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Cardio Exam 4 > Path: Valvular Disease > Flashcards

Path: Valvular Disease Flashcards

1
Q

What is heart valve stenosis?

A

Slow onset of an inability of a valve to open completely due to leaflet distortion, fibrosis or calcification.

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2
Q

What is heart valve insufficiency?

A

Slow or Rapid onset of an inability to close a valve completely leading to regurgitation. Caused by cusp disease or damage to associated valve structures.

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3
Q

Which two organs are most commonly affected secondary to valvular disease?

A

Lungs and Liver due to blood congestion

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4
Q

Complication of a congenital bicuspid aortic valve.

A

Rapid onset of calcification and stenosis

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5
Q

What is the normal pressure gradient in the aortic valve area and the pressure gradient in a stenotic valve?

A

Normal: zero
Stenotic: any pressure gradient, disease becomes serious around 50mmHg.

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6
Q

What is the cause of Senlle degenerative calcific aortic stenosis?

A

Normal wear and tear on the valve.

-senile means a condition that occurs as people age

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7
Q

Characteristic of calcific aortic stenosis on biopsy.

A

Osseous metaplasia: the tissue looks like bone

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8
Q

Morphological change of the heart with aortic valve insufficiency.

A

Left Ventricular Hypertrophy: the regurgitated blood increases afterload (end diastolic volume) and the ventricle dilates and contract with greater force due to increased blood volume.

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9
Q

What are 4 general causes of aortic insufficiency?

A
  1. Aortic Root dilation: syphilis, marfan, ankylosing spondylitis
  2. Aortic Cusp Abnormality: arthritis, marfan, HTN
  3. Increased Afterload: supravalvular aortic stenosis (coarctation), systemic HTN
  4. Pharmacologic: Phentermine-Fenfluramine (caused pulmonary HTN).
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10
Q

What are two general causes of mitral valve insufficiency?

A
  1. Abnormalities of leaflets and/or commissures.
    - prolapse, inflammation, infection
  2. Abnormalities of the Tensor Apparatus.
    - papillary muscles, chordae tendinae, mitral annulus, calcification
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11
Q

Most common cause of mitral valve prolapse.

A

Hereditary Connective Tissue Disorder

-Marfan, Ehlers-Danlos

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12
Q

What changes occur to the tissue structure of a Floppy Mitral Valve (type of mitral valve prolapse)?

A

Valve leaflets become thick and rubbery allowing “billowing up” of valve into the LA. The chordae tendinae elongate and thin out.

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13
Q

What microscopic tissue type is lost in mitral valve prolapse?

A

Type III collagen leading to loss of structural integrity.

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14
Q

How can mitral valve prolapse lead to infective endocarditis?

A

Changes in valve morphology alter the normal flow of blood in the area allowing stasis and a reservoir for bacterial colonization.

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15
Q

How can mitral valve prolapse lead to stroke or systemic infarct.

A

Changes in valve morphology alter the normal flow of blood in the area allowing stasis and thrombus formation which can embolize to other sites in the body.

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16
Q

What is Mitral Annular Calcification?

A

Buildup of calcium nodules on the valve leaflets. Calcium nodules anywhere can lead to thrombus formation or allow bacterial growth.

17
Q

Major cause of Mitral Valve Stenosis.

A

Rheumatic Fever

18
Q

Major cause of Acute Infective Endocarditis

A

Staph aureus: very fast progression (days to weeks)

19
Q

Major cause of Subacute Infective Endocarditis

A

Viridans Strep family: slow progression (weeks to months)

20
Q

What else should a physician worry about in a patient that is diagnosed with endocarditis caused by Strep. bovis?

A

GI malignancy: this bug is part of normal GI flora and usually only undergoes hematogenous spread with tumor invasion of colon mucosa.

21
Q

Main pathogen that causes infective endocarditis in debilitated alcoholics.

A

Strep. pneumoniae

22
Q

Main bug that causes IE in IV drug abusers.

A

Staph aureus

23
Q

Main bugs that cause IE in patients with prosthetic heart valves.

A

Early: Staph epidermidis
Late: Streptococci sp.

24
Q

What is the difference in the valve tissue in acute IE vs. Subacute IE?

A

The valve tissue does not have to be damaged for bacteria to infect in acute, however, the valves must be damaged in Subacute.

25
Q

How does Subacute IE progress?

A
  1. Valves are damaged
  2. Thrombi form (non-bacterial thrombotic endocarditis)
  3. bacteria colonize thrombotic valve
26
Q

Which population developed mostly Right Heart IE?

A

IV drug users

-acute IE caused by S. aureus

27
Q

Which side of the valves do most IE vegetations form?

A

Atrial Side of AV valves
Ventricular side of Semilunar Valves
(vegetations consist of fibrin and bacteria)

28
Q

Name 4 sites of complications that arise from left-sided IE.

A
  1. Brain: abscess, infarct, meningitis
  2. Heart: MI
  3. Spleen: abscess
  4. Kidneys: abscess
29
Q

Name the site of complication of right-sided IE.

A

Lungs: abscess, infarct, pneumonia

30
Q

How can IE lead to glomerulonephritis?

A

Buildup of Ag-Ab complexes in the glomerulus

31
Q

Two most common organisms that cause fungal IE.

A
  1. Candida

2. Aspergillus

32
Q

Only type of Vegetation to extend to the Chordae Tendinae.

A

IE

33
Q

Only type of Vegetation to extend to both sides of the valves.

A

Libman Sacks Endocarditis (LSE)

-complication of SLE

34
Q

Complications of vegetations that form due to Antiphospholipid Syndrome.

A 
Hypercoagulable State:
Pregnancy Loss (thrombi occlude placental blood flow)

Thrombocytopenia (many clots form leading to low platelet counts and inability to clot should an actual injury occur)

35
Q

2 major complications of heart valve replacement.

A

Hemolysis: prosthetic valves alter blood flow thru the area and can increase shear force on RBCs leading to lysis.

Valve Stenosis: exuberant healing of tissue can overgrow around the valve and block it.

Cardio Exam 4 (15 decks)

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