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CVS M2 > Valvular Diseases > Flashcards

Valvular Diseases Flashcards

1
Q

What are causes of stenosis?

A
  1. Post inflammatory scarring
  2. Calcification
  3. Congenital
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2
Q

What are causes of insufficiency?

A
  1. Post inflammatory scarring
  2. Developmental (ie. marfans caused by mutation in fibrillin)
  3. Degenerative (myxomatous degeneration of mitral valve)
  4. Infectious
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3
Q

Can stenosis and insufficiency co-exist?

A

yes

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4
Q

Which are side of heart are valves more affected?

A

left

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5
Q

What types of valves are at higher risk of damage?

A
  1. Congenital bicuspid aortic valve
  2. Valves damaged by RHD
  3. Prosthetic Valves
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6
Q

Risk factor for acceleration of aortic valve calcification?

A

Congenital bicuspid aortic valves

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7
Q

What does aortic valve calcification result in?

A

aortic stenosis

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8
Q

Pathogenesis of aortic valve calcification?

A

age associated degeneration

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9
Q

Who gets mitral valve prolapse commonly? Ratio?

A

Women. 7:1 F:M ratio

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10
Q

What is the pathogenesis of mitral valve prolapse?

A

Usually unknown, associated with Marfan (Fibrillin-1 mutation)

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11
Q

Characteristics of mitral valve prolapse?

A
  1. Ballooning of valvular cusps with affected leaflets thickened and rubbery
  2. Myxoid degeneration of valve leaflets
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12
Q

What is the end result of mitral valve prolapse?

A

Mitral Regurg

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13
Q

Pathogenesis of RHD

A

Immune response to Gp A streptococcal antigens that cross react with host proteins

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14
Q

How to diagnose RHD?

A

JONES criteria - Joint, Myocarditis, Nodule, Erythema, Syndenham Chorea;

Minor: CSR, ERP, Arthralgia, Fever,

Diagnosis: Antistreptolysin O titre OR 2 major OR 1 major 2 minor

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15
Q

Morphology of Acute RHD?

A
  1. pancarditis
  2. aschoff bodies
    - t cells
    - plasma cells
    - aschoff giant cells
    - caterpillar cells (activated macrophages)
  3. verrucae
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16
Q

Morphology of Chronic RHD?

A
  1. Inflammation, Fibrosis, Damage to Valves
    - Always involve mitral valve with a smaller proportion the aortic valve
    - Tricuspid and pulmonary valve involvement infrequent
    - leads to stenosis or regurg
17
Q

Pt with chronic RHD predisposed to which 3 diseases?

A
  1. Infective endocarditis
  2. Thromboembolism
  3. Arrythmias
18
Q

Pathogenesis of Infective Endocarditis?

A
  1. Microbial infection of cardiac valves or endocardium = formation of vegetations = tissue destruction
19
Q

Percentage of IE cases with a) mitral valve b) aortic valve c) tricuspid valve d) prosthesis e) Congenital Heart Diseases involvement

A

a) 25-30%
b) 25-35%
c). 10%
d) 10%
e) 10%

20
Q

Common pts that get IE?

A
  1. IV drug abusers
  2. Open Heart Surgery
  3. Septicaemia pt
21
Q

When might one get subacute IE?

A
  1. Insidious infection of abnormal heart valves (Congenital defects, prosthetic)
  2. Organisms of low pathogenicity derived from normal commensals of skin, mouth and gut
22
Q

Organisms implicated in a) subacute IE, b) acute IE c) prosthetic valve IE d) other bacteria e) other organisms

A

a) step. viridans
b) s. aureus
c) s. epidermidis
d) enterococci, HACEK
e) fungi

23
Q

What can predispose one to IE?

A
  1. Abnormal Valves
  2. Micro-organism seeding into blood
    - dental or surgical procedure
    - contaminated needle shared by IV drug users
    - breaks in epithelial barriers of the gut, oral cavity, skin
24
Q

Complications of IE?

A

Local
- valve rupture
- myocardial ring abscess
- suppurative pericarditis

distant
- septic emboli
- immune complex
- anemia of chronic disease
- splenomegaly

25
Q

other causes of vegetations (other than RHD and IE)

A
  1. Nonbacterial thrombotic endocarditis
  2. Libman-Sacks Endocarditis (lupus)
26
Q

What patients have Nonbacterial thrombotic endocarditis?

A

cancer/sepsis pt

27
Q

pathogenesis of nonbacterial thrombotic endocarditis?

A

hypercoagulability of blood forming small, non infective platelet rich vegetations on heart valves

28
Q

complications of heart valvular disease

A

heart
- heart failure
- hypertrophy of LV
- arrythmias
- ischemia
- predisposition to IE

lung
- congestion
- pul hTn

CVS M2 (10 decks)

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