Pathology: Valvular Diseases

Question 1

Morphology of Rheumatic Valvular Disease

• What is are the main characteristics of this disease on a histological scale?

Answer 1

Question 2

In Rheumatic Valvular Disease, what is the inflammation due to? What condition do most patients have before getting it?

Answer 2

Question 3

Clinical features of rheumatic heart disease

• Describe the differences in the outcomes of cultures and serum tests done on patients who have rheumatic heart disease due to rheumatic fever

Answer 3

Question 4

What do matrix metalloproteinases do?

Answer 4

Destroy/Remodel ECM

Question 5

The top figure is a normal heart valve and the bottom myxomatous mitral
valve (E).

Answer 5

Question 6

A patient had a history of chronic strep throat. They died and the picture shown is of their mitral valve. What would indicate that they had Rheumatic heart disease?

Answer 6

Question 7

Clinical Features of Calcific Aortic Stenosis

• In severe disease, how much are the valve orifices compromised?
• How is Cardiac Output maintained, and how does this affect blood pressure?
  
  • Relating to the answer to the above question, what kind of pathology can develop?
• If not treated with surgery, what percentage of patients die 2 to 3 years after Dx?

Answer 7

Question 8

• This image shows an aortic valve.
  
  • What kind of pathology is present?
  • What do you see at the arrow?
    
    • How is the feature at the arrow different in rheumatic aortic valve stenosis

Answer 8

Question 9

• Degenerative valve disease is a term used to describe changes that affect the integrity of valvular ECM.
  
  • List these changes (4)

Answer 9

Question 10

Clinical features of rheumatic heart disease

• What PT population is Acute rheumatic fever common in?
• When do symptoms start, and what symptoms are usually seen at first?

Answer 10

Question 11

Clinical features of rheumatic heart disease

• What type of criteria is used to Dx acute rheumatic fever?

Answer 11

Question 12

What is the likely basis for Primary myxomatous degeneration of the mitral valve?

Answer 12

Question 13

What is the morphologic hallmark of Calcific Aortic degeneration (Aortic Stenosis)?

Describe how this impedes valve opening

Answer 13

Question 14

What devastating type of cardiac inflammation can Rheumatic fever cause?

Answer 14

• Pancarditis: inflammation of the entire heart: the epicardium, the myocardium, and the endocardium.

Question 15

The incidence of rheumatic fever (and rheumatic HD)

• What are the differences between the developed world and the developing world?

Answer 15

Question 16

Morphology of Rheumatic Valvular Disease

• What makes up the Aschoff bodies seen in Rheumatic Valvular Disease?
• What are Anitschkow cells?
  
  • Describe how these cells look

Answer 16

Question 17

What produces the most important clinical features in Rheumatic heart disease?

Answer 17

Question 18

In Rheumatic Heart Disease

• What can happen to the pericardium that generally resolves without
  sequelae?
• What happens in the myocardium?

Answer 18

Question 19

Describe how turbulent flow through diseased valves manifests

Answer 19

Murmurs

The sound foes in the direction of blood flow

Question 20

Clinical Features of Myxomatous Mitral Valve

• What conditions can PTs develop?
• What increased risks to PTs face?

Answer 20

Question 21

In Rheumatic Heart Disease

• What kind of changes and pathology can happen to the heart valves?
  
  • Use specific names for any growths

Answer 21

• Fibrinoid necrosis and fibrin deposition along the lines of closure
  
  • Form 1- to 2-mm vegetations, verrucae, that cause little disturbance in cardiac function.

Question 22

• In those with the primary mitral disease, concomitant tricuspid valve involvement is _________; _________ commonly, aortic and pulmonic valves also may be affected.

Answer 22

• In those with primary mitral disease, concomitant tricuspid valve involvement is frequent (20% to 40% of cases); less commonly, aortic and pulmonic valves also may be affected.

Question 23

Define Stenosis

Answer 23

Question 24

• Bicuspid aortic valves are generally neither stenotic nor incompetent through early life.
  
  • If the above statement is true, how do bicuspid aortic valves actually cause harm to people?

Answer 24

Question 25

Consequences of rheumatic heart disease * What are the most important functional consequences of this disease? * Which consequence tends to be more dominant? * What valve is implicated by itself in almost **70% o**f cases? * The above valve is combined with which other valve in about **25% of cases?** * What valve is almost never associated with this disease? * What happens to the left atrium, and why? * What conditions can this cause? * What can occur due to the long-standing passive venous congestion? * What changes in the heart because of this?

Answer 25

Question 26

Clinical features of rheumatic heart disease * Acute rheumatic fever can cause carditis, amongst other things * What are the general clinical signs of carditis? * If Myocarditis from rheumatic fever is severe enough, what can occur in the heart? * How many people die from acute rheumatic fever?

