Patho Valvular diseases Flashcards
Calcific Aortic Disease (CAD)
Progressive calcium deposition in the aortic valve leading to stenosis.
Epidemiology of CAD
More common in males over 65 with risk factors like hypertension dyslipidemia smoking and diabetes.
Presentation of CAD
Asymptomatic in early stages; symptoms of aortic valve stenosis in advanced stages.
Diagnosis of CAD
Auscultation echocardiography cardiac imaging (CT/MRI).
Risk Factors for CAD
Advanced age male gender hypertension dyslipidemia smoking diabetes genetic predisposition chronic kidney disease rheumatic fever history.
Pathogenesis of CAD
Endothelial injury inflammation osteoblastic differentiation calcium deposition valve thickening and stenosis.
Mitral Valve Prolapse (MVP)
Abnormal protrusion of one or both mitral valve leaflets into the left atrium during systole.
Epidemiology of MVP
Prevalence 2-3 percent more common in females often incidentally discovered familial clustering.
Presentation of MVP
Often asymptomatic; can include palpitations chest pain fatigue dyspnea mid-systolic click or late systolic murmur.
Diagnosis of MVP
Echocardiography showing MV leaflet displacement regurgitation and chordae rupture.
Risk Factors for MVP
Genetic predisposition connective tissue disorders like Marfan syndrome and Ehlers-Danlos syndrome female gender.
Complications of MVP
Risk of infective endocarditis and sudden cardiac death.
Pathogenesis of MVP
Structural abnormalities in MV leaflets and chordae tendineae abnormalities in connective tissue proteins myxomatous degeneration.
Mitral Annular Calcification (MAC)
Chronic degenerative process characterized by calcification of the mitral valve fibrous annulus.
Epidemiology of MAC
Increased age more common in females associated with cardiovascular risk factors and chronic kidney disease.
Presentation of MAC
Mitral regurgitation atrial fibrillation embolic events.
Diagnosis of MAC
Echocardiography radiology like CT and MRI.
Pathogenesis of MAC
Multifactorial: shared with atherosclerosis chronic inflammation endothelial dysfunction metabolic factors calcium deposition annular thickening valve dysfunction.
Rheumatic Valve Disease
Inflammatory disease developing as a complication of untreated Group A Streptococcus bacterial infection.
Epidemiology of Rheumatic Valve Disease
Common in children aged 5 to 15 years.
Pathogenesis of Rheumatic Valve Disease
Delayed immune response to Group A Streptococcus M proteins mimicking host antigens.
Major Criteria of Rheumatic Valve Disease
Carditis arthritis chorea erythema marginatum subcutaneous nodules.
Minor Criteria of Rheumatic Valve Disease
Polyarthralgia hyperpyrexia elevated ESR or CRP prolonged PR interval.
Clinical Signs of Rheumatic Valve Disease
History of throat infection fever joint pain murmurs chest pain tachycardia heart failure.
Infective Endocarditis
Colonization of endocardial surface by infective pathogens leading to formation of infective vegetations.
Risk Factors for Infective Endocarditis
Cardiac valve disease prosthetic heart valves history of infective endocarditis congenital heart defects intravenous drug use poor dental hygiene invasive surgical procedures immunocompromised state older age male gender chronic intravascular devices.
Common Pathogens in Infective Endocarditis
Viridans streptococci staphylococcus aureus enterococci coagulase-negative staphylococci streptococcus bovis HACEK group gram-negative bacilli fungi (Candida).
Pathogenesis of Infective Endocarditis
Endothelial damage platelet adherence bacterial adherence and colonization formation of vegetations inflammatory response.
Clinical Presentation of Infective Endocarditis
Fever chills fatigue malaise new or changing cardiac murmurs embolic complications.
Complications of Infective Endocarditis
Valve dysfunction cardiac failure rupture of cardiac structures systemic embolization systemic infections septicemia intracranial hemorrhage brain abscesses meningitis encephalopathy.
Diagnosis of Infective Endocarditis
Positive blood cultures echocardiographic evidence of endocardial involvement.
Modified Duke Criteria for Infective Endocarditis
Two major criteria one major and three minor criteria five minor criteria for definite endocarditis.
Infective Endocarditis in Intravenous Drug Users
Major risk factor due to unsterile needles microorganisms include methicillin-resistant Staphylococcus aureus streptococcus species.
Non-Bacterial Thrombotic Endocarditis (NBTE)
Formation of sterile vegetations on valves due to fibrin and platelet deposition.
Underlying Conditions for NBTE
Advanced malignancies autoimmune disorders chronic inflammatory conditions hypercoagulable state.
Pathogenesis of NBTE
Sterile vegetations on valve cusps without bacterial infection.
Bicuspid Aortic Valve
Common congenital cardiac defect affecting 1-2 percent of the population.
Complications of Bicuspid Aortic Valve
Aortic stenosis aortic regurgitation valve calcification aortic dilatation aortic dissection aortic aneurysm formation infective endocarditis.
