Pathology of Valvular Heart Disease Flashcards
What population is most at risk for acute rheumatic fever?
Children 5-15yo
What clinical symptoms are associated with acute rheumatic fever?
STREP - Syndenham’s chorea, transitory migratory arthritis, rheumatic subcutaneous nodules, erythema marginatum, pancarditis
What are Janeway lesions?
Associated with infective endocarditis, non-tender lesions of the soles and palms from microemboli
What population is most affected by mitral valve prolapse?
Young women, 20-40yo
What pathogen is most associated with infective endocarditis in patients with a prosthetic heart valve?
Staph epidermidis
True/False. Aschoff bodies are present in chronic rheumatic fever.
False - they are rarely seen in chronic rheumatic fever. Increased vascularity and lymphocytic infiltrates are commonly present.
What pathogen is most associated with subacute endocarditis?
Strep viridans
Fish-mouth deformity describes the gross appearance of what valve pathology?
Chronic rheumatic fever - due to fibrous thickening of the valve leaflets
True/False. Nonbacterial thrombotic endocarditis does not elicit an inflammatory response.
True - only thrombi are present
Acute rheumatic carditis involves all layers of the heart. What histologic findings are present?
Aschoff bodies - fibrinoid necrosis surrounded by monocytes
Anitschkow cells - histiocytes with vesicular nuclei located within Aschoff bodies
What is the most common valvular abnormality?
Acquired aortic stenosis
What type of murmur presents in calcific aortic stenosis?
High-pitched systolic murmur
Marfan’s syndrome is most associated with what valvular disorder?
Mitral valve prolapse
These are tender subcutaneous nodules in the pulp of digits associated with infectious endocarditis.
Osler nodes
True/False. If a patient is unable to take an anticoagulant, a bioprosthetic valve replacement is a better choice.
True - this is compared to use of a mechanical valve which is likely to cause hemolysis
This type of endocarditis is characterized by pink, warty vegetations of the mitral and tricuspid valves.
Libman-Sacks Endocarditis (Endocarditis of SLE)
What pathogen is most associated with infective endocarditis in IV drug users?
Staph aureus, staph epidermidis
What are MacCallum plaques?
Subendocardial lesions in the left atrium due to valve necrosis associated with rheumatic fever
What is the histologic appearance of acute endocarditis?
Acute inflammatory infiltrated with abundant neutrophils
This heart pathology commonly involves the aortic valve and is associated with mucin-secreting adenocarcinomas that create a hypercoaguable state.
Nonbacterial thrombotic endocarditis
Endocardial plaque-like thickenings are found in patients with carcinoid syndrome. What causes this?
Carcinoid syndrome is due to a carcinoid tumor releasing serotonin, histamine, bradykinin, and other proteins. These cause plaque-like changes in the heart
What population is most at risk for chronic rheumatic fever?
Women
In what population is mitral annular calcification most common?
Women 60+yo with mitral valve prolapse
A midsystolic click is characteristic of what valvular disorder?
Mitral valve prolapse
Rheumatic fever follows infection with what pathogen?
Strep A pharyngitis
What is the most common congenital cardiovascular malformation?
Bicuspid aortic valve
These are physical findings caused by microemboli in patients with infective endocarditis.
Janeway lesions, Osler nodes, Roth spots
What valvular disease is a complication of rheumatic fever?
Mitral stenosis
What valve is commonly implicated in infective endocarditis of a patient with a history of IV drug use?
Tricuspid valve - first valve of the heart
Carcinoids of the GI tract generally do not cause heart lesions. Why is this?
The liver metabolizes many of the molecules released from the tumor preventing them from reaching the heart
This valvular disorder is characterized by calcium deposits in the fibrous ring of the mitral valve.
Mitral annular calcification
What is the pathophysiology of mitral valve prolapse in Marfan’s patients?
Mutations in fibrillin-1, which alters cell-matrix interactions and dysregulates TGF-B signaling
The right side of the heart is more susceptible to lesions due to carcinoid syndrome. Why is this?
Monoamine oxidase in the lungs neutralized many of the molecules secreted by the tumor thus protecting the left side of the heart
What are Ruth Spots?
Associated with infective endocarditis, they are splinter hemorrhages in the nail beds due to microemboli
True/False. In rheumatic fever, strep pyogenes attack proteins in the heart, joints, and other tissues.
False. Rheumatic fever is an autoimmune response. Antibodies against strep pyogenes react with glycoproteins to cause inflammation and damage.
