Valvular and congenital patho Flashcards
What is valvular stenosis?
Failure of valve to open completely → prevents forward flow
What is valvular insufficiency/ regurgitation/ incompetence?
Failure of valve to close complete → allow reverse flow
True or false:
Valvular stenosis and insufficiency can co-exist.
True
What are the risk factors to developing valvular heart disease?
Structurally abnormal valves:
1) Bicuspid aortic valve
2) Valves damaged by rheumatic heart disease
3) Prosthetic valves
What are 2 causes of valvular stenosis?
1) Post inflammatory scarring
- rheumatic heart disease
2) Calcification
- senile calcific aortic stenosis
3) Congenital
What are 3 causes of valvular insufficiency?
1) Post inflammatory scarring
- rheumatic heart disease
2) Genetic/developmental
- Marfan’s
3) Degenerative
- Mitral valve prolapse with Myxomatous (gelatinous) degeneration of the mitral
valve
4) Infectious
- eg. syphillis, IE
What is the most common cardiac valvular abnormality?
Aortic valve calcification
What does aortic valve calcification lead to?
Aortic stenosis
Aortic valve calcification is a/w___________ and accelerated in ________________.
Aortic valve calcification:
- a/w: age-associated degeneration
- accelerated in congenitally bicuspid aortic valves
What does mitral valve prolapse lead to?
Mitral regurgitation
What is the gross appearance of mitral valve prolapse?
Ballooning of the valvular cusps with Myxoid degeneration of affected leaflets thickened and rubbery
Mitral valve prolapse most commonly affects ______________ and the most commonly caused by ____________.
Young women
Unknown cause but a/w Marfan syndrome
What is the pathogenesis of Rheumatic fever?
M protein in Group A Strep (molecular mimicry) → Type 2 HS → Cross reactive Abs → heart cells
In acute rheumatic heart disease, inflammation occurs in ________________ and form __________________.
Any or all 3 layers of heart (pancarditis)
Form vegetations (verrucae)
What is the characteristic histological feature of acute rheumatic heart disease?
Aschoff bodies
- T lymphocytes
– Plasma cells
– Aschoff giant cells
– Activated macrophage (Anitschkow cell /
caterpillar cell)
Which valve is most commonly affected in chronic rheumatic heart disease?
Mitral > Aortic > Tricuspid and pulmonary (L>R)
Chronic rheumatic heart disease often leads to ________________ and predisposes a px to: (2).
Leads to stenosis and regurgitation (#1 mitral)
Predispose to IE, Thromboemboli, Arrythmias
How is rheumatic fever diagnosed?
Revised Jones Criteria:
carditis, arthritis, chorea, erythema marginatum, and subcutaneous nodules
What is infective endocarditis?
disease caused by microbial infection of the cardiac valves or endocardium → formation of vegetations leading to tissue destruction
Which valves are most commonly affected in IE?
Mitral and Aortic (L>R)
How is Infective Endocarditis diagnosed?
Modified Duke Criteria
What are 2 risk factors for ACUTE infective endocarditis?
1) IV drug use
2) Open heart surgery
3) Septicaemia
(normal valves, highly virulent pathogens)
What is the most common causative pathogen of acute endocarditis?
Staph aureus
What is the most common causative pathogen of subacute endocarditis?
Strep viridans
What is the most common causative pathogen of prosthetic valve endocarditis?
Staph epidermidis
Other than Staph aureus and epidermidis and strep viridans, what are 2 other organisms that can cause infective endocarditis?
1) HACEK group
2) Enterococci
3) Fungi
What are 2 risk factors in general that predispose a px to infective endocarditis?
1) Abnormal valves
2) Microbial seeding into blood (eg. dental/surgical procedures, IV drug use, break in epithelial barriers)
What are 5 complications of infective endocarditis?
Local
1) Valve rupture
2) Myocardial ring abscess
3) Suppurative pericarditis
Distant
1) Septic emboli
2) Immune complex mediated glomerulonephritis
3) Anemia (due to chronic disease)
4) Splenomegaly
What are 2 causes of heart valve vegetations?
1) Infection (IE)
2) Non-bacterial thrombotic endocarditis
3) Lupus (Libman-Sacks endocarditis)
4) RHD
Nonbacterial thrombotic endocarditis common occurs in ________________px with __________ blood due to acute phase response. This causes _________________ vegetations on heart valves
NBTE:
- occurs in severely debilitated cancer/sepsis px
- hypercoagulable blood
- small, non-infective, platelet-rich vegetations
What are 4 complications of heart valvular disease?
Heart
1) LVH
2) Myocardial ischaemia
3) HF
4) Arrythmias
5) IE
Lung
1) Congestion
2) Pulmonary hypertension
What are 2 causes of cardiac tamponade?
1) Ruptured MI
2) Aortic dissection
3) Trauma (fish bone)
What is the term for pus in the pericardium?
Purulent/suppurative pericarditis
True or false:
When fluid accumulates in the pericardium, whether acutely or chronically, it is not well tolerated and will cause cardiac tamponade.
False.
Chronic increases in fluid can be well tolerated; Acute increases can be fatal (eg. Cardiac tamponade)
What are 3 causes of pericarditis?
1) Infection
2) Trauma
3) Autoimmune (eg. RHD, lupus)
4) Metabolic (eg. uremic)
5) Iatrogenic (eg. post-op, radiation)
6) Neoplasms
What are 4 pathological subtypes of pericarditis?
1) Serous pericarditis
– Non-infectious inflammatory diseases
2) Fibrinous pericarditis (can overlap with serous)
– Eg. Post MI, RHD, etc
3) Suppurative (purulent) pericarditis
– Infections
4) Hemorrhagic pericarditis
– Direct spread or metastatic malignant neoplasm
5) Caseous pericarditis
– Tuberculosis
What are 2 results of chronic healed pericarditis?
1) Adhesive pericarditis (mild)
2) Adhesive mediastinopericarditis (severe)
3) Constrictive pericarditis (severe)
Which type of shunt is cyanotic, left to right or right to left?
Right to left
What is the most common cyanotic congenital heart disease?
Tetralogy of fallot
What are 3 acyanotic congenital heart diseases?
Obstructions
1) Pulmonary stenosis
2) Coarctation of aorta
3) Aortic stenosis
L→R shunts
4) VSD
5) ASD
6) PDA
What is the most common congenital heart disease?
VSD
Why are ASD, VSD and PDA all acyanotic when they provide a passage for mixing of oxygenated and deoxygenation blood?
Left heart is at much higher pressure → limited effect of tissue perfusion (only flow from L→R not R→L)
What is the #1 concern of left to right shunts?
Eisenmenger syndrome:
L→R shunt
→ ↑P in pulmonary circulation
→ pulmonary arterioles hypertrophy and vasoconstrict to maintain P → ↑R
→ RVH → ↑R heart P
→ R→L shunt
→ De-O2 blood enters systemic circulation → ↓tissue perfusion → cyanosis
What are 3 examples of cyanotic congenital heart diseases?
1) Tetralogy of fallot (#1)
2) Truncus arteriosus
3) Transposition of great arteries
4) Tricuspid atresia
5) Total anomalous pulmonary venous return
What is the tetralogy of fallot?
1) Pulmonary stenosis
2) RVH
3) VSD
4) Overriding aorta (both R and LV open to aorta)
What is a paradoxical embolism?
Thrombo-embolism can travel to systemic circulation via septal defect
What is transposition of great vessels?
RV → Aorta
LV → Pulmonary trunk
What is coarctation of aorta?
narrowing of the aorta, most commonly occurring just beyond the left subclavian artery
