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Pathology- CP > Valvular Disease > Flashcards

Valvular Disease Flashcards

1
Q

Describe cardiac valves in a disease state

A
  • Stenotic valve tends to obstruct blood flow
  • Incompetent valves allow back flow
    • Incompetence, insufficiency and regurgitation are the same
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2
Q

Briefly describe the anatomy of the atrioventricular valves

A
  • Tricuspid mitral leaflets
  • Function of AV depends on proper functioning on leaflets and tendinous cord or attached papillary muscle of ventricular wall
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3
Q

What are the names of the semi-lunar valves?

A
  • Aortic

- Pulmonary cusps

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4
Q

Describe the histology of the valves

A
  • Dense collagen core at outflow surface, connected valvular supporting structures (fibres)
  • Central core of loose CT (spongiosa)
  • Layer rich in elastin on inflow surface (ventricular)
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5
Q

Describe the pathological changes that occur in valves

A
  • Fibrotic thickening- rheumatic disease + infective endocarditis
  • Damage to collagen that weakens the leaflets, e.g. mitral valve prolapse
  • Nodular calcification beginning in interstitial cells, e.g. calcific aortic stenosis
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6
Q

What is thematic fever (RF)?

A
  • Acute, immunologically mediated, multi-system inflammatory disease
  • Occurs a few weeks after an episode of group A stop, pharyngitis
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7
Q

Describe the pathogenesis of rheumatic fever

A
  • Acute RF- immune response to group A strep antigens cross react with host proteins (like antibodies)
  • Can also recognise cardiac self-antigens- can activate complement and recruit Fc receptor cells
  • Autoimmune
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8
Q

Describe the diagnostics of acute rheumatic fever

A
  • Fever and rash on examination
  • On auscultation- pericardial friction rub
  • Chest X-ray- dilated heart shadow
  • Sore throat history
  • Cross reaction
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9
Q

What are the clinicopathological correlations in rheumatic fever?

A
  • Synovitis –> migratory polyarthritis
  • Pericarditis–> hearing friction rubs
  • Myocarditis–> cardiac dilatation
  • Dermatitis–> rash (erythema marginatum)
  • Systemic inflammatory response–> cytokines and acute inflammation- pyrexia
  • Destruction of ganglia basal cells–> Sydenham chorea
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10
Q

What is Sydenham chorea?

A

Involuntary movements rapid arms and legs

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11
Q

What is infective endocarditis?

A
  • Microbial infection of valves or mural endocardium–> vegetation formation
  • Thrombotic debris and organisms
  • Often associated with destruction of underlying cardiac tissue
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12
Q

Describe acute infective endocarditis

A
  • Caused by highly virulent organism (e.g. staph aureus) rapidly producing necrotising/ destructive lesions
  • Difficult to cure with antibiotics alone
  • May need surgery
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13
Q

What are the most etiological agents of infective endocarditis?

A
  • Strep. viridans (normal component of oral flora)

- Staph. aureus

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14
Q

What are the portals of entry of bacteria into the bloodstream?

A
  • Mouth/ GI tract
  • Any source of infection
  • Injected of contaminated marterial
  • Dental procedures
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15
Q

Describe vegetations in IE

A
  • Wart-like materials
  • Projections
  • Collections of thrombotic and inflammatory material together with micro-organisms
  • Histology- infective, grain stain shows gram +ve cocci
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16
Q

What are the clinical features of IE?

A
  • Fever
  • Malaise
  • Weight loss
  • New or changing heart murmur
17
Q

What embolic phenomena might be present in IE?

A
  • Splinter haemorrhage (underneath nails)
  • Osler’s nodes in hands
  • Janeway lesions in feet
  • Roth’s spots in retina
18
Q

What would be required to make a diagnosis of IE?

A
  • Blood culture- usually 3 sets needed before AB therapy
  • Echocardiogram- shows vegetation quite well
  • Vegetations on imaging study
19
Q

What is the treatment for IE?

