Valvular and Neoplastic Heart Disease

Question 1

Bicuspid Aortic Valve

Answer 1

2 cusps instead of 3
Aortic stenosis appears in 50s and 60s
Can get infective endocarditis
May lead to aortopathy

Question 2

Valvular Degeneration due to Calcification

Answer 2

Most common
“Wear and tear”
Dystrophic calcification- little bit of fibrosis followed by calcification
Probably related to atherosclerosis

Question 3

Calcified Aortic Stenosis

Answer 3

Calcified masses prevent cusp opening
Causes increased pressure gradient across valve
Leads to concentric LVH
Symptoms: CHF, MI, syncope

Question 4

Mitral Valve Prolapse

Answer 4

Myxomatous degernation of Mitral Valve
Enlarged, floppy leaflets
Balloon into atrium during systole
The ballooning can cause injury to atrium
Mucus-y matrix, gives it rubbery appearance
Unknown path, ?developmental defect in connective tissue

Question 5

Mitral Valve Prolapse Characterisitics

Answer 5

3% pop (young women)
Asymptomatic, or chest pain, dyspnea, fatigue, depression, anxiety
Midsystolic click
Rare, serious complications: infective endocarditis, mitral insufficiency, stroke (from embolism of leaflet or atrial thrombi), arrhythmias

Question 6

Infective Endocarditis

Answer 6

Destructive inflammation of cardiac valves and endocardium

Bacterial infection most common, can be fungi/parasites

Question 7

Infective Endocarditis - vegetation

Answer 7

Abnormal outgrowth
Composed of various tissues elements including fibrin and collagen
Large, bulky, destructive, erosive, friable (CAN EMBOLIZE)

Question 8

Acute Infective Endocarditis

Answer 8

From highly virulent microorganisms
Rapid, severe destruction of valve
50% mortality
STAPH AUREUS

Question 9

Subacute Infective Endocarditis

Answer 9

Low virulence organism
Affect previously deformed valve
Recovery with appropriate treatment
Strep viridans

Question 10

Infective Endocarditis

Patients at Risk

Answer 10

Valvular disease
Prosthetic valves
Immune deficient
Diabetic
IV drug users
Alcoholics

Question 11

Infective Endocarditis Complications

Answer 11

Cardiac: valve insufficiency/stenosis, abscess, valve dehiscence or paravalvular leak in prosthetics
Emboli: Brain, kidney, spleen, lungs, (slinter hemorrhage, conjuctival petechiae, Janeway lesions)
Immunologic: glomerulonephritis, osler nodes (immune depositions)

Question 12

Infective Endocarditis Tx

Answer 12

IV antibiotics
Surgery
Prophylaxis with antibiotics for those at high risk

Question 13

NONINFECTED Vegetations

Answer 13

Nonbacterial Thrombotic Endocarditis
Endocarditis of Systemic Lupus Erythematosus
Acute Rheumatic Fever

Question 14

Nonbacterial Thrombotic Endocarditis

Answer 14

Marantic Endocarditis
Sterile thrombi (vegetations) that form on valve
Small, non-destructive, loosely attached
Made of fibrin
In patients prone to hypercoagulable states (sepsis, cancer, burns, indwelling catheters leading to endocardial trauma)

Question 15

Endocarditis of Systemic Lupus Erythematosus

Answer 15

Libman-Sacks Endocarditis
Sterile vegetations on mitral/tricuspid valves and cords
Small
Immune complex deposition and associated inflammation
Valvulitis: leads to fibrosis and valve deformity

Question 16

Rheumatic Fever

Answer 16

10 days to 6 weeks after Group A streptococcal pharyngitis
Acute systemic manifestations
Chronic rheumatic heart disease

Question 17

Acute Rheumatic Fever

Answer 17

Immune response when Group A strep corss-rxt with host tissues
M protein antibodies and self-antigens in the heart
CD4+ T cells specific for strep peptides rxt with cardiac self proteins
Inflammation: T lymph, plasma cells, macrophages AKA ANITSCHOW cells or caterpillar cells)

Question 18

Acute Rheumatic Fever

Major Manifestations

Answer 18

Migratory polyarthritis in the large joints
Carditis (pancarditis, can be peri, myo, or endo)
Subcutaneous nodules
Eryhtema marginatum rash of the skin
Sydenham chorea (involunatry, purposeless, rapid movements)

Question 19

Acute Rheumatic Fever

Minor Manifestations

Answer 19

Fever
Arthralgia
Elevated acute-phase reactants

Question 20

Acute Rhematic Fever

Jones Criteria

Answer 20

Group A strep infection
\+
2 Major manifestations
or
1 Major and 2 Minor Manifestations

Question 21

Chronic Rheumatic Fever

Answer 21

Valve leaflet, fibrosis, fusion
Fish mouth or buttonhole stenosis
Cords short/thick/fused
Mitral valve usually involved, next aortic, tricuspid/pulm rare

Question 22

Carcinoid Tumor

Answer 22

Neuroendocrine tumor
Secretes bioactive products (5-HT, kallikrein, bradykinin, histamine, prostaglandins, tachykinins)
Episodic flushing of the skin, cramps, nausea, vomiting, diarrhea

Question 23

Carcinoid Heart Disease

Answer 23

Right side of heart
Plaque-like thickening/coating of endocardium and valves (mucopolysaccharide matrix)
Correlation with 5-HT
Incompetent tricuspid valves

Question 24

Myxoma

Answer 24

Most common primary ADULT tumor of the heart
90% atria, L:R 4:1
Gelatinous tumor with little stalk and incompletely formed blood vessels
Stalk can go through AV valve and block flow to LV
Excretion of IL-6 can cause fever and malaise
Embolization

Question 25

Rhabdomyoma

Answer 25

Primary PEDIATRIC heart tumor
Covers valve or cardiac chamber
Can regress spontaneously

Question 26

Angiosarcoma

Answer 26

Malignant, aggressive

Arise from endothelial cells

Question 27

Cardiac Mets

Answer 27

Most common MALIGNANCY of heart
Lung, lymphoma, breast, leukemia, melanoma, heptocellular, colon
Pericardial mets: pericardial effusions, tamponade