Pathophys of Valvular Heart Disease, Pathology of Acquired Valvular Disease

Question 1

Other than changes of stenotic valve, obstruction leading to aortic stenosis can occur via

Answer 1

above (supravalvular)

below (HOCM)

Question 2

aortic stenosis etiology 50-60 y/o

Answer 2

bicuspid

Question 3

aortic stenosis etiology 60-70 y/o

Answer 3

rheumatic

Question 4

aortic stenosis etiology >70

Answer 4

senile degenerative

Question 5

wall stress=

Answer 5

Pressureradius/2wall thickness

Question 6

physical findings of AS

Answer 6

• small/delayed carotid upstroke
• late peaking systolic aortic murmur
• absence of S2

Question 7

AS tx

Answer 7

mechanical problem –> surgery

Esp if…

• severe stenosis and symptomatic (including isolated systolic dysfunc/dec EF)
• AS and undergoing CABG

baloon valvuloplasty is suboptimal

Question 8

aortic regurg primary valve etiology

Answer 8

congenital, rheumatic, endocarditis, trauma

Question 9

aortic regurg primary aortic root dilatation etiology

Answer 9

rheumatoid syndromes, CMN, Marfan’s, atherosclerotic

Question 10

aortic regurgitation pathophys

Answer 10

huge RDV allows for ejection of large SV to maintain forward SV –> asymptomatic for years

but eventually wall stress inc, EF falls–> fatigue/DOE –> CHF –> death

Question 11

aortic regurgitation physical exam

Answer 11

• long loud diastolic murmur, Austin-Flint murmur
• bounding pulses
• wide pulse pressure

Question 12

AR tx

Answer 12

-afterload reduction (nifedipine, ACE inhib) may slow LV deterioration

Question 13

aortic valve replacement in AR, when to do

Answer 13

• for symptomatic pts with severe AR

- asymptomatic pts with chronic severe AR and LV systolic dysfunction

Question 14

mitral stenosis etiology in adults

Answer 14

always rheumatic –> inflammation –> deformity and fibrosis of leaflets –> fusion of commissures and chordae –> Ca and stiffening

Question 15

mitral stenosis eventual outcome

Answer 15

inc LAP, LA dilation

inc RV and RA dilation and failure from pulm HTN

–> nutmeg liver

Question 16

mitral stenosis sx

Answer 16

• none for years
• DOE, fatigue
• sx inc w/ onset of afib
• later, w/ RHF –> edema, venous congestion
• emboli

Question 17

mitral stenosis PE

Answer 17

• loud S1, opening snap
• low diastolic rumble
• RV enlargement

Question 18

mitral stenosis therapy

Answer 18

early: diuretics, beta blockers
later: MVR, balloon MVP

Question 19

mitral regurgitation

Answer 19

• ejection of portion of SV into LA (low pressure)

- chronic volume-overload of the LV

Question 20

chronic MR

Answer 20

• rheumatic

- non-rheumatic (MVP, papillary m. dysfunction, endocarditis, LV dilatation, Marfan’s)

Question 21

MR physical exam

Answer 21

• loud, holosystolic murmur. Apex to axilla
• dec S1
• S3 rumble

Question 22

chronic MR tx

Answer 22

• afterload reduction and diuretics

- surgical soon after sx develop (prevents irreversible changes in LV, LA, pulm vasculature)

Question 23

tricuspid/pulmonic stenosis

Answer 23

usu congenital, early sx

P overload on chamber prod to valve

tx: balloon valvuloplasty

Question 24

tricuspid/pulmonic stenosis in adults

Answer 24

carcinoid syndrome

Question 25

tricuspid regurgitation etiology

Answer 25

usually secondary to RV/annular dilation

endocarditis in IVDA

RV and RA dilatation

large V waves on PE

systemic venous congestion

Question 26

large V waves on PE

Answer 26

tricuspid regurgitation

Question 27

most comm cause mitral stenosis

Answer 27

rheumatic heart disease

Question 28

most comm cause aortic stenosis

Answer 28

calcification

Question 29

most comm valve abnormalities

Answer 29

calcific AS

MVP

Question 30

calcific AS

Answer 30

one of the most comm valvular abnormalities

Question 31

myxoid degeneration

Answer 31

MVP

Question 32

rheumatic fever

Answer 32

heart/joints/skin/brain effets

group A beta hemolytic strep pharyngitis
cross rxn w/ glycoproteins

Question 33

major criteria of rheumatic fever

Answer 33

• migratory polyarthritis of lg joints
• carditis (PANcarditis)
• subcutaneous nodules
• sydenham’s chorea

Jones’ criteria

Question 34

minor criteria of rheumatic fever

Answer 34

• fever
• arthralgia
• acute phase reactants
• antistreptolysin O
• ESR

Question 35

to dx rheumatic fever, need

Answer 35

2 major or 1 major + 2 minor

Question 36

histo findings of rheumatic fever

Answer 36

Aschoff nodule (fibrinoid necrosis, inflammatory cells, HISTIOCYTES (aschoff giant cells) Anitschkow cells (caterpillar))

Question 37

Aschoff

Answer 37

giant cells (histiocytes

Question 38

Anitschkow cell

Answer 38

specialized macrophage

looks like caterpillar

inside Aschoff nodule

Question 39

fish mouth

Answer 39

mitral stenosis

Question 40

most common organism in infective endocarditis

Answer 40

• alpha hemolytic strep (VIRIDANS)

^less virulent

Question 41

most common organism in infective endocarditis w/ IV drug use

Answer 41

staph aureus

Question 42

HACEK organisms

Answer 42

• hemophilus
• actinobacillus
• cardiobacterium
• eikenella
• kingells

Question 43

complications of infective endocarditis

Answer 43

• valve destruction
• ring abscesses
• suppurative pericarditis (neutrophils)
• septic emboli forming abscesses (brain, heart, spleen, kidneys, lungs)

Question 44

non-infected endocarditis vegetations

Answer 44

1. nonbacterial thrombotic endocarditis (NBTE)

2. Libman-Sacks endocarditis (SLE)

Question 45

nonbacterial thrombotic endocarditis (NBTE)

Answer 45

• hypercoaguable states
• other malignant
• debilitation, burns, sepsis, in-swelling venous catheter

Question 46

Libman-Sacks endocarditis (SLE)

Answer 46

• 1-4mm single or multiple sterile verrucous vegetations (typically UNDERSURFACES aka inflow tract of mitral valve)
• fibrinoid material within and HEMATOXYPHIL bodies (macrophages or neutrophils which have phagocytksed nucleus of injured cell)