Valvular Disease Flashcards
What is the most common valvular disease?
calcific aortic stenosis
What are the mechanisms of aortic stenosis?
- aortic valve sclerosis
- bicuspid aortic valve
- rheumatic fever -> aquired bicuspid aortic valve
What is aortic valve scleoris?
calcification and fibrosis of the aortic valve preventing full opening of the valve
mechanisms similar to those of athersclerosis and with similar risk factors:
- age
- HTN
- hyperlipidemia
- inflammation
When is aortic valve sclerosis seen?
age 60-80
What is a bicuspid aortic valve?
congenital fusion of 2 of the 3 arotic valve leaflets
-predisposes to valve calcification (seen earlier)
can be aquired as a result of rheumatic heart disease
What changes occur in the heart due to aortic stenosis?
increased resistance of the aortic opening -> increased pressure -> LVH
What is the clinical presentation of aortic stenosis?
initially asymptomatic
progression may lead to symptoms with exertion and eventually at rest
Presentation:
- systolic ejection murmur (crescendo-decrescendo)
- > angina -> syncope -> CHF
What is the prognosis and treatment for aortic stenosis?
prognosis worsens with progression of symptoms
-angina -> syncope -> CHF = approx. 5, 3, and 2 years respectively until death
threatment is surgical aortic valve replacement/repair:
-in symptomatic or functionally deficient pts
What is mitral annular calcification?
calcification of the mitral annulus at the base of the mitral leaftlets
What is the epidemiology of mitral annular calcification?
- females
- >60
How does mitral annular calcification present?
Complications?
normally remains asymptomatic
Complications:
- mitral regurgitaiton
- mitral stenosis
- arrhythmia
- thrombus formation
- infective endocarditis
What is mitral valve prolapse?
(causes)
mitral valve leaflets prolapse into LA during LV contraction
Causes:
- mostly idiopathic
- connective tissue diseases (Marfan and Ehlers-Danlos)
- ischemia; chordae tendinae damage
- rheumatic heart disease
What structural findings are associated with mitral valve prolapse?
- thick and rubbery leaflets; deposition of GAGs -> myxomatous degeneration
- “hooding” of leaflets
What is the epidemiology of mitral valve prolapse?
- relatively common 2-3% of adults
- 7:1 female predominance
How does mitral valve prolapse present?
Complications?
asymptomatic with mid-systolic click; murmur if reguritaiton is present
Complicaitons:
-mitral regurgitation; most common cause in developed countries
Rare:
- infective endocarditis
- mitral insufficiency (possible chordal rupture)
- arrhythmia (typically atrial, rarely ventricular)
- thromboembolism
What is the prognosis and treatment for mitral valve prolapse?
very good prognosis; serious complications are rare
generally does not require treatment itself beyond treatment of complications
What is rheumatic fever?
autoimmune condition triggered by molecular mimicry of M streptococcal Ag of group A streptococcus
Ab and cell-mediated reaction to heart, joints, soft tissue, skin, and nervous system
What is the clinical presentation of rheumatic fever?
occurs 2-4 weeks after group A strep infection
Presentation:
- fever >101 + J♥(O)NES criteria
- Joints: migratory polyarthritis (mostly large joints)
- ♥: pancarditis (endo, myo, and pericarditis)
- Nodules: subcutaneous nodules
- Erythema marginatum (ring-shaped macular rash)
- Sydenham chorea (ballismus occasionally w/ behavorial changes)
What tests are used to diagnose rheumatic fever?
- antistreptolysin O (ASO)
- antistreptococcal DNAse B (ADB)
cannot culture for strep as inciting infeciton has likely resolved
What are complications of rheumatic fever?
collectively refered to as rheumatic heart disease
Acute (inflammation):
- pancarditis
- verrcurae, valvular vegetations
- MacCallum plaque (thickened posterior LA wall)
Chronic (valvular changes):
- valvular lesions -> regurgitaiton/stenosis
- affects mitral > aortic > tricuspid (rarely pulmonary); MAT
-LAE -> A-fib
-infective endocarditis
What pathologic findings are associated with the heart in rheumatic fever?
Aschoff bodies:
-lesions in the heart consisting of T-cells, plasma cells, and Anitschkow cells
Anitschkow cells:
- **pathognomonic** for rheumatic fever
- macrophage
- caterpilar-like chromatin
- owl-eye apperance
What is infective endocarditits?
(risk factors)
infection of damaged cardiac valves or structural anomalies in the heart
Risk factors:
- male
- age >60
- IVDU
- body peircings
- poor dentition; dental procedures
What organisms are responsible for infective endocarditits?
native, structurally abnormal valves -> Streptococcus viridians
poor dentition -> HACEK (Heomphilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)
prosthetic valves -> Staphylococcus epidermidis
IVD -> Staphylococcus aureus
What valves does infective endocarditis normally effect?
mitral > aortic > tricuspid > pulmonary (same order as rheumatic heart disease)
IVD particularlly affects the right sided valves -> tricuspid/pulmonary
What is the clinical presentation of infective endocarditis?
Acute endocarditits:
- rapid onset of high fever + extracardiac manifestations
- typically S. aureus
Subacute endocarditis:
-slow onset of low fever + extracardiac manifestations
Extracardiac manifestations:
- splinter hemorraghes
- Osler nodes (painful nodules on pads of fingers/toes)
- Roth spots (retinal hemorrhages with pale center)
- Janeway lesions (non-tender, macules on palms and soles)
What is nonbacterial thrombotic endocarditis?
(cause)
sterile valvular thrombi
caused by procoagulative states:
- sepsis
- cancer
- antiphospholipid syndrome
- SLE -> Libman-Sacks
What is carcinoid heart disease?
(pathophysiology)
caused by mediators released by carcinoid tumors; most commonly serotonin
liver clears excess serotonin from carcinoid tumors, progression of tumor growth can produce too much serotonin for the liver to clear or metastasis to the liver can occur allowing serotonin to enter hepatic vein and reach heart
serotonin stimulates fibrosis of the cardiac valves
What valves are typically affected in carcinoid heart disease?
right sided valves, tricuspid > pulmonary
pulmonary tissue also clears serotonin, protecting left valves
How does carcinoid syndrome/carcinoid heart disease present?
Systemic/carcinoid syndrome:
- flushing
- dermatitis
- bronchoconstriction
- diarrhea
Heart:
-tricuspid insufficiency -> right sided heart failure
