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Block C: Circulation > Pathology > Flashcards

Pathology Flashcards

1
Q

What is valvular stenosis?

A

Obstruction caused by a failure of a valve to open

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2
Q

What is valvular regurgitation (insufficiency/incompetence)?

A

Reverse flow caused by a failure of a valve to close completely

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3
Q

What is the other name of mitral stenosis?

A

Chronic Rheumatic Heart Disease

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4
Q

What causes mitral stenosis?

A

Inflammation of acute rheumatic fever

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5
Q

Non-suppurative post-streptococcal inflammatory disease. What is it?

A

Mitral Stenosis/Chronic Rheumatic Heart Disease

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6
Q

What is the risk population for Chronic Rheumatic Heart Disease?

A

5 to 15 years old in poor, tropical country

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7
Q

What causes Acute Rheumatic Fever?

A

Streptococcal infection

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8
Q

What are the major manifestations of Acute Rheumatic Fever (4)?

A

Carditis
Migratory polyathrytis at large joints
Subcutaneous nodules
Cutaneous erythema

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9
Q

What are the minor manifestations of Acute Rheumatic Fever (2)?

A

Fever

Elevated Phase Reactant

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10
Q

What is Jones criteria for Acute Rheumatic Fever?

A

Evidence of streptococcal infection + 2 major manifestations or 1 major manifestation + 2 minor manifestations

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11
Q

What is the clearest pathological sign of Acute Rheumatic Fever?

A

Aschoff body with granulomas

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12
Q

Acute Rheumatic Fever leads to Chronic Rheumatic Heart Disease how long after the onset of Acute Rheumatic Fever?

A

20 to 40 years later

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13
Q

What are the manifestations of Acute Rheumatic Fever at the level of the heart?

A

Fibrinous exudate at the pericardium
Myocarditis at the myocardium
Valve vegetation

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14
Q 
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?
A

Mitral Stenosis/Chronic Rheumatic Heart Disease

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15
Q

What causes Degenerative (Senile) Calcific Aortic Stenosis?

A

By a progressive deposition of calcium

btw, no commisural fusion in this disease

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16
Q

Who are the more at risk for Degenerative (Senile) Calcific Aortic Stenosis?

A

People over 65 years old

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17
Q

Degenerative (Senile) Calcific Aortic Stenosis is risk factor for what?

A

Atherosclerosis

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18
Q

Affects mostly the males
Caused by fibrosis & superimposed calcification 15 years prior to the onset
What is the Dx?

A

Bicuspid Aortic Valvular Stenosis

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19
Q

What is the most frequent cause of Mitral Valve Prolapse?

A

Myxomatous Degeneration

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20
Q

What is a complication of Mitral Valve Prolapse?

A

Rupture of Chordea

21
Q

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?

A

Mitral Valve Prolapse

22
Q

Thrombi (vegetation) at the valves can be seen in which diseases?

A

Acute Rheumatic Fever
Non-bacterial thrombosis endocarditis
Infective endocarditis

23
Q

This disease occurs in 50% of patients with hypercoagulable state or disseminated intravascular coagulation (like adenocarcinoma or AIDS). What is it?

A

Non-bacterial thrombosis endocarditis

24
Q

What are the two types of infective endocarditis?

A

Acute bacterial endocarditis

Subacute bacterial endocarditis

25
Q

Which valvular heart disease shows both stenosis and regurgitation?

A

Infective endocarditis

It leads to a fatal cuspal destruction

26
Q

Which bacteria is often responsible for acute bacterial endocarditis?

A

Staphylococcus aureus

27
Q

Which, from aute bacterial endocarditis and subacute bacterial endocarditis, does the responsible bacteria has to take place of a previously damaged valve?

A

Subacute bacterial endocarditis

28
Q

Which bacteria is often responsible for subacute bacterial endocarditis?

A

Viridans streptococcus

29
Q

Intravenous drug users
Staphylococcus aureus
Emboli to lungs
are all key words linking to what disease?

A

Right-sided valve infective endocarditis

30
Q

What are the steps to infective endocarditis?

A
  1. Endocardial surface injury (presence of a foreign body and turbulent flow)
  2. Formation of sterile thrombi (vegetation) at site of injury
  3. Trauma to mucosa or skin surface
  4. Bacterial adherence to injured endocardial surface
31
Q

Prolification of neutrophils is a sign of which valvular heart disease?

A

Infective endocarditis

32
Q

Cardiac eccentric hypertrophy is a response to what?

A

Volume overload

33
Q

Cardiac concentric hypertrophy is a response to what?

A

Pressure overload

34
Q

In eccentric hypertrophy, what do the sacromeres do?

A

They accumulate in series to be thicker

35
Q

In concentric hypertrophy, what do the sacromeres do?

A

They accumulate in parallel to take more volume

36
Q

What is the etiology of aortic stenosis?

A

Aortic stenosis can be caused by:
Degenerative calcification
Bicuspid aortic valve (that also exacerbates degenerative calcification)
Rheumatic aortic valve disease

37
Q

Why does aortic stenosis leads to left ventricle concentric hypertrophy?

A

Decreased valve area requires higher left ventricle pressure to overcome impedance. Higher pressure is reached via concentric hypertrophy

38
Q

What happens to the pressure-volume loop to a patient with aortic stenosis?

A

Higher peak pressure

Higher end-systolic volume

39
Q 
Crescendo-decrescendo from S1 to S2
Weak and delayed pulse
Coarse late-peaking systolic ejection murmur
S4
are signs of what?
A

Aortic stenosis

40
Q

What proportion of patients with aortic stenosis will be symptomatic over 20 years?

A

20%

41
Q

What is the medical treatment for aortic stenosis?

A

No treatment. Only aortic valve replacement

42
Q

What is the etiology of mitral stenosis?

A 
Mitral stenosis can be caused by:
Rheumatic heart disease
Mitral annulus calcification
Infective endocarditis
Congenital mitral stenosis
43
Q

What is the immediate consequence of mitral stenosis?

A

Left atrium doesn’t have the time to empty in left ventricle and closes before emptying

44
Q

Mitral stenosis may lead to what?

A

Pulmonary hypertension

Left atrial enlargement (that may become atrial fibrillation)

45
Q

What is the survival rate, on 10 years, of asymptomatic mitral stenosis?

A

Over 80%

46
Q

What is the survival rate, on 10 years, of untreated symptomatic mitral stenosis?

A

50-60%

47
Q

What is the murmur of mitral stenosis?

A

Decrescendo from S1 with a snap at S2

48
Q

What is the medical treatment for mitral stenosis?

A

Decrease heart rate
Reduce water and sodium uptake
Anticoagulant if patient shows atrial fibrillation

49
Q

What is the interventional treatment for mitral stenosis?

A

Open mitral commissurotomy
Mitral valve replacement
Percutaneous balloon mitral valvuloplasy

Block C: Circulation (10 decks)

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