Pathology

Question 1

What is valvular stenosis?

Answer 1

Obstruction caused by a failure of a valve to open

Question 2

What is valvular regurgitation (insufficiency/incompetence)?

Answer 2

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

Question 3

What is the other name of mitral stenosis?

Answer 3

Chronic Rheumatic Heart Disease

Question 4

What causes mitral stenosis?

Answer 4

Inflammation of acute rheumatic fever

Question 5

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

Answer 5

Mitral Stenosis/Chronic Rheumatic Heart Disease

Question 6

What is the risk population for Chronic Rheumatic Heart Disease?

Answer 6

5 to 15 years old in poor, tropical country

Question 7

What causes Acute Rheumatic Fever?

Answer 7

Streptococcal infection

Question 8

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

Answer 8

Carditis
Migratory polyathrytis at large joints
Subcutaneous nodules
Cutaneous erythema

Question 9

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

Answer 9

Fever

Elevated Phase Reactant

Question 10

What is Jones criteria for Acute Rheumatic Fever?

Answer 10

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

Question 11

What is the clearest pathological sign of Acute Rheumatic Fever?

Answer 11

Aschoff body with granulomas

Question 12

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

Answer 12

20 to 40 years later

Question 13

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

Answer 13

Fibrinous exudate at the pericardium
Myocarditis at the myocardium
Valve vegetation

Question 14

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?

Answer 14

Mitral Stenosis/Chronic Rheumatic Heart Disease

Question 15

What causes Degenerative (Senile) Calcific Aortic Stenosis?

Answer 15

By a progressive deposition of calcium

btw, no commisural fusion in this disease

Question 16

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

Answer 16

People over 65 years old

Question 17

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

Answer 17

Atherosclerosis

Question 18

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

Answer 18

Bicuspid Aortic Valvular Stenosis

Question 19

What is the most frequent cause of Mitral Valve Prolapse?

Answer 19

Myxomatous Degeneration

Question 20

What is a complication of Mitral Valve Prolapse?

Answer 20

Rupture of Chordea

Question 21

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?

Answer 21

Mitral Valve Prolapse

Question 22

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

Answer 22

Acute Rheumatic Fever
Non-bacterial thrombosis endocarditis
Infective endocarditis

Question 23

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

Answer 23

Non-bacterial thrombosis endocarditis

Question 24

What are the two types of infective endocarditis?

Answer 24

Acute bacterial endocarditis

Subacute bacterial endocarditis

Question 25

Which valvular heart disease shows both stenosis and regurgitation?

Answer 25

Infective endocarditis | It leads to a fatal cuspal destruction

Question 26

Which bacteria is often responsible for acute bacterial endocarditis?

Answer 26

Staphylococcus aureus

Question 27

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

Answer 27

Subacute bacterial endocarditis

Question 28

Which bacteria is often responsible for subacute bacterial endocarditis?

Answer 28

Viridans streptococcus

Question 29

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

Answer 29

Right-sided valve infective endocarditis

Question 30

What are the steps to infective endocarditis?

Answer 30

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

Question 31

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

Answer 31

Infective endocarditis

Question 32

Cardiac eccentric hypertrophy is a response to what?

Answer 32

Volume overload

Question 33

Cardiac concentric hypertrophy is a response to what?

Answer 33

Pressure overload

Question 34

In eccentric hypertrophy, what do the sacromeres do?

Answer 34

They accumulate in series to be thicker

Question 35

In concentric hypertrophy, what do the sacromeres do?

Answer 35

They accumulate in parallel to take more volume

Question 36

What is the etiology of aortic stenosis?

Answer 36

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

Question 37

Why does aortic stenosis leads to left ventricle concentric hypertrophy?

Answer 37

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

Question 38

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

Answer 38

Higher peak pressure | Higher end-systolic volume

Question 39

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

Answer 39

Aortic stenosis

Question 40

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

Answer 40

20%

Question 41

What is the medical treatment for aortic stenosis?

Answer 41

No treatment. Only aortic valve replacement

Question 42

What is the etiology of mitral stenosis?

Answer 42

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

Question 43

What is the immediate consequence of mitral stenosis?

Answer 43

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

Question 44

Mitral stenosis may lead to what?

Answer 44

Pulmonary hypertension | Left atrial enlargement (that may become atrial fibrillation)

Question 45

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

Answer 45

Over 80%

Question 46

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

Answer 46

50-60%

Question 47

What is the murmur of mitral stenosis?

Answer 47

Decrescendo from S1 with a snap at S2

Question 48

What is the medical treatment for mitral stenosis?

Answer 48

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

Question 49

What is the interventional treatment for mitral stenosis?

Answer 49

Open mitral commissurotomy Mitral valve replacement Percutaneous balloon mitral valvuloplasy