Pathology Flashcards
What is valvular stenosis?
Obstruction caused by a failure of a valve to open
What is valvular regurgitation (insufficiency/incompetence)?
Reverse flow caused by a failure of a valve to close completely
What is the other name of mitral stenosis?
Chronic Rheumatic Heart Disease
What causes mitral stenosis?
Inflammation of acute rheumatic fever
Non-suppurative post-streptococcal inflammatory disease. What is it?
Mitral Stenosis/Chronic Rheumatic Heart Disease
What is the risk population for Chronic Rheumatic Heart Disease?
5 to 15 years old in poor, tropical country
What causes Acute Rheumatic Fever?
Streptococcal infection
What are the major manifestations of Acute Rheumatic Fever (4)?
Carditis
Migratory polyathrytis at large joints
Subcutaneous nodules
Cutaneous erythema
What are the minor manifestations of Acute Rheumatic Fever (2)?
Fever
Elevated Phase Reactant
What is Jones criteria for Acute Rheumatic Fever?
Evidence of streptococcal infection + 2 major manifestations or 1 major manifestation + 2 minor manifestations
What is the clearest pathological sign of Acute Rheumatic Fever?
Aschoff body with granulomas
Acute Rheumatic Fever leads to Chronic Rheumatic Heart Disease how long after the onset of Acute Rheumatic Fever?
20 to 40 years later
What are the manifestations of Acute Rheumatic Fever at the level of the heart?
Fibrinous exudate at the pericardium
Myocarditis at the myocardium
Valve vegetation
Fusion of commisures of valves Thickening at lines of closure of the valves Fibrosis and inflammation at the valves Fish-mouth deformity are signs of what?
Mitral Stenosis/Chronic Rheumatic Heart Disease
What causes Degenerative (Senile) Calcific Aortic Stenosis?
By a progressive deposition of calcium
btw, no commisural fusion in this disease
Who are the more at risk for Degenerative (Senile) Calcific Aortic Stenosis?
People over 65 years old
Degenerative (Senile) Calcific Aortic Stenosis is risk factor for what?
Atherosclerosis
Affects mostly the males
Caused by fibrosis & superimposed calcification 15 years prior to the onset
What is the Dx?
Bicuspid Aortic Valvular Stenosis
What is the most frequent cause of Mitral Valve Prolapse?
Myxomatous Degeneration
What is a complication of Mitral Valve Prolapse?
Rupture of Chordea
Affects 5% of the population, mostly the women
Autosomal dominant
Associated with loss of collagen and elastic tissue leading to an accumulation of proteoglycan within leaflets
What is the Dx?
Mitral Valve Prolapse
Thrombi (vegetation) at the valves can be seen in which diseases?
Acute Rheumatic Fever
Non-bacterial thrombosis endocarditis
Infective endocarditis
This disease occurs in 50% of patients with hypercoagulable state or disseminated intravascular coagulation (like adenocarcinoma or AIDS). What is it?
Non-bacterial thrombosis endocarditis
What are the two types of infective endocarditis?
Acute bacterial endocarditis
Subacute bacterial endocarditis
Which valvular heart disease shows both stenosis and regurgitation?
Infective endocarditis
It leads to a fatal cuspal destruction
Which bacteria is often responsible for acute bacterial endocarditis?
Staphylococcus aureus
Which, from aute bacterial endocarditis and subacute bacterial endocarditis, does the responsible bacteria has to take place of a previously damaged valve?
Subacute bacterial endocarditis
Which bacteria is often responsible for subacute bacterial endocarditis?
Viridans streptococcus
Intravenous drug users
Staphylococcus aureus
Emboli to lungs
are all key words linking to what disease?
Right-sided valve infective endocarditis
What are the steps to infective endocarditis?
- Endocardial surface injury (presence of a foreign body and turbulent flow)
- Formation of sterile thrombi (vegetation) at site of injury
- Trauma to mucosa or skin surface
- Bacterial adherence to injured endocardial surface
Prolification of neutrophils is a sign of which valvular heart disease?
Infective endocarditis
Cardiac eccentric hypertrophy is a response to what?
Volume overload
Cardiac concentric hypertrophy is a response to what?
Pressure overload
In eccentric hypertrophy, what do the sacromeres do?
They accumulate in series to be thicker
In concentric hypertrophy, what do the sacromeres do?
They accumulate in parallel to take more volume
What is the etiology of aortic stenosis?
Aortic stenosis can be caused by:
Degenerative calcification
Bicuspid aortic valve (that also exacerbates degenerative calcification)
Rheumatic aortic valve disease
Why does aortic stenosis leads to left ventricle concentric hypertrophy?
Decreased valve area requires higher left ventricle pressure to overcome impedance. Higher pressure is reached via concentric hypertrophy
What happens to the pressure-volume loop to a patient with aortic stenosis?
Higher peak pressure
Higher end-systolic volume
Crescendo-decrescendo from S1 to S2 Weak and delayed pulse Coarse late-peaking systolic ejection murmur S4 are signs of what?
Aortic stenosis
What proportion of patients with aortic stenosis will be symptomatic over 20 years?
20%
What is the medical treatment for aortic stenosis?
No treatment. Only aortic valve replacement
What is the etiology of mitral stenosis?
Mitral stenosis can be caused by: Rheumatic heart disease Mitral annulus calcification Infective endocarditis Congenital mitral stenosis
What is the immediate consequence of mitral stenosis?
Left atrium doesn’t have the time to empty in left ventricle and closes before emptying
Mitral stenosis may lead to what?
Pulmonary hypertension
Left atrial enlargement (that may become atrial fibrillation)
What is the survival rate, on 10 years, of asymptomatic mitral stenosis?
Over 80%
What is the survival rate, on 10 years, of untreated symptomatic mitral stenosis?
50-60%
What is the murmur of mitral stenosis?
Decrescendo from S1 with a snap at S2
What is the medical treatment for mitral stenosis?
Decrease heart rate
Reduce water and sodium uptake
Anticoagulant if patient shows atrial fibrillation
What is the interventional treatment for mitral stenosis?
Open mitral commissurotomy
Mitral valve replacement
Percutaneous balloon mitral valvuloplasy
