Pathology of valvular heart disease

Question 1

Which side of heart affected by systemic HTN (BP > 140/9))

Answer 1

left heart

Question 2

define essential htn

90%

Answer 2

1) idiopathic

Question 3

define secondary HTN

Answer 3

1) renal disease (diabetes/renal artery stenosis)
2) endocrine (adrneal neoplasm, steroids)
3) CV (coarctation

Question 4

pathogenesis of HTN

Answer 4

1) sustained pressure overload on LV
2) hypertrophy of myofibers
3) addl sarcomeres (myofibrils) added

Question 5

microscopic effects of hypertrophy

Answer 5

SAME # OF MYOCYTES

INCR # OF SARCOMERES

nuclei get bigger = box car nuclei

Question 6

clinical effects of systemic HTN effecting LV

Answer 6

1) MAINLY silent

2) HA or dizziness

Question 7

complications of systemic HTN (LV)

Answer 7

1) atherosclerosis/aneruysm
2) cerebral disease = ischemic (arteriosclerosis) or hemorrhage

3) kidney = CHRONIC RENAL DISEASE
- arteriolosclerosis
- glomerulosclerosis

4) CHF (pulm edema + Right HF)

Question 8

complications of pulmonary HTN (RV)

Answer 8

Left heart failure
congenital heart disease (VSD)
cor pulmonale

Question 9

causes of pulm HTN

Answer 9

1) left heart failure = VSD =
2) cor pulmonale
3) emphysema
4) pulm emboli;
5) morbid obesity

Question 10

what happens to liver in right heart failure

Answer 10

NUTMEG LIVER = centrilobular congestion +/- necrosis

Question 11

Developmental valve disease MAY NOT BE recognized in neonatal/child

Answer 11

1) hypoplastic valve
2) unicuspid aortic valve
3) bicuspid aortic valve

Question 12

problem with congenital valve disease

Answer 12

1) decr outflow –> ventricular hypertrophy

2) incr tubrulence –> valve thicken + stenosis

Question 13

toxic metabolic effects on cardiac valves

Answer 13

1) stenosis

2) regurg/insufficency

Question 14

effects of stenosis and regurg on heart

Answer 14

myocardial hypertrophy/dilation proximal to abnormal valve

Question 15

most common valves affected in degenerative syndromes

Answer 15

aortic

mitral valve

Question 16

abnormal valves from degenerative syndrome show incr susceptibility to ____

Answer 16

1) nodular calcification + fibrosis
2) vegetation
3) infectiona

Question 17

a

Answer 17

a

Question 18

a

Answer 18

a

Question 19

Names for valve changes

Answer 19

ballooning, tenting, myxomatous degeneration, hooding

Question 20

what is most common cause of isolated mitral regurg

Answer 20

mitral valve prolapse

Question 21

pathogenesis of mitral valve prolapse

Answer 21

1) defect in ECM metab
2) accumulate myxomatous ECM
3) balloon leaflet into LA during sysstole
4) elongation of chrodae

Question 22

problem in Marfan’s

Answer 22

fibrillin defect = elastic fiber

Question 23

effect of marfan’s on heart

Answer 23

1) mitral valve prolpase
2) aortic ring dilation because aorta more elastic
3) aneurysm of aorta –> dissection

Question 24

complications of mitral valve prolapse

Answer 24

ASYMPTOMATIC

regurg

endocarditis

Question 25

age group with calcific aortic stenosis

Answer 25

elderly –> senile calcific stenosis or degenerative aortic

Question 26

cause of calcific aortic stensosi

Answer 26

valve abnormality (LV outflow problem or LVH)

Question 27

clinical effects of calcific aortic stenosis

Answer 27

1) hypertrophied ventricle has incr load
2) if blood supply from heart decr, angina
3) if blood supply from system decr, syncope and dizziness

Question 28

define rheumatic fever

Answer 28

antibodies against M protein of group A strep cross react against body’s own glycoproteins

Question 29

diagnosis of rheumatic fever

Answer 29

JONES

1) joints = migratory polyarthritis
2) heart = pancaridtis
3) nodules
4) erythema marginatum
5) syndehnham chorea

Question 30

diagnosis of strep

Answer 30

postiive throat culture

or antibodies against streptolysin O

Question 31

what is pancarditis

Answer 31

10d - 6week after pharyngitis

Question 32

chronic effects of pancarditis

Answer 32

1) endocarditis = fibrosis –> vegetation on valves
2) myocarditis = Aschoff bodies
3) fibrinous pericaridtis –> fibrosis

Question 33

symptoms of pancaridtis

Answer 33

acute = arrhythmia, pericardial friction rub

chronic = mitral + aortic valve disease

Question 34

endocarditis define

Answer 34

inflammation of endocardium and valves –> fibrosis

Question 35

valves affected by endocarditis

Answer 35

1) mitral valve

2) aortic + mitral

Question 36

findings in rheumatic heart disease = endocarditis

Answer 36

1) valve leaflet and cusp = fibrosis, fusion, calcif

2) chordae tendinae = fibrosis, fusion

Question 37

complications of rheumatic heart disease –> endocaridtis

Answer 37

1) stenosis “fish mouth”
2) regurg

–> infective endocaridtis

Question 38

time line of rheumatic heart disease

Answer 38

1) group A strep
2) 2-6 weeks = acute rheum fever
3) years/decades = rheum heart disease

Question 39

in common among aortic stenosis/regurg and mitral stenosis/

Answer 39

all caused by rheumatic heart disease

Question 40

definition of vegetations

Answer 40

thrombus (clot) on valve

if sterile = no organism

Question 41

etiology of vegetation

Answer 41

Damaged valve from rheumatic heart disease
or Libman sachs endocarditis

Normal valve with Hypercoagulable state

Question 42

complications of vegetations

Answer 42

1) embolism
2) valve dysfunction
3) infection

Question 43

define infective endocarditis

Answer 43

primary infection of normal or damaged valve from bacteria

bacteria or non-bacteria

Question 44

sources of bacteria leading to infective endocariditis

Answer 44

skin/oral flora/GI tract

Question 45

in infective endocarditis normal valves are more common affected by ___

Answer 45

virulent organism (staph aureus)

Question 46

in infective endocarditis vulenrable valves are more common affected by ___

Answer 46

benign bacteria (strep viridans)

Question 47

bacteremic episodes of endocarditis caused by what

Answer 47

organism implant on valve/endocardial surface

dental/surgical/IVs
(mucosal injury in GI)
(skin injury

Question 48

bacteremic episodes of endocarditis cause what

Answer 48

acute endocarditis caused by highly virulent organisms A

Question 49

TYPES OF VALVES AFFECTED BY ACUTE ENDOCARDITIS

Answer 49

both normal and abnormal

Question 50

type of onset in subacute endocarditis

Answer 50

insidious (fever, weight loss)

Question 51

complications of subacute endocarditis

Answer 51

septic emboli to heart, skin, (Janeway), gut