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Pathoma pathology > Valvular disorders > Flashcards

Valvular disorders Flashcards

1
Q

What are the four valves in the heart and what is their function?

A

tricuspid, pulmonary, mitral, and aortic that prevent
back flow.

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2
Q

What is the general effect of valvular lesions?

A

Valvular lesions generally result in stenosis (decreased caliber of the valve orifice) or regurgitation (backflow).

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3
Q

What is Rheumatic Fever?

A

Rheumatic fever (RF) is an illness which arises as a complication of untreated or inadequately treated strep throat infection. Rheumatic fever can seriously damage the valves of the heart.

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4
Q

What complication leads to acute rheumatic fever?

A

Systemic complication of pharyngitis due to group A [5-hemolytic streptococci; affects children 2 - 3 weeks after an episode of streptococcal pharyngitis (“strep
throat”)

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5
Q

What causes Acute rheumatic fever?

A

Caused by molecular mimicry; bacterial M protein resembles proteins in human tissue.

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6
Q

How is Acute Rheumatic fever diagnosed?

A

Diagnosis is based on Jones criteria.

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7
Q

What is jones criteria?

A
  1. Evidence of prior group A |5-hemolytic streptococcal infection (e.g., elevated ASO or anti-DNase B titers) with the presence of major and minor criteria
  2. Minor criteria are nonspecific and include fever and elevated ESR.
  3. Major criteria
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8
Q

What are the major criterias in jones criteria?

A
  1. Migratory polyarthritis
  2. Pancarditis

3-Subcutaneous nodules
4. Erythema marginatum

5.Sydenham chorea

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9
Q

What is Migratory polyarthritis?

A

swelling and pain in a large joint (e.g., wrist, knees, ankles) that resolves within days and “migrates” to involve another large joint

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10
Q

What is pancarditis?

A

diffuse inflammation of the heart

  • *a. Endocarditis**—Mitral valve is involved more commonly than the aortic valve. Characterized by small vegetations along lines of closure that lead to regurgitation
  • *b. Myocarditis** with Aschotf bodies that are characterized by foci of chronic inflammation, reactive histiocytes with slender, wavy nuclei (Anitschkow cells), giant cells, and fibrinoid material; myocarditis is the most common cause of death during the acute phase.
  • *c. Pericarditis**—leads to friction rub and chest pain
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11
Q

What is Erythema marginatum?

A

annular, nonpruritic rash with erythematous borders, commonly involving trunk and limbs

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12
Q

What is Sydenham chorea?

A

rapid, involuntary muscle movements

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13
Q

What is the complication of acute rheumatic fever?

A

Acute attack usually resolves, but may progress to chronic rheumatic heart disease; repeat exposure to group A -hemolytic streptococci results in relapse ol the acute phase and increases risk for chronic disease

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14
Q

What is the consequence of rheumatic fever in chronic rheumatic heart disease?

A

Valve scarring that arises as a consequence of rheumatic fever

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15
Q

What is the most common structures affected in Chronic Rheumatic Fever?

A

Almost always involves the mitral valve; leads to thickening of chordae tendineae and cusps

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16
Q

What is the hearts usual appearance in Chronic rheumatic fever?

A

Results in stenosis with a classic ‘fish mouth’ appearance

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17
Q

What is the second most common valve affected in chronic rheumatic heart disease?

A

Occasionally involves the aortic valve; leads to fusion of the commissures

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18
Q

What is the main complication in chronic rheumatic heart disease?

A

Complications include infectious endocarditis.

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19
Q

What is Aortic Stenosis?

A

Narrowing of the aortic valve orifice

20
Q

What is the usual cause of aortic stenosis?

A

Usually due to fibrosis and calcification from “wear and tear”

21
Q

At what age does Aortic stenosi usually occur?

A

Presents in late adulthood (> 60 years)

22
Q

What valve disorderincreases risk and hastens aortic stenosis?

A

Bicuspid aortic valve increases risk and hastens disease onset. A normal aortic valve has three cusps; fewer cusps results in increased “wear and tear” on each cusp.

23
Q

Can chronic rheumatic valve disease cause aortic stenosis?

