pathology of acquired heart disease

Question 1

Three thin, delicate cusps with orifices of the coronary arteries

Answer 1

aortic valve

Question 2

component of valves (4)

Answer 2

1. fibrosa- dense collagenous core
2. spongiosa- central core
3. atrialis- elastic rich layer
4. ventricularis- elastic rich layer

Question 3

which 2 cardiac valves are most commonly involved with acquired diseases

Answer 3

aortic and mitral

Question 4

effects of mitral stenosis

Answer 4

back up of blood in the LA and the pulm. vasculature

• Pulm. edema

Question 5

late stages of mitral stenosis

Answer 5

• RV failure

- congestion of the liver

Question 6

mitral regurg. effects

Answer 6

• increased LV workload leading to LV hypertrophy and failure

Question 7

effects of aortic stenosis

Answer 7

LV hypertrophy and failure

Question 8

effects of aortic incompetence

Answer 8

volume overload

Question 9

main cause of aortic regurg

Answer 9

HTN used to be Rheum. fever

Question 10

late effects of aortic regurg

Answer 10

LV hypertrophy and failure

Question 11

most common valvular diseases

Answer 11

calcific aortic stenosis and MVP

Question 12

most common cause of mitral stenosis

Answer 12

rheum. fever

Question 13

major causes of valve disease

Answer 13

1. aging
2. congenital
3. Rheum. fever
4. infective endocarditis
5. non-infective vegetations

Question 14

BAV predisposed one for calcification?

Answer 14

yep

Question 15

calcific stenosis we see a gradual increase of _________ and ________

Answer 15

LV outflow obstruction and pressure load

Question 16

myxomatous degeneration of the mitral valve floppy valve disease

Answer 16

MVP

Question 17

MVP:

1. occurs primarily on
2. what do we hear?
3. uncommonly associated with
4. complications

Answer 17

1. young females
2. midsystolic click- barlow’s syndrome
3. marfan’s syndrome
4. Mitral regurg., emboli, infective endocarditis, arrhythmia

Question 18

acute, immune mediated, multisystemic inflammatory disease

Answer 18

rheumatic fever

Question 19

Rheum fever:

1. acute effects on
2. caused by
3. what happens?

Answer 19

1. heart, joints, skin and brain
2. group A- Beta hemolytic streptococcal pharyngitis– pyrogenes
3. anti-strept ab produced and they cross react with glycoproteins

Question 20

diagnosing rheum. fever

1. Jones’ criteria
2. how mant major vs minor?

Answer 20

1. Major: migratory polyarthirits of large joints, carditis, subcutaneous nodules, erythmea marginatum, sydenham’s chorea
   Minor: fever, ESR…
2. 2 major or 1 major and 2 minor

Question 21

effects on heart are cimulative with rheum. fever?

Answer 21

yep

Question 22

Rheum. fever histo

Answer 22

• aschoff nodule

- anitschkow cells

Question 23

rheumatic endocarditis

Answer 23

vegetation on closure line of cusps

Question 24

infection of valves or other parts of endocardium

Answer 24

infective endocarditis

Question 25

splinter hemorrhage

Answer 25

infective endocarditis

Question 26

organisms of infective endocarditis

Answer 26

alpha- hemolytic strpt- viridians

Question 27

bulky friable destructive vegetations that occur everywhere on valves

Answer 27

infective endocarditis

Question 28

enfective endocarditis affects _____ valves

Answer 28

– mitral and aortic valves even in IV drug use

Question 29

infective endocarditis

1. consists of
2. complications

Answer 29

1. fibrin, inflammatory cells and bacteria–> fibrosis and calcification
2. suppurative pericarditis, valve destruction, ring abscesses and septic emboli

Question 30

non-bacterial thrombotic endocarditis

1. causes
2. vegetations where?

Answer 30

1. SLE and hypercoagulable states, malignancy and sepsis

2. undersurfaces of mitral valves

Question 31

libman sacks endocarditis

Answer 31

associated with SLE; vegetations on mitral and tricuspid valves

Question 32

fibrinoid material with inflammation and hematoxyphil bodies with multiple sterile pink verrucous vegetations

Answer 32

SLE in NBTE

Question 33

What accounts for the majority of acquired valvular diseases in the United States

Answer 33

Acquired stenosis of the aortic and mitral valve account for 2/3 of valvular diseases

Question 34

Mitral valve stenosis leads to which changes in the lung, heart and liver?

Answer 34

Pulmonary edema, right ventricular failure and congested liver

Question 35

What characterizes calcific aortic stenosis?

Answer 35

Degeneration of the valve with calcifications

Question 36

What valve abnormality leads to the “hooding” seen in mitral valve prolapse

Answer 36

Myxomatous degeneration of the valve

Question 37

What characterizes an Aschoff nodule?

Answer 37

Fibrinoid necrosis surrounded by inflammatory cells

Question 38

What are the major differences between acute and subacute endocarditis?

Answer 38

Acute : normal valve, virulent organism, marked destruction, high mortality
Subacute: abnormal valve, low virulence of organisms, less destruction, low mortality