Pathogenesis of Bicuspid Aortic Valve
Incomplete formation of aortic valve leading to a two-leaflet valve instead of three.
Presentation of Bicuspid Aortic Valve
Often asymptomatic can lead to heart murmur or symptoms related to aortic valve dysfunction.
Diagnosis of Bicuspid Aortic Valve
Echocardiography is the primary diagnostic tool.
Treatment of Bicuspid Aortic Valve
Monitoring and potential surgical intervention depending on severity of complications.
Papillary Fibroelastoma
Rare benign cardiac tumor typically affecting the aortic and mitral valves.
Epidemiology of Papillary Fibroelastoma
Second most common primary cardiac tumor after myxoma.
Histology of Papillary Fibroelastoma
Small projections of connective tissue attached to valve by a stalk.
Clinical Presentation of Papillary Fibroelastoma
Often asymptomatic but can cause transient ischemic attacks strokes myocardial infarction cardiac failure and embolization.
Diagnosis of Papillary Fibroelastoma
Echocardiography is the primary diagnostic tool.
Treatment of Papillary Fibroelastoma
Surgical excision is often recommended if symptomatic or causing complications.
Disorders of Valve Prosthesis
Complications associated with artificial heart valves.
Types of Valve Prostheses
Mechanical valves bioprosthetic valves.
Complications of Valve Prostheses
Thrombosis pannus formation structural valve deterioration hemolysis paravalvular leak infection.
Thrombosis in Valve Prostheses
Blood clot formation on or around the artificial valve.
Pannus Formation
Growth of fibrous tissue around the valve causing obstruction.
Structural Valve Deterioration
Wear and tear of bioprosthetic valves over time leading to valve dysfunction.
Hemolysis in Valve Prostheses
Destruction of red blood cells due to mechanical damage from artificial valves.
Paravalvular Leak
Leakage of blood around the valve prosthesis due to improper seating or dehiscence.
Infection of Valve Prostheses
Prosthetic valve endocarditis caused by bacterial colonization.
Diagnosis of Valve Prosthesis Complications
Echocardiography is the primary diagnostic tool.
Management of Valve Prosthesis Complications
Anticoagulation therapy surgical intervention valve replacement depending on the complication.
In which of the following conditions is erythema marginatum a clinical feature? a. Infective endocarditis b. Myocardial infarction c. Cardiomyopathy d. Rheumatic fever e. Pericarditis
d. Rheumatic fever
Which pathogen is most commonly associated with infective endocarditis in intravenous drug users? a. Streptococcus pneumoniae b. Staphylococcus aureus c. Enterococcus faecalis d. Haemophilus influenzae e. Pseudomonas aeruginosa
b. Staphylococcus aureus
What is the most likely cause of mitral valve prolapse in a young female with a family history of the condition? a. Rheumatic heart disease b. Infective endocarditis c. Marfan syndrome d. Ehlers-Danlos syndrome e. Bicuspid aortic valve
c. Marfan syndrome
A 45-year-old patient presents with a history of progressive exertional dyspnea and is found to have calcification of the aortic valve. What is the most likely diagnosis? a. Mitral valve prolapse b. Calcific aortic stenosis c. Rheumatic heart disease d. Infective endocarditis e. Tricuspid regurgitation
b. Calcific aortic stenosis
Which of the following conditions is associated with the formation of sterile vegetations on cardiac valves? a. Infective endocarditis b. Non-bacterial thrombotic endocarditis c. Myocardial infarction d. Rheumatic fever e. Pericarditis
b. Non-bacterial thrombotic endocarditis
In a patient with Marfan syndrome; which valve is most likely to be affected? a. Tricuspid valve b. Pulmonary valve c. Mitral valve d. Aortic valve e. Both c and d
e. Both c and d (Mitral valve and Aortic valve)
A 30-year-old IV drug user presents with fever; new heart murmur; and positive blood cultures for Staphylococcus aureus. What is the most likely diagnosis? a. Viral myocarditis b. Infective endocarditis c. Libman-Sacks endocarditis d. Non-bacterial thrombotic endocarditis e. Pericarditis
b. Infective endocarditis
Which type of valve disease is characterized by myxomatous degeneration? a. Calcific aortic stenosis b. Mitral valve prolapse c. Rheumatic heart disease d. Infective endocarditis e. Tricuspid regurgitation
b. Mitral valve prolapse
A patient with a history of rheumatic fever presents with shortness of breath and a diastolic murmur. Which valve is most likely affected? a. Aortic valve b. Mitral valve c. Tricuspid valve d. Pulmonary valve e. Both a and b
b. Mitral valve
Which diagnostic tool is primarily used for the evaluation of valvular heart diseases? a. Electrocardiography (ECG) b. Echocardiography c. Cardiac MRI d. Chest X-ray e. Coronary angiography
b. Echocardiography
