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Pathology 3001 > Valvular disease > Flashcards

Valvular disease Flashcards

1
Q

What percentage of heart failure involves valve disease?

A

10%

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2
Q

What are the components of the heart valves?

A
  • Valve rings
  • Cusp
  • Chordae
  • Papillary muscle (mitral and tricuspid only)
    (pathologies can be due to problems in any of these structures)
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3
Q

What is the function of the valve cusps?

A

To allow forward flow but to prevent back-flow

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4
Q

What is the definition of stenosis?

A

Narrowing of the valve outlet caused by thickening of valve cusps, or increased rigidity or scarring

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5
Q

What is the definition of incompetence?

A

(aka insufficiency or regurgitation)

- Caused by incomplete seal when valves close, allowing blood to flow backwards

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6
Q

What are the aquired causes of cardiac valve stenosis?

A
  • Rheumatic fever
  • MI
  • Age related - idiopathic aortic calcific stenosis
  • Endocarditis
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7
Q

What valves can be heard in systole?

A

Mitral and Tricuspid

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8
Q

What valves can be heard in diastole?

A

Aortic and pulmonary

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9
Q

Common causes of cardiac valves stenosis and incompetence?

A
  • Congenital heart disease (bicuspid valve, atresia)
  • Cardiomyopathy (hypertrophic, dilated)
  • Aquired
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10
Q

What are the aquired causes of cardiac valve stenosis?

A
  • Rheumatic fever
  • MI
  • Age related - idiopathic aortic calcific stenosis
  • Endocarditis
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11
Q

How can aortic stenosis lead to sudden death?

A

Heart cannot reach demands, often during exercise. Ventricular hypertrophy
Arrhythmias
Can lead to ventricular fibrilation

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12
Q

What is rheumatic fever?

A

Immune mediated response to streptococcal infection (3 weeks post) results in damage to connective tissue.
Attacks collagen in heart valves
- Occurs in children 4-16 years

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13
Q

What does aortic regurgitation result in?

A
  • Increased work load to heart
  • Left ventricular hypertrophy
  • Cardiac failure
  • Can occur in the presence of aortic stenosis
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14
Q

What can be the causes of mitral incompetence?

A
  • Cusp damage (rheumatic heart disease - scarring, contraction)
  • Chordae (as above)
  • Papillary muscle (e.g post MI)
  • Valve rings (as above, age)
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15
Q

What heart valve is most commonly damaged by rheumatic fever?

A

Mitral valve

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16
Q

What can mitral incompetence lead to?

A
  • Pulmonary hypertension

- Right Ventricular hypertrophy

17
Q

What can cause aortic incompetence?

A
  • MI
  • Infective endocarditis
  • Rheumatic fever
  • Marfan’s syndrome
  • Dilation of aortic root (age-related or syphilitic)
  • Some rheumatological disorders, e.g rheumatoid arthritis, ankylosing spondylitis
18
Q

What are the consequences of aortic stenosis?

A
  • Increases the work of the heart
  • Left ventricular hypertrophy
  • Clinical symptoms
    Angina, dyspnoea, syncope, sudden death
19
Q

What can be the effects of mitral stenosis?

A
  • Restricts blood flow to left ventrical
  • Atrial fibrilation
  • Back pressure results in pulmonary hypertension
  • Heart failure
20
Q

What can be heard in mitral stenosis?

A

Opening snap and diastolic murmur

21
Q

What can be heard in aortic incomptence?

A
  • Diastolic murmur

- Wide pulse pressure, collapsing pulse, angina, left ventricular failure

22
Q

What can be heard in mitral incompetence?

A
  • Pansystolic murmur

- Mid-systolic click and late systolic murmur in mitral prolaspe

23
Q

What can cause aortic stenosis?

A
  • Calcific degeneration

- Rheumatic fever

24
Q

Define infective endocarditis

A

Infection of valve with formation of thrombotic vegetations

25
Q

What determines the severity of infective endocarditis

A

The virulence of organisms determines damage and severity

26
Q

What can directly cause infective endocarditis via bacteria?

A
  • Dental operations
  • Catheterisation
  • 10% unknown
  • IV drug abuse
27
Q

In what type of endocarditis can the valves be normal?

A

Acute native valve endocarditis

28
Q

What type of endocarditis is more aggressive?

A

Acute native endocarditis

29
Q

What organisms most commonly cause acute native endocarditis?

A
  • Virulent organisms, such as Staph aureus and group B streptococci
30
Q

What organisms most commonly cause subacute native valve endocarditis?

A

Alpha-haemolytic streptococci, enterococci

31
Q

What percentage of infective endocarditis cases are prosthetic valve endocarditis?

A

10 - 20%

32
Q

What percentage of mechanical and bioprosthetic valves become infected?

A

5%

33
Q

What organisms can cause early onset prosthetic valve endocarditis?

A
  • Staph aureus
  • Gram-negative bacilli
  • Candida species
34
Q

What organisms can cause late onset prosthetic valve endocarditis?

A
  • Staphylococci
  • Alpha-haemolytic streptococci
  • Enterococci
35
Q

What percentage of IV drug abuse endocarditis cases involve the tricuspid valve?

A

50%

36
Q

What organism most commonly causes IV drug abuse endocarditis?

A

Staph. aureus

37
Q

What percentage of patients with IV drug abuse endocarditis have an underlying valvular abnormality?

A

25%

38
Q

How is infective endocarditis treated and prevented?

A
  • Treat strep infection with antibiotics
  • Prophylactic cover for invasive procedures e.g dental work
  • Replacing damaged valves

Pathology 3001 (15 decks)

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