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Valvular Disease, infections, vasculitis Flashcards

1
Q

what is the most common mitral valve disease?

A

mitral valve prolapse?

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2
Q

who gets mitral valve prolapse?

A

young to middle aged women mostly

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3
Q

who gets mitral valve prolapse?

A

young to middle aged women mostly

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4
Q

what are some signs and symptoms of mitral valve prolapse?

A

cardiac arrhythmias, mitral regurgitation, valve incompetence, infective endocarditis, stroke from thrombus, chordae tendinae rupture

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5
Q

what are pathological findings in mitral valve prolapse?

A

myxomatous degeneration

associated with connective tissue diseases - marfans

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6
Q

what are auscultatory findings in mitral valve prolapse?

A

midsystolic click and late systolic murmur

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7
Q

what are treatments of mitral valve prolapse?

A

acute: diuretics, vasodilators, sodium nitroprusside, cardiogenic shock –> IABP, severe? –> MV repair/replacement

chronic: diuretics
hypertensive? –> vasodilator (sodium nitroprusside), MV replacement/repair

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8
Q

what are causes of mitral stenosis?

A 
congenital deformities
systemic disease (SLE, RA, carcinoid syndrome)
pseudo mitral stenosis
mitral annular calcification
rheumatic valvular disease
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9
Q

what are signs and symptoms of mitral stenosis?

A

infective endocarditis, stroke from thrombus, cardiac arrhythmia, dyspnea and cough, orthopnea, chest pain, hoarseness, peripheral edema, fatigue, passively leads to RVH

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10
Q

what are pathological findings of mitral stenosis?

A

calcification of mitral valve
JVP wave shifted up
transvalvular gradient increased (magnitude tells you about severity)

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11
Q

what are auscultatory findings of mitral stenosis?

A

diastolic rumble
possible presystolic accentuation of murmur
with increased severity: holodiastolic murmur
OS (decrease in A2 to OS with increased severity)

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12
Q

what are treatments for mitral stenosis?

A 
volume management
rate control
treat coexisting conditions
percutatneous balloon valvulopathy
mitral valve commisurotomy
mitral valve replacement
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13
Q

what are pathological findings of rheumatic valvular disease?

A

chronic: thickening and fibrosis of valve –> stenosis and regurgitation (Dx w/ ultrasound)

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14
Q

what are auscultatory findings in rheumatic valvular disease?

A

transient regurgitant murmurs, mid-diastolic murmurs (Carey-Coons murmur)

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15
Q

what are causes of mitral regurgitation?

A 
mitral valve prolapse
rhemuatic valvular disease
endocarditis
dilated cardiomyopathy
coronary ischemia
trauma
systemic disease
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16
Q

what is the effect of mitral regurgitation on JVP

A

prominent v waves and rapid y descent

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17
Q

what are auscultatory findings in mitral regurgitation

A

pan or holosystolic murmur
early diastolic murmur
possible S3
(5th ICS in anteroaxillary line and radiates to axilla)

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18
Q

what are causes of aortic stenosis?

A

congenital (bicuspid)
rheumatic valve disease: ARF –> valvulitis (concomitant MVD (esp women)
calcific degeneration from atherosclerosis, rheumatic fever or endocarditis
systemic disease

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19
Q

what are symptoms of aortic stenosis

A 
pulmonary edema and hypertension
angina
syncope
dyspnea and CHF,
massive LVH
mitral regurgitation
aortic dissection
aortic valve perforation
MI
cardiac arrhythmia
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20
Q

what are pathological findings in aortic stenosis?

A

inferolateral displacement of PMI
duration of apical impulse prolonged
contour of carotid pulse decreases in amplitude and delay in contour of carotid upstroke = pulsus parvus et tardus

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21
Q

auscultatory findings in aortic stenosis?

A

rhomboid SEM (peaks later with severity)
early systolic ejection click
splitting of S2 narrows (with possible paradoxical splitting)
S4 possible

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22
Q

what are treatments for aortic stenosis?

