Valvular Disease I Flashcards
describe basic anatomy of valves
endocardium, covered by endothelium, interior of dense connective tissue (collagen and elastin), thin and transparent
basic mitral valve anatomy
two leaflets- anterior and posterior
two pap muscles w/ chordinae tendinae
4-6 cm orifice
vessels surrounding mitral valve
coronary sinus and LCx artery
a murmur found in healthy adult
soft flow murmur at left sternal border
pericardial rub
squeaky sound of rubbing of visceral and parietal pericardial layers
snap
high frequency sound after S2, from the sudden arrest of the mitral/tricuspid valve opening
which valve disorders are diastolic murmurs? systolic?
MS and AR are diastolic, AS and MR are systolic
what is bicuspid aortic valve?
congenital fusion of 2/3 cusps during development
associations w/ bicuspid aortic valve
coarcted aorta, turner syndrome (45,X), dilation of ascending aorta
consequences of bicuspid aortic valve/dilation of aorta
more likely to rupture and need aneurysm screening- repair at 5 cm rather than 5.5
pathology of mitral valve prolapse
valve collagen/elastic fibers fragment and accumulation of myxomatous connective tissue
causes weakened leaflet stretch followed by prolapsing into LA during systole
clinical assoc w/ mitral valve prolapse
infective endocarditis, palpations, arryhthmias
mitral regurg, this is what determines surgery or no (often repair not replace)
etiology of mitral valve prolapse
genetic, CT diseases like Marfans
etiology of rheumatic heart disease
group A beta-hemolytic strep (pyogenes), strep pharyngitis can progress to acute rheumatic fever if cardiac cells attacked by Abs
Dx of Acute rheumatic fever
Jones Criteria: Major- -Joint (polyarthritis) -Carditis (heart symbol instead of C is the O) -Nodules (subcutaneous) -Erythema Marginatum -Sydenham Chorea (involuntary movements)
need two or 1 w/ 2 minor criteria
pathogenesis of ARF
antibodies to GAS protein M antigens attack cardiac cells, most importantly endocardial valves
gross pathology of ARF
swollen valves w/ fibrin vegetations at edges
histopath of ARF
granulomas/Aschoff Bodies, dgenerated collagen
presence of macrophages in the granulomas calls Anischkow cells (owl eye/caterpillar nucleus)
pathogenesis of chronic rheumatic heart diseaes
repair from rheumatic fever w/ fibrosis of the heart valves
gross patho of CRHD
thickened valves (maybe fusion), stiff valves, thick and short chordae tendinae
define endocarditis
infection of endocardium, especially the valves following fibrin vegetation and infection/inflammation
IE etiology
mostly bacterial
two subtypes of IE
acute bacterial: acute fulminant infection, occurs w/ normal valves from virulent pathogens like S aureus, can have valve damage/necrosis
subacute: longer term course, less virulent (Strep viridans), occurs w/ abnormal heart valve, less likely to have damage/necrosis
complications of IE
fibrin thrombus (w/ or w/o bacteria) can embolize to CNS, kidneys, spleen, etc and cause infarct/abscess
visibly: spinter hemorrhage in fingernail and petechiae in eyes
common feature of cardiac lesions predisposing to IE
disruption of the endothelial surface of endocardium
ex) AS, AR, MR, MVP, congenital heart defects, prosthetic heart valve
typical organisms of IE
Staph: staph aureus, coag neg staph
strep: S viridans, enterococci
culture neg: (HACEK) Haemophilus Aggregatibacter Cardiobacterium Eikenella Kingella
Tx for IE
IV and oral antibiotics, surgery to remove vegetations or replace valves
IE prophylaxis
antibiotics in pts about to have procedures that produce bacteremia, any patients w/ conditions that predispose to IE (valve or cardiac lesions)
pathogenesis of calcific valvular disease
similar to atherosclerosis, left sided valves have wear and tear (in old ppl) and become thickened and rigid w/ calcification on the cusps
clinical aspects of calcific valvular disease
cause AS, MS/MR, only Tx is replacement
nonbacterial thrombotic endocarditis- epi and patho
aka marantic endocarditis, occurs in pts w/ wasting diseases like cancer, sterile fibrin vegetations on LV valves can embolize and infarct
define carcinoid tumor
malignancy of neuroendocrine cells that produce abnormally high levels of serotonin
patho of carcinoid tumor w/ valvular disease
serotonin induces fibrosis of valves in right heart, thickening and restriction of RV valves, severe tricuspid regurg and pulmonary stenosis
4 other causes of valvular heart disease
trauma (eg ruptured pap muscle), syphilis (dilated aortic root), ankylosing spondylisis (chronic inflammation- fibrosis), marfans (aortic root dilation, MVP)