Answer 26

Question 27

How much does acquired stenosis of the aortic and mitral valves account for all valvular diseases?

Answer 27

Question 28

Morphology of chronic rheumatic heart disease * What destroys the normal leaflet architecture? * The image shows cardiac valves with chronic rheumatic involvement. * What does panel A show specifically, and where? * What does panel B show?

Answer 28

Question 29

What are the 4 main determinates of the outcome of valvular disease?

Answer 29

Question 30

Clinical Features of Myxomatous Mitral Valve * How do most patients present? * What occurs in a minority of cases? * What do you hear upon Auscultation? * What is this due to?

Answer 30

Question 31

What is the principal type of valvular pathology associated with Rheumatic fever?

Answer 31

Question 32

Primary mitral valve prolapse is a form of myxomatous mitral degeneration. * What is the population that this disease affects? * What is the incidence amongst adults? * How is this different than secondary mitral valve prolapse?

Answer 32

Question 33

What is Commissural fusion a sign of, and how does it manifest in degenerative aortic stenosis?

Answer 33

Question 34

* This show an aortic valve. * How do you know right away that there is pathology? * What kind of pathology do you see? * What does the arrow show?

Answer 34

* Aortic valve should be tricuspid. This shows a congenitally bicuspid valve * It shows Calcific aortic stenosis of a congenitally bicuspid valve * One cusp has a partial fusion at its center, called a **raphe** (arrow).

Question 35

Clinical features of rheumatic heart disease * If a valve was involved with a previous case of rheumatic carditis, what can happen to it later on in life? * What are the major secondary types of pathology associated with chronic rheumatic heart disease? * Think changes in heart function, size, and rhythm.

Answer 35

Question 36

Define Insufficiency

Answer 36

Question 37

What kind of pathology does this image of the myocardium show?

Answer 37

Question 38

Morphology of chronic rheumatic heart disease * What "type" of stenosis is seen in this mitral valve? * What is it caused by? * What are the arrows pointing to?

Answer 38

Question 39

What is the most common congenital valvular lesion? How often does this occur? What may be the genetic pathway that causes this?

Answer 39

Question 40

In myxomatous degeneration of the mitral valve, describe what happens to the * Mitral leaflets * Tendinous cords

Answer 40

Question 41

Clinical features of rheumatic heart disease * After an initial attack and the generation of immunologic memory, * What happens to patients in terms of recurrence of disease? * When does this become evident?

Answer 41

Question 42

In myxomatous degeneration of the mitral valve * What happens to the mitral leaflets? * Is the main problem of this disease related to the systole or diastole?

Answer 42

Question 43

Pathogenesis of Rheumatic Valvular Disease * Why is there a delay in symptom onset? * Why do we suspect that there is a genetic component to this disease? * What is the deforming fibrotic lesion associated with Rheumatic Valvular Disease a product of?

Answer 43

Question 44

Are stenosis and regurgitation/insufficiency mutually exclusive?

Answer 44

No

Question 45

Describe the shape of the two cusps in bicuspid aortic valves

Answer 45

Question 46

* This shows an image of a mitral valve. This heart belonged to a patient who had chronic Rheumatic heart disease. * What are the indications in the image that are associated with chronic Rheumatic heart disease?

Answer 46

* (A) Acute rheumatic mitral valvulitis superimposed on chronic rheumatic heart disease. * Small vegetations (**verrucae**) are visible along the line of closure of the mitral valve leaflet (**arrows**). * Previous episodes of rheumatic valvulitis have caused **fibrous thickening and fusion of the** **chordae** **tendineae****.**

Question 47

Pathogenesis of Rheumatic Valvular Disease * What causes Acute rheumatic fever? * What Antibodies are involved? * What role does the activation of complement, Fc receptor–bearing cells, and CD4+ T cells play, if any?

Answer 47

Question 48

Describe the long-term prognosis of rheumatic heart disease

Answer 48

Question 49

Morphology of chronic rheumatic heart disease * What are the main characteristics? * What happens to the Aschoff bodies, Valve cusps, leaflets, and mitral valve?

Answer 49

Question 50

What causes the incidence of Calcific Aortic degeneration (Aortic Stenosis) to increase?

Answer 50

Question 51

How is the most common cause of Aortic Stenosis usually discovered?

Answer 51

Question 52

Microscopically, what is the main change in primary myxomatous degeneration of the mitral valve? * What happens to the fibrosa layer? * What happens to the spongiosa layer? * What is Secondary myxomatous change usually due to?

Answer 52

Question 53

During acute RF, where can Aschoff bodies be found?

Answer 53