A 
diuretics
digoxin
dopamine 
dobutamine
aortic valve replacement
percutaneous balloon valvuloplasty
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23
Q

what is the most common congenital CV abnormality

A

bicuspid aortic valve

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24
Q

what are signs and symptoms of bicuspid aortic valve

A

aortic dissection –> severe tearing chest pain radiating back
endocarditis
responsible for 50% of aortic stenosis cases
EKG shows LVH

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25
causes of aortic regurgitation
acquired: RVD, endocarditis, aortic root disease, systemic diseases congenital: bicuspid or quadricuspid, sinus of valsalva aneurysm, subaortic membranes, subaortic VSD
26
signs and symptoms of aortic regurgitation?
chronic: CHF, eccentric hypertrophy, progressive LV cavity dilation, increase in wall thickness, cardiomegaly, increased myocardial mass LV wall stress, increased afterload mismatch and LV systolic dysfunction widening of aortic pulse pressure acute: pulmonary edema,
27
what are pathological findings in aortic regurgitation
``` long latent period without symptoms laterally displaced PMI Quinke's sign Corrigan's water hammer pulse Deroziez's sign Hill's sign ```
28
what are auscultatory findings in aortic regurgitation
``` diastolic murmur (3rd or 4th ICS at LSB) descrescendo appreciated along RSB if related to aortic root dilation (Harvey's sign) severity associated with duration rather than intensity austin-flint murmur: low frequency diastolic murmur ```
29
what are treatment options for aortic regurgitation?
valve replacements echos: 1-2 yrs if asymptomatic and mild and normal LV 6-12 months if asymptomatic, moderate/severe aortic regurgitation, preserved LV if preserved LV systolic function and diastolic hypertension --> diuretics, sodium restriction and vasodilator therapy (nifedipine or ACE inhibitors) aortic root replacement in those with concomitant aortic pathology NO IABP
30
what are causes of carcinoid heart disease?
tumor produces 5-HT or other vasoactive compounds thickened valvular plaques made of smooth muscle collagen and matrix thickened tricuspid valve and fusion of the chordae tendinae associated with the carcinoid tumors
31
why don't GI carcinoids cause heart lesions?
metabolized by liver
32
how do you get left side lesions?
exogenous vasoactive peptide use, rare otherwise
33
what is unique about carcinoid heart disease?
right sided valve disease
34
what is rheumatic endocarditis?
fibrinous necrosis of cusps and cords vegetations overlie areas of necrosis inflammation of the heart damage to heart tissues
35
what is the cause of rheumatic valvular disease?
antigenic cross reaction between streptrococcus and heart disease direct invasion by bacteria immune cross reaction to heart tissues
36
who commonly gets rheumatic valvular disease?
children from 5 to 15
37
what is the pathology of rheumatic valvular disease?
composed of fibrin, inflammatory cells --> scarring and deformity of valve results in valve stenosis and insufficiency typical course of RF dose not involve rheumatic heart disease
38
What is non-bacterial thrombotic endocarditis?
a bland thrombus that sits on valve surface no bacteria no inflammation can flick off clots to other organs
39
what are the clinical manifestations of NBTE?
valve stenosis or insufficiency stroke lower extremity ischemia associated with hypercoagulable states
40
who gets NBTE?
people with debilitating diseases like cancer
41
who gets libman-sacks?
sle
42
what is libman sack endocarditis?
non-infectious small thrombi on outer and inner surgaces of mitral and tricuspid may also occur on chrdae and ventricular wall
43
what is the pathology of libman-sacks?
valve lesions: composed of fibrin, cellular debris can become active with valvulitis
44
what is the most common cause of pulmonic stenosis?
congenital
45
what valves are most commonly affected?
mitral and aortic
46
what is the most common etiology of valve disease?
calcific degeneration
47
what are causes of LVH?
hypertension and hypertrophic myopathy
48
why can you get atrial fibrillation from mitral stenosis?
atrial chamber dilates resulting in improper electrical signal conduction when the mitral valve is narrowed or blocked
49
what is the most common acquired valvular heart disease?
aortic stenosis
50
what are three complications you see with any abnormal valve?
cardiac arrhythmia, thrombosis, infection
51
what is endocarditis?
inflammation of heart typically involve valves
52
what is myocarditis?
inflammation of heart muscle caused by viruses, immune reactions (lupus, RF) transplant rejection and drug reaction
53
what is pericarditis?
inflammation of the outside of the heart and heart sac, primary pericarditis is viral typically see accompanying fluid collection
54
what are clinical findings of pericarditis?
chest pain, sharp retrosternal, radiates back relieved by sitting up or leaning forward worsened with lying down friction rub **cardiac tamponade** Jugular venous distention, hypotension, muffled heart sounds emergent treatment = pericardiocentesis
