Pathophys of Valvular Heart Disease, Pathology of Acquired Valvular Disease Flashcards

1
Q

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

A

above (supravalvular)

below (HOCM)

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2
Q

aortic stenosis etiology 50-60 y/o

A

bicuspid

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3
Q

aortic stenosis etiology 60-70 y/o

A

rheumatic

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4
Q

aortic stenosis etiology >70

A

senile degenerative

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5
Q

wall stress=

A

Pressureradius/2wall thickness

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6
Q

physical findings of AS

A
  • small/delayed carotid upstroke
  • late peaking systolic aortic murmur
  • absence of S2
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7
Q

AS tx

A

mechanical problem –> surgery

Esp if…

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

baloon valvuloplasty is suboptimal

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8
Q

aortic regurg primary valve etiology

A

congenital, rheumatic, endocarditis, trauma

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9
Q

aortic regurg primary aortic root dilatation etiology

A

rheumatoid syndromes, CMN, Marfan’s, atherosclerotic

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10
Q

aortic regurgitation pathophys

A

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

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11
Q

aortic regurgitation physical exam

A
  • long loud diastolic murmur, Austin-Flint murmur
  • bounding pulses
  • wide pulse pressure
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12
Q

AR tx

A

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

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13
Q

aortic valve replacement in AR, when to do

A
  • for symptomatic pts with severe AR

- asymptomatic pts with chronic severe AR and LV systolic dysfunction

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14
Q

mitral stenosis etiology in adults

A

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

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15
Q

mitral stenosis eventual outcome

A

inc LAP, LA dilation

inc RV and RA dilation and failure from pulm HTN

–> nutmeg liver

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16
Q

mitral stenosis sx

A
  • none for years
  • DOE, fatigue
  • sx inc w/ onset of afib
  • later, w/ RHF –> edema, venous congestion
  • emboli
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17
Q

mitral stenosis PE

A
  • loud S1, opening snap
  • low diastolic rumble
  • RV enlargement
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18
Q

mitral stenosis therapy

A

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

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19
Q

mitral regurgitation

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

- chronic volume-overload of the LV

20
Q

chronic MR

A
  • rheumatic

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

21
Q

MR physical exam

A
  • loud, holosystolic murmur. Apex to axilla
  • dec S1
  • S3 rumble
22
Q

chronic MR tx

A
  • afterload reduction and diuretics

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

23
Q

tricuspid/pulmonic stenosis

A

usu congenital, early sx

P overload on chamber prod to valve

tx: balloon valvuloplasty

24
Q

tricuspid/pulmonic stenosis in adults

A

carcinoid syndrome

25
tricuspid regurgitation etiology
usually secondary to RV/annular dilation endocarditis in IVDA RV and RA dilatation large V waves on PE systemic venous congestion
26
large V waves on PE
tricuspid regurgitation
27
most comm cause mitral stenosis
rheumatic heart disease
28
most comm cause aortic stenosis
calcification
29
most comm valve abnormalities
calcific AS | MVP
30
calcific AS
one of the most comm valvular abnormalities
31
myxoid degeneration
MVP
32
rheumatic fever
heart/joints/skin/brain effets group A beta hemolytic strep pharyngitis cross rxn w/ glycoproteins
33
major criteria of rheumatic fever
- migratory polyarthritis of lg joints - carditis (PANcarditis) - subcutaneous nodules - sydenham's chorea Jones' criteria
34
minor criteria of rheumatic fever
- fever - arthralgia - acute phase reactants - antistreptolysin O - ESR
35
to dx rheumatic fever, need
2 major or 1 major + 2 minor
36
histo findings of rheumatic fever
Aschoff nodule (fibrinoid necrosis, inflammatory cells, HISTIOCYTES (aschoff giant cells) Anitschkow cells (caterpillar))
37
Aschoff
giant cells (histiocytes
38
Anitschkow cell
specialized macrophage looks like caterpillar inside Aschoff nodule
39
fish mouth
mitral stenosis
40
most common organism in infective endocarditis
- alpha hemolytic strep (VIRIDANS) ^less virulent
41
most common organism in infective endocarditis w/ IV drug use
staph aureus
42
HACEK organisms
- hemophilus - actinobacillus - cardiobacterium - eikenella - kingells
43
complications of infective endocarditis
- valve destruction - ring abscesses - suppurative pericarditis (neutrophils) - septic emboli forming abscesses (brain, heart, spleen, kidneys, lungs)
44
non-infected endocarditis vegetations
1. nonbacterial thrombotic endocarditis (NBTE) | 2. Libman-Sacks endocarditis (SLE)
45
nonbacterial thrombotic endocarditis (NBTE)
- hypercoaguable states - other malignant - debilitation, burns, sepsis, in-swelling venous catheter
46
Libman-Sacks endocarditis (SLE)
- 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)