A
  • Antibiotics
  • Surgery (prosthetic valve)
    • Valve replacement
20
Q

What are the potential complications of surgery for IE?

A
  • HF, sepsis, multi-organ failure
  • In-hospital mortality- 15-20%
  • Patients who survive often have permanent scarred valves
21
Q

Are prosthetic valves a risk for IE and why?

A
  • Yes
  • Could have for another reason
  • Vegetation might grow around prosthetic valve
  • Very high risk of IE
  • Antibiotic prophylaxis has to be considered
22
Q

Why are valve diseases associated with murmurs?

A
  • Abnormal flow associated with valve defects may cause turbulence
  • Turbulence can be heard as a murmur
  • Damaged valve
23
Q

What causes valvular stenosis?

A
  • Acquired valvular stenosis relatively few causes- usually consequence of remote/ chronic injury- declares itself over years
24
Q

What causes valvular insufficiency?

A
  • Intrinsic disease- valve cusps, damage to supporting structures
  • MI
  • Many more causes and may appear acutely with cord rupture or chronically is disorders associated with leaflet scarring
  • Acute MI- may only see post-morem
25
Q

What are examples of supporting structures that could be damaged in valvular insufficiency?

A
  • Aorta
  • Mitral annulus
  • Tendinous cords
  • Papillary muscles
  • Ventricular free wall
26
Q

What are the major aetiologies of acquired mitral valve disease?

A
  • Stenosis- post-inflammatory scarring from RD
  • Regurgitation
    • Post-inflammatory scarring
    • IE
    • Mitral valve prolapse
  • Rupture of chordal tendinae
27
Q

What are the major causes of acquired aortic valve disease?

A
  • Senile calcification of aortic stenosis
  • Post-inflammatory scarring (RD)
  • Calcification of congenitally deformed valve
28
Q

What leads to regurgitation in acquired aortic valve disease?

A
  • Post-inflammatory scarring (rheumatic heart disease)
  • Aortic dissection- tear in wall of vessel
  • IE
29
Q

Describe aortic stenosis

A
  • Most common valvular disease
  • Age-related ‘wear and tear’- either normal valves or congenitally bicuspid
  • Calcification likely due to chronic injury- hyperlipidaemia, HT, inflammation- atherosclerosis
  • Onset of symptoms (angina, CHF syncope)–> cardiac decompensation + CHD–> surgical valve replacement
  • Abnormal ventricular emptying- ejection systolic normal due to obstruction to this
30
Q

Describe mitral regurgitaton

A
  • Malfunction of mitral valve
  • Rheumatic fever of IE
  • Myxoid degeneration of blood
  • Blood regurgitates during ventricular contraction producing pan-systolic murmur
  • can rupture papillary muscle
31
Q

What is mitral valve prolapse?

A
  • Myxomatous degeneration of mitral valve

- One or both mitral leaflets floppy and prolapse/ balloon back into LA during systole

32
Q

Describe the aetiology of mitral prolapse

A
  • Unknown in most most cases

- Uncommonly associated with Marfan’s syndrome

33
Q

What complications are associated with mitral valve prolapse?

A
  • Usually asymptomatic
  • IE
  • Mitral regurgitation
  • Stroke or other systemic infarct
  • Arrhythmias- both ventricular and atrial
  • MVP more common cause of mitral valve surgery
34
Q

Describe the histology of mitral valve prolapse

A
  • Key change in tissue is marked thickening of spongiosa layer with deposition mucoid material
  • -> Myxomatous degeneration
35
Q

How does mitral stenosis present and why?

A
  • Diastolic murmur

- Obstruction of ventricular filling during diastole

36
Q

What is aortic regurgitation?

A
  • Blood regurgitates during ventricular relaxation causing a diastolic murmur
  • Common in aortic dissection
37
Q

What are the consequences of valvular diseases?

A
  • Hypertrophy of myocardium
  • Heart failure
  • Infective endocarditis
  • Cardiac arrhythmias

Pathology- CP (7 decks)

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