (water-hammer) pulse, LV is dilated and hypertrophic
15
Q
Multiple valve disease
A
- > 50% rheumatic
- 40% due to degenerative
- Often just Ao and Mitral, but can be Ao, mitral, and tricuspid (pulm often spared)
