Pathology of Valvular Heart Disease

Question 1

What population is most at risk for acute rheumatic fever?

Answer 1

Children 5-15yo

Question 2

What clinical symptoms are associated with acute rheumatic fever?

Answer 2

STREP - Syndenham’s chorea, transitory migratory arthritis, rheumatic subcutaneous nodules, erythema marginatum, pancarditis

Question 3

What are Janeway lesions?

Answer 3

Associated with infective endocarditis, non-tender lesions of the soles and palms from microemboli

Question 4

What population is most affected by mitral valve prolapse?

Answer 4

Young women, 20-40yo

Question 5

What pathogen is most associated with infective endocarditis in patients with a prosthetic heart valve?

Answer 5

Staph epidermidis

Question 6

True/False. Aschoff bodies are present in chronic rheumatic fever.

Answer 6

False - they are rarely seen in chronic rheumatic fever. Increased vascularity and lymphocytic infiltrates are commonly present.

Question 7

What pathogen is most associated with subacute endocarditis?

Answer 7

Strep viridans

Question 8

Fish-mouth deformity describes the gross appearance of what valve pathology?

Answer 8

Chronic rheumatic fever - due to fibrous thickening of the valve leaflets

Question 9

True/False. Nonbacterial thrombotic endocarditis does not elicit an inflammatory response.

Answer 9

True - only thrombi are present

Question 10

Acute rheumatic carditis involves all layers of the heart. What histologic findings are present?

Answer 10

Aschoff bodies - fibrinoid necrosis surrounded by monocytes

Anitschkow cells - histiocytes with vesicular nuclei located within Aschoff bodies

Question 11

What is the most common valvular abnormality?

Answer 11

Acquired aortic stenosis

Question 12

What type of murmur presents in calcific aortic stenosis?

Answer 12

High-pitched systolic murmur

Question 13

Marfan’s syndrome is most associated with what valvular disorder?

Answer 13

Mitral valve prolapse

Question 14

These are tender subcutaneous nodules in the pulp of digits associated with infectious endocarditis.

Answer 14

Osler nodes

Question 15

True/False. If a patient is unable to take an anticoagulant, a bioprosthetic valve replacement is a better choice.

Answer 15

True - this is compared to use of a mechanical valve which is likely to cause hemolysis

Question 16

This type of endocarditis is characterized by pink, warty vegetations of the mitral and tricuspid valves.

Answer 16

Libman-Sacks Endocarditis (Endocarditis of SLE)

Question 17

What pathogen is most associated with infective endocarditis in IV drug users?

Answer 17

Staph aureus, staph epidermidis

Question 18

What are MacCallum plaques?

Answer 18

Subendocardial lesions in the left atrium due to valve necrosis associated with rheumatic fever

Question 19

What is the histologic appearance of acute endocarditis?

Answer 19

Acute inflammatory infiltrated with abundant neutrophils

Question 20

This heart pathology commonly involves the aortic valve and is associated with mucin-secreting adenocarcinomas that create a hypercoaguable state.

Answer 20

Nonbacterial thrombotic endocarditis

Question 21

Endocardial plaque-like thickenings are found in patients with carcinoid syndrome. What causes this?

Answer 21

Carcinoid syndrome is due to a carcinoid tumor releasing serotonin, histamine, bradykinin, and other proteins. These cause plaque-like changes in the heart

Question 22

What population is most at risk for chronic rheumatic fever?

Answer 22

Women

Question 23

In what population is mitral annular calcification most common?

Answer 23

Women 60+yo with mitral valve prolapse

Question 24

A midsystolic click is characteristic of what valvular disorder?

Answer 24

Mitral valve prolapse

Question 25

Rheumatic fever follows infection with what pathogen?

Answer 25

Strep A pharyngitis

Question 26

What is the most common congenital cardiovascular malformation?

Answer 26

Bicuspid aortic valve

Question 27

These are physical findings caused by microemboli in patients with infective endocarditis.

Answer 27

Janeway lesions, Osler nodes, Roth spots

Question 28

What valvular disease is a complication of rheumatic fever?

Answer 28

Mitral stenosis

Question 29

What valve is commonly implicated in infective endocarditis of a patient with a history of IV drug use?

Answer 29

Tricuspid valve - first valve of the heart

Question 30

Carcinoids of the GI tract generally do not cause heart lesions. Why is this?

Answer 30

The liver metabolizes many of the molecules released from the tumor preventing them from reaching the heart

Question 31

This valvular disorder is characterized by calcium deposits in the fibrous ring of the mitral valve.

Answer 31

Mitral annular calcification

Question 32

What is the pathophysiology of mitral valve prolapse in Marfan’s patients?

Answer 32

Mutations in fibrillin-1, which alters cell-matrix interactions and dysregulates TGF-B signaling

Question 33

The right side of the heart is more susceptible to lesions due to carcinoid syndrome. Why is this?

Answer 33

Monoamine oxidase in the lungs neutralized many of the molecules secreted by the tumor thus protecting the left side of the heart

Question 34

What are Ruth Spots?

Answer 34

Associated with infective endocarditis, they are splinter hemorrhages in the nail beds due to microemboli

Question 35

True/False. In rheumatic fever, strep pyogenes attack proteins in the heart, joints, and other tissues.

Answer 35

False. Rheumatic fever is an autoimmune response. Antibodies against strep pyogenes react with glycoproteins to cause inflammation and damage.