55
what are complications of pericarditis?
acute complications: cardiac tamponade, cardiac arrhythmia | chronic: scarring with adhesions
56
what are requirements for pathology diagnosis?
inflammatory infiltrates, myocyte damage and/or necrosis
57
what is the difference between acute and subacute bacterial endocarditis?
acute: normal valve, highly virulent organism, rapid course with high mortality subacute: abnormal valve; less virulent organism, protracted course (weeks to months)
58
what are signs and symptoms of bacterial endocarditis?
Duke criteria (2M or !M +3m or 5m) Pathology: bugs, histology Major: blood, echo dx, new regurgitation Minor: abnormal valve, IVDA fever, classic lesion, single unusual blood culture, echo suggestive
59
what histological findings do you see in bacterial endocarditis?
acute inflammation inflammatory debris bacteria colonies s. epidermitis, s. aureus, p. aeruginosa in IV drug users or contaminated water supplies
60
what lesions do you see in bacterial endocarditis
``` septic emboli to other organs and issues splinter hemorrhages janeway lesions osler nodes roth's spots kidney abscesses brain infarcts ```
61
what are complications of bacterial endocarditis
``` destruction/rupture of valve heart failure valve insufficiency septic emolic events subacute: valve fibrosis and stenosis ```
62
what are histological findings in rheumatic myocarditis?
aschoff body: diagnostic myocardial lesion, composed of t cells, plasma cells and activated macrophages, anitschow cells - diagnostic cell, activated macrophages with slender wavy chromatin "caterpillar cells"; multinucleated
63
what are complications associated with rheumatic myocarditis?
endocarditis, myocarditis (usually cause of death), pericarditis, pancarditis
64
what is the cause of viral myocarditis?
infection viral: coxsackie, influenzae chagas disease lyme disease
65
what are signs and symptoms of viral myocarditis?
viral illness symptoms, cardiac arrhythmia, palpitations, dypnea, pre-cordial discomfort, can progress rapidly to heart failure and death
66
what are pathological findings in viral myocarditis?
gross pathology pale floppy myocardium microscopic pathology: lymphocytic infiltrate myocyte necrosis clinical pathology: elevated CK-MB and troponins
67
what are complications of viral myocarditis?
chronic heart disease dilated cardiomyopathy can lead to death
68
what is eosinophillic myocarditis?
``` drug reaction (hypersensitivity) caused by antibiotics, chemotherapeutics typically have rash or other immune response chagas disease (protozoal infection) trypanosoma cruzi kissing bug achalasia in GI path ```
69
what is giant cell myocarditis
unusual variant of garden variety myocarditis mixed infiltrate with giant cells more extensive myocyte necrosis aggressive course with poor prognosis
70
what is the gross pathology of myocarditis?
pale yellow discoloration of myocardium
71
what is the etiology of serous pericarditis?
SLE, rheumatic fever, viral infection
72
what are the types of pericarditis?
serous, fibrinous, purulent, hemorrhagic
73
what are pathological findings in serous pericarditis?
straw-colored pericardial effusion | protein rich exudate
74
what is the etiology of fibrinous pericarditis?
acute myocardial infarction uremia - renal failure post-pericardotomy syndrome - after coronary artery bypass graft syndrome dressler's syndrome
75
what are the pathological findings in fibrinous pericarditis?
sticky adherent fibrin strands on surface | fibrin rich exudate
76
what is the etiology of purulent pericarditis?
infection
77
what are pathological findings in purulent pericarditis?
thick yellow effusion (pus) inflammatory exudate
78
what is the etiology of hemorrhadic pericarditis?
tumor invasion of pericardium tuberculosis bacterial infection
79
what is the most common organism for infective endocarditis?
s. aureus
80
what are causes of myocarditis?
viral, RF, chagas disease
81
what are pathologic criteria for diagnosis of myocarditis?
lymphocyte infiltrate and myocyte necrosis
82
what are the etiologies of the four types of pericarditis?
serous - RF, viral myocarditis fibrinous - renal failure and post-coronary graft surgery purulent - infection hemorrhagic - tumor
83
what are the clinical signs of pericarditis?
jugular venous distension, hypotension, muffled heart sounds
84
what are the types of large vessel vasculitis?
giant cell arteritis | takayasu arteritis
85
what are the types of medium vessel vasculitis?
polyarteritis nodosum kawasaki disease beurger
86
what are the types of small vessel vasculitis?
microscopy polyangitis, chrug-strauss, wegners
87
what is c- anca
serum Ab to neutrophils that binds proteinase 3 within cytoplasm
88
what is p-anca?
serum Ab to neutrophils that binds myeloperoxidase located at perinuclear area
89
what are pathological findings of hemorrhagic pericarditis?
bloody inflammatory effusion

Cardio (6 decks)

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