Patho: Valvular Heart Diseases Flashcards
Determine if the following affect the function of the semilunar valves or the AV valves:
1) leaflets
2) cusps
3) cuspal attachments
4) tendinous cords
5) papillary muscles
1) AV
2) semilunar
3) semilunar
4) AV
5) AV
Histology
Layer at the outflow: ___
Proteoglycan rich: ___
Rich in elastin for prompt valve closure: ___
Fibrosa - dense, collagenous, maintain structure
Spongiosa - lightly-staining
Ventricularis/Atrialis - inflow; has collagen for mechanical integrity
Identify this cell:
Most abundant cell type in valves
Synthesize ECM
Produce matrix-degrading enzymes
Produce inhibitors
Interstitial cells
Note: blood supply through diffusion since valves are thin
Diseases and their type of acquired valvular diseases
1) rheumatic heart disease: ___
2) calcific aortic stenosis: ___
3) mitral valve prolapse
1) fibrotic thickening
2) nodular calcification
3) damage to collagen
Identify which type of nodular calcification:
1) progressive calcification, has a midline raphe
2) most common; etiologic cause is age-associated wear-and-tear; deposition of hydroxyapatite
3) degenerative calcific deposits at fibrous annulus
1) Calcific Stenosis of Congenitally Bicuspid Aortic Valve (BAV) - predisposed to other cardiac conditions e.g. aortic dilation & dissections, infective endocarditis, aortic insufficiency
2) Calcific Aortic Stenosis - mounded calcified nodules on the outflow surface; commissural fissure not seen
3) Mitral Annular Calcification - complications: nodules can provide site of thrombus formation; arrhythmia
Most frequent cause of pure, isolated mitral regurgitation
Mitral Valve Prolapse/Myxomatous Degeneration of the Mitral Valve - leaflet/s ballon back during systole
T/F: In mitral valve prolapse, there is an audible click associated with late systolic murmur.
True: mid-systolic, non-ejection click
Involves myxomatous degeneration of the spongiosa layer
A) calcified aortic stenosis
B) rheumatic heart disease
C) mitral stenosis
D) mitral valve prolapse
Answer is D.
increased deposition of highly sulfated hydrophilic matrix → associated marked thickening of the spongiosa layer → associated attenuation of the collagenous fibrosa layer → compromised structural integrity
T/F: MVP is not a predisposing factor for thrombus formation and infective endocarditis.
False
Acute, immunologically mediated, multisystem inflammatory disease involving fibrotic thickening. Usually occurs after a GAS pharyngitis episode.
Rheumatic fever - pathogenesis involves antibody binding and T-cell mediated reaction
JONES criteria: _____
Need 2 major manifestation os 1 major and 2 minor (fever, arthralgia, elevated levels of acute phase reactants)
J - joints: migratory polyarthritis O - looks like the heart -> pancarditis N - (subcutaneous) nodules E - erythema marginatum of the skin S - Syndenham chorea (involuntary, rapid, purposeless movement
Acute rheumatic carditis: Identify which carditis (pan-, endo-, etc.)
1) inflammation in all layers
2) involves pericardial effusion
3) involves Aschoff nodules
4) fibrinoid necrosis within cusps & tendinous chords
5) can cause cardiac dilation
6) usually involves left-sided valves
1) pan-
2) peri- (with fibrinoid pericarditis)
3) myo-
4) endo-
5) myo-
6) endo-
Number one cause of rheumatic mitral stenosis; “fish mouth” or “buttonhole” stenosis
A) acute rheumatic carditis
B) fibrinoid pericarditis
C) chronic rheumatic carditis
D) rheumatic fever
Answer is C.
Chronic rheumatic carditis: clinically manifests years or decades after initial episode of rheumatic fever
Microbial infection of the heart/mural endocardium leading to vegetation; often associated with destruction of underlying cardiac tissues
Infective endocarditis
Note: Usually for IE, there’s an infection somewhere else in your body and then the microorganisms get into the heart and adhere to the thrombus
T/F: The usual underlying condition prior to aortic stenosis is heart diseases that manifests with turbulence, trauma, and stasis.
F. Aortic stenosis -> infective endocarditis
Traditional classification of IE:
1) insidious infection of a structurally abnormal valve by low virulent organism
2) infection from a previously healthy individual, through a highly virulent organism
1) subacute IE
2) acute IE - rapidly produces necrotizing destructive lesions
Most common agent in prosthetic valve IE: A) Streptococcus viridans B) Staphylococcus epidermidis C) Eikenella D) Enterococci
Answer is B.
What is EHACEK?
Drugs. Enterococci, hemophilus, actinobacillus, cardiobacterium, eikenella, kingella, gram-negative bacilli, fungi
Hallmark feature of IE (gross morphology): ___
vegetations on heart valves
Role of lab diagnostic tests
1) Determines proper antibiotic therapy, confirms presence of microorganism in the circulation
2) For monitoring response to treatment
1) Blood culture
2) Inflammatory markers
Mnemonic for systemic complications of IE: FROM JANE
Fever, roth spots, osler nodes, murmur, Janeway lesions, anemia, nail-bed hemorrhage, emboli
No associated tissue destruction & resulting complications: which type of IE?
Nonbacterial thrombotic endocarditis (NBTE)
IE involves tissue destruction
Which type of endocarditis: immune complex deposition in the valves results in complement activation and recruitment of FC-receptor-bearing cells (neutrophils, macrophages)
Libman-Sacks Disease (Endocarditis of SLE)
Syndrom marked by flushing, diarrhea, dermatitis, bronchoconstriction
Typically occur when there is a massive hepatic metastatic burden
Carcinoid syndrome - caused by bioactive compounds released by carcinoid tumors
Carcinoid heart disease