A

May also arise as a consequence of chronic rheumatic valve disease; coexisting mitral stenosis and fusion of the aortic valve commissures distinguish rheumatic
disease from “wear and tear.”

24
Q

What sound is heard in aortic stenosis and when?

A

Cardiac compensation leads to a prolonged asymptomatic stage during which a systolic ejection click followed by a crescendo-decrescendo murmur is heard.

25
Q

What are the complications in aortic stenosis?

A
  • *1. Concentric left ventricular hypertrophy**—may progress to cardiac failure
  • *2. Angina and syncope with exercise**—Limited ability to increase blood flow across the stenotic valve leads to decreased perfusion of the myocardium and brain,
  • *3. Microangiopathic hemolytic anemia**— RBCs are damaged (producing schistocytes) while crossing the calcified valve.
26
Q

What is the treatment in aortic stenosis?

A

Treatment is valve replacement after onset of complications.

27
Q

What is aortic regurgitation?

A

Backtlow of blood from the aorta into the left ventricle during diastole

28
Q

What is the cause of aortic regurgitation?

A

Arises due to aortic root dilation (e.g., syphilitic aneurysm and aortic dissection) or valve damage (e.g.. infectious endocarditis); most common cause is isolated root dilation

29
Q

What are the clinical features in aortic regurgitation?

A
  1. Early, blowing diastolic murmur
  2. Hyperdynamic circulation due to increased pulse pressure
  3. Results in LV dilation and eccentric hypertrophy (due to volume overload)
30
Q

What is pulse pressure?

A

Pulse pressure is the difference between systolic and diastolic pressures

31
Q

Why does the diastolic pressure decrease and the systolic increase in aortic regurgitation?

A

Diastolic pressure decreases due to regurgitation, while systolic pressure increases due to increased stroke volume

32
Q

What are the caracteristics of the pulse in aortic regurgitation?

A

Presents with bounding pulse (water-hammer pulse), pulsating nail bed (Quincke pulse), and head bobbing

33
Q

What is the treatment in aortic regurgitation?

A

Treatment is valve replacement once LV dysfunction develops

34
Q

What is mitral valve prolapse?

A

Ballooning of mitral valve into left atrium during systole

35
Q

Why does mitral prolapse happen?

A

Due to myxoid degeneration (accumulation of ground substance) of the valve, making it floppy

36
Q

What is the etiology of mitral valve prolapse?

A

Etiology is unknown; may be seen in Marfan syndrome or Ehlers-Danlos syndrome

37
Q

What sound does mitral prolapse do?

A

Presents with an incidental mid-systolic click followed by a regurgitation murmur; usually asymptomatic

38
Q

How does squatting affect mitral prolapse sound?

A

Click and murmur become louder with squatting (increased systemic resistance decreases left ventricular emptying).

39
Q

What are the complications in mitral prolapse?

A

Complications are rare, but include infectious endocarditis, arrhythmia, and severe mitral regurgitation.

40
Q

What is the treatment in mitral prolapse?

A

Treatment is valve replacement.

41
Q

What is mitral regurgitation?

A

Reflux of blood from the left ventricle into the left atrium during systole

42
Q

Why does mitral regurgitation happen?

A

Usually arises as a complication of mitral valve prolapse; other causes include LV dilatation (e.g., left-sided cardiac failure), infective endocarditis, acute rheumatic heart disease, and papillary muscle rupture after a myocardial infarction.

43
Q

What are the clinical features in mitral regurgitation?

A
  1. Holosystolic “blowing” murmur; louder with squatting (increased systemic resistance decreases left ventricular emptying) and expiration (increased return to left atrium)
  2. Results in volume overload and left-sided heart failure
44
Q

What is Mitral stenosis?

A

Narrowing of the mitral valve orifice

45
Q

Why does mitral stenosis usually happen?

A

Usually due to chronic rheumatic valve disease

46
Q

What are the clinical features in mitral stenosis?

A
  1. Opening snap followed by diastolic rumble
  2. Volume overload leads to dilatation of the left atrium
47
Q

what does the dilatation of the left atrium lead to in mitral stenosis?

A

Pathoma pathology (7 decks)

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