Pathology of Valvular Heart Disease

Question 1

Discuss Calcific Aortic Stenosis

Answer 1

1. Most common valve abnormality
2. HEAPED UP; calcified nodules of valve cusps.
3. Do not involve commissures/cusp margins
4. Extends into sinus of Valsalva
5. Fusion of commissures is NOT common
6. Asymptomatic = Excellent prognosis

Question 2

Discuss Mitral Annular Calcification

Answer 2

1. Deposits on fibrous ring
2. Risk of thrombi and endocarditis
3. Usually doesn’t affect valve function

Question 3

Discuss Rheumatic Heart Disease

Answer 3

1. Thick, calcified and distorted cusps
2. Fusion of valve commisures
3. Associated with MITRAL VALVE abnormalities
4. Immunologically mediated; antibodies against M protein cross react with self antigens

Question 4

How do yo diagnose rheumatic heart disease?

Answer 4

Evidence of Group A strep infection and antibodies

Question 5

Describe the histopathology of rheumatic heart disease

Answer 5

1. Aschoff body: Foci of inflammatory cells and Large macrophages
2. Small verroucous vegetations over foci of fibrinoid necrosis along lines of valve closure (endocardium)
3. McCallum plaques: Irregular areas of thickening (endocardium of LA)

Question 6

Describe the characteristics of Mitral Valve Prolapse

Answer 6

1. Mitral valve leaflets are floppy and balloon into atrium
2. Leaflets are often large, redundant, thick and rubbery
3. Chordae tendinae are elongated and thin
4. Expansion of spongiosa layer with deposition of mucoid material
5. Usually asymptomatic, MID SYSTOLIC CLICK

Question 7

Discuss Bicuspid Aortic Valve

Answer 7

1. Most frequent congenital CV malformation

2. Midline raphe present

Question 8

What are the complications of Bicuspid Aortic Valve?

Answer 8

Aortic Stenosis, Dissection and Infective Endocarditiis

Question 9

Name the 4 types of Endocarditis

Answer 9

Infective, Rheumatic, Nonbacterial thrombotic, Libman-Sacks Disease

Question 10

Discuss Infective endocarditis

Answer 10

1. Colonization of the heart valves by microbes

2. Bulky, friable vegetations that can cause Ring abscesses and new murmurs

Question 11

Name the 3 types of Infective endocarditis

Answer 11

Native Valve, Prosthetic, Intravenous Drug

Question 12

Discuss Acute Native Valve Endocarditis

Answer 12

Occurs in previously normal valves, STAPH AUREUS

Question 13

Discuss Subacute Native Valve Endocarditis

Answer 13

Occurs in previously normal valves, STREP VIRIDANS

Question 14

Which organism causes prosthetic valve endocarditis?

Answer 14

STAPH EPIDERMIDIS

Question 15

Discuss Intravenous Drug Endocarditis

Answer 15

1. Most often involves right sided heart valves.

2. STAPH AUREUS

Question 16

Discuss Nonbacterial thrombotic endocarditis

Answer 16

1. Multiple deposits of sterile thrombi on leaflets on cardiac valves
2. Does not illicit inflammatory response and are not destructive.
3. MARANTIC ENDOCARDITIS: In persons with debilitating illness
4. Along the lines of valve closure; Loosely adherent
5. NO MICROORGANiSMS histologically

Question 17

Discuss Libman-Sacks Disease

Answer 17

1. Only in SLE pts
2. Fibrinous material contains hematoxylin bodies
3. Can form on any surface of the valve.

Question 18

Where do Carcinoid tumors come from?

Answer 18

Derived from neuroendocrine cells; Found in Small intestine

Question 19

Discuss Carcinoid Syndrome

Answer 19

A systemic syndrome due to the secretion of vasoactive substances into the systemic circulation by carcinoid tumors
Cutaneous flushing, Sweating, Bronchospasm, Abdominal pain

Question 20

Which side of the heart is affected by carcinoid tumors?

Answer 20

Right side

1. Tricuspid insufficiency
2. Pulmonic insufficiency

Question 21

Histologically describe a carcinoid tumor

Answer 21

Firm plaque-like areas of endocardium thickening.

1. Contain smooth muscle and collagen