Pathology of valvular heart disease Flashcards
Which side of heart affected by systemic HTN (BP > 140/9))
left heart
define essential htn
90%
1) idiopathic
define secondary HTN
1) renal disease (diabetes/renal artery stenosis)
2) endocrine (adrneal neoplasm, steroids)
3) CV (coarctation
pathogenesis of HTN
1) sustained pressure overload on LV
2) hypertrophy of myofibers
3) addl sarcomeres (myofibrils) added
microscopic effects of hypertrophy
SAME # OF MYOCYTES
INCR # OF SARCOMERES
nuclei get bigger = box car nuclei
clinical effects of systemic HTN effecting LV
1) MAINLY silent
2) HA or dizziness
complications of systemic HTN (LV)
1) atherosclerosis/aneruysm
2) cerebral disease = ischemic (arteriosclerosis) or hemorrhage
3) kidney = CHRONIC RENAL DISEASE
- arteriolosclerosis
- glomerulosclerosis
4) CHF (pulm edema + Right HF)
complications of pulmonary HTN (RV)
Left heart failure
congenital heart disease (VSD)
cor pulmonale
causes of pulm HTN
1) left heart failure = VSD =
2) cor pulmonale
3) emphysema
4) pulm emboli;
5) morbid obesity
what happens to liver in right heart failure
NUTMEG LIVER = centrilobular congestion +/- necrosis
Developmental valve disease MAY NOT BE recognized in neonatal/child
1) hypoplastic valve
2) unicuspid aortic valve
3) bicuspid aortic valve
problem with congenital valve disease
1) decr outflow –> ventricular hypertrophy
2) incr tubrulence –> valve thicken + stenosis
toxic metabolic effects on cardiac valves
1) stenosis
2) regurg/insufficency
effects of stenosis and regurg on heart
myocardial hypertrophy/dilation proximal to abnormal valve
most common valves affected in degenerative syndromes
aortic
mitral valve
abnormal valves from degenerative syndrome show incr susceptibility to ____
1) nodular calcification + fibrosis
2) vegetation
3) infectiona
a
a
a
a
Names for valve changes
ballooning, tenting, myxomatous degeneration, hooding
what is most common cause of isolated mitral regurg
mitral valve prolapse
pathogenesis of mitral valve prolapse
1) defect in ECM metab
2) accumulate myxomatous ECM
3) balloon leaflet into LA during sysstole
4) elongation of chrodae
problem in Marfan’s
fibrillin defect = elastic fiber
effect of marfan’s on heart
1) mitral valve prolpase
2) aortic ring dilation because aorta more elastic
3) aneurysm of aorta –> dissection
complications of mitral valve prolapse
ASYMPTOMATIC
regurg
endocarditis
age group with calcific aortic stenosis
elderly –> senile calcific stenosis or degenerative aortic
cause of calcific aortic stensosi
valve abnormality (LV outflow problem or LVH)
clinical effects of calcific aortic stenosis
1) hypertrophied ventricle has incr load
2) if blood supply from heart decr, angina
3) if blood supply from system decr, syncope and dizziness
define rheumatic fever
antibodies against M protein of group A strep cross react against body’s own glycoproteins
diagnosis of rheumatic fever
JONES
1) joints = migratory polyarthritis
2) heart = pancaridtis
3) nodules
4) erythema marginatum
5) syndehnham chorea
diagnosis of strep
postiive throat culture
or antibodies against streptolysin O
what is pancarditis
10d - 6week after pharyngitis
chronic effects of pancarditis
1) endocarditis = fibrosis –> vegetation on valves
2) myocarditis = Aschoff bodies
3) fibrinous pericaridtis –> fibrosis
symptoms of pancaridtis
acute = arrhythmia, pericardial friction rub
chronic = mitral + aortic valve disease
endocarditis define
inflammation of endocardium and valves –> fibrosis
valves affected by endocarditis
1) mitral valve
2) aortic + mitral
findings in rheumatic heart disease = endocarditis
1) valve leaflet and cusp = fibrosis, fusion, calcif
2) chordae tendinae = fibrosis, fusion
complications of rheumatic heart disease –> endocaridtis
1) stenosis “fish mouth”
2) regurg
–> infective endocaridtis
time line of rheumatic heart disease
1) group A strep
2) 2-6 weeks = acute rheum fever
3) years/decades = rheum heart disease
in common among aortic stenosis/regurg and mitral stenosis/
all caused by rheumatic heart disease
definition of vegetations
thrombus (clot) on valve
if sterile = no organism
etiology of vegetation
Damaged valve from rheumatic heart disease
or Libman sachs endocarditis
Normal valve with Hypercoagulable state
complications of vegetations
1) embolism
2) valve dysfunction
3) infection
define infective endocarditis
primary infection of normal or damaged valve from bacteria
bacteria or non-bacteria
sources of bacteria leading to infective endocariditis
skin/oral flora/GI tract
in infective endocarditis normal valves are more common affected by ___
virulent organism (staph aureus)
in infective endocarditis vulenrable valves are more common affected by ___
benign bacteria (strep viridans)
bacteremic episodes of endocarditis caused by what
organism implant on valve/endocardial surface
dental/surgical/IVs
(mucosal injury in GI)
(skin injury
bacteremic episodes of endocarditis cause what
acute endocarditis caused by highly virulent organisms A
TYPES OF VALVES AFFECTED BY ACUTE ENDOCARDITIS
both normal and abnormal
type of onset in subacute endocarditis
insidious (fever, weight loss)
complications of subacute endocarditis
septic emboli to heart, skin, (Janeway), gut
