Valvular Disease I

Question 1

describe basic anatomy of valves

Answer 1

endocardium, covered by endothelium, interior of dense connective tissue (collagen and elastin), thin and transparent

Question 2

basic mitral valve anatomy

Answer 2

two leaflets- anterior and posterior

two pap muscles w/ chordinae tendinae

4-6 cm orifice

Question 3

vessels surrounding mitral valve

Answer 3

coronary sinus and LCx artery

Question 4

a murmur found in healthy adult

Answer 4

soft flow murmur at left sternal border

Question 5

pericardial rub

Answer 5

squeaky sound of rubbing of visceral and parietal pericardial layers

Question 6

snap

Answer 6

high frequency sound after S2, from the sudden arrest of the mitral/tricuspid valve opening

Question 7

which valve disorders are diastolic murmurs? systolic?

Answer 7

MS and AR are diastolic, AS and MR are systolic

Question 8

what is bicuspid aortic valve?

Answer 8

congenital fusion of 2/3 cusps during development

Question 9

associations w/ bicuspid aortic valve

Answer 9

coarcted aorta, turner syndrome (45,X), dilation of ascending aorta

Question 10

consequences of bicuspid aortic valve/dilation of aorta

Answer 10

more likely to rupture and need aneurysm screening- repair at 5 cm rather than 5.5

Question 11

pathology of mitral valve prolapse

Answer 11

valve collagen/elastic fibers fragment and accumulation of myxomatous connective tissue

causes weakened leaflet stretch followed by prolapsing into LA during systole

Question 12

clinical assoc w/ mitral valve prolapse

Answer 12

infective endocarditis, palpations, arryhthmias

mitral regurg, this is what determines surgery or no (often repair not replace)

Question 13

etiology of mitral valve prolapse

Answer 13

genetic, CT diseases like Marfans

Question 14

etiology of rheumatic heart disease

Answer 14

group A beta-hemolytic strep (pyogenes), strep pharyngitis can progress to acute rheumatic fever if cardiac cells attacked by Abs

Question 15

Dx of Acute rheumatic fever

Answer 15

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

Question 16

pathogenesis of ARF

Answer 16

antibodies to GAS protein M antigens attack cardiac cells, most importantly endocardial valves

Question 17

gross pathology of ARF

Answer 17

swollen valves w/ fibrin vegetations at edges

Question 18

histopath of ARF

Answer 18

granulomas/Aschoff Bodies, dgenerated collagen

presence of macrophages in the granulomas calls Anischkow cells (owl eye/caterpillar nucleus)

Question 19

pathogenesis of chronic rheumatic heart diseaes

Answer 19

repair from rheumatic fever w/ fibrosis of the heart valves

Question 20

gross patho of CRHD

Answer 20

thickened valves (maybe fusion), stiff valves, thick and short chordae tendinae

Question 21

define endocarditis

Answer 21

infection of endocardium, especially the valves following fibrin vegetation and infection/inflammation

Question 22

IE etiology

Answer 22

mostly bacterial

Question 23

two subtypes of IE

Answer 23

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

Question 24

complications of IE

Answer 24

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

Question 25

common feature of cardiac lesions predisposing to IE

Answer 25

disruption of the endothelial surface of endocardium

ex) AS, AR, MR, MVP, congenital heart defects, prosthetic heart valve

Question 26

typical organisms of IE

Answer 26

Staph: staph aureus, coag neg staph

strep: S viridans, enterococci

culture neg: (HACEK)
Haemophilus
Aggregatibacter
Cardiobacterium
Eikenella
Kingella

Question 27

Tx for IE

Answer 27

IV and oral antibiotics, surgery to remove vegetations or replace valves

Question 28

IE prophylaxis

Answer 28

antibiotics in pts about to have procedures that produce bacteremia, any patients w/ conditions that predispose to IE (valve or cardiac lesions)

Question 29

pathogenesis of calcific valvular disease

Answer 29

similar to atherosclerosis, left sided valves have wear and tear (in old ppl) and become thickened and rigid w/ calcification on the cusps

Question 30

clinical aspects of calcific valvular disease

Answer 30

cause AS, MS/MR, only Tx is replacement

Question 31

nonbacterial thrombotic endocarditis- epi and patho

Answer 31

aka marantic endocarditis, occurs in pts w/ wasting diseases like cancer, sterile fibrin vegetations on LV valves can embolize and infarct

Question 32

define carcinoid tumor

Answer 32

malignancy of neuroendocrine cells that produce abnormally high levels of serotonin

Question 33

patho of carcinoid tumor w/ valvular disease

Answer 33

serotonin induces fibrosis of valves in right heart, thickening and restriction of RV valves, severe tricuspid regurg and pulmonary stenosis

Question 34

4 other causes of valvular heart disease

Answer 34

trauma (eg ruptured pap muscle), syphilis (dilated aortic root), ankylosing spondylisis (chronic inflammation- fibrosis), marfans (aortic root dilation, MVP)