Valvular Disorders

Question 1

Acute Rheumatic Fever (cause and 5 major criteria)

Answer 1

About 2-3 weeks post GAS (Beta-hemolytic) caused by molecular mimicry from bacterial M protein
Jones Criteria - Migratory polyarthritis, pancarditis, Subcutaneous nodules, erythema marginatum (commonly involving trunk and limbs, has red border), Sydenham chorea (rapid involuntary movements)

Question 2

Pancarditis from Acute Rheumatic Fever (complication, histological findings, clinical finding)

Answer 2

Endocarditis most commonly on mitral valve leading to regurg
Myocarditis with Aschoff bodies (focal inflammation/Anitschkow cells (reactive histiocytes with wavy nuclei)) - most common cause of death
Pericarditis with friction rub and chest pain)

Question 3

Chronic Rheumatic Heart Disease

Answer 3

Increased risk from multiple acute infections leads to scarring -> MV stenosis and maybe aortic later with fusion of the commisures (fish mouth)

Question 4

Aortic Stenosis (cause, 2 ways to distinguish isolated from chronic rheumatic heart disease, auscultation)

Answer 4

Usually just age/wear and tear, but bicuspid increases this and can occur earlier
Chronic RHD will have coexisting MV stenosis (because that occurs first) and fusion of commisures
Has systolic ejection click followed by crescendo-decrescendo murmur

Question 5

Aortic Regurg (cause, clinical findings, auscultation, hypertrophy)

Answer 5

From aortic root dilatation like from syphilis or something
Will have increased pulse pressure with bounding pulses/pulsating nail bed (Quincke pulse)/HEAD BOBBING
Early, blowing diastolic murmur
LV dilation with eccentric hypertrophy

Question 6

Mitral Valve Prolapse (cause, auscultation)

Answer 6

From myxoid degeneration of valve, maybe from Marfan’s or EDS or something
Has mid-systolic click followed by regurg murmur, louder with squatting

Question 7

Mitral Regurg (causes, auscultation)

Answer 7

Mitral valve prolapse, LV dilatation, ACUTE rheumatic heart disease, papillary muscle rupture after MI
Holosystolic blowing murmur louder with squatting and expiration (increased venous return)

Question 8

Mitral Stenosis (cause, auscultation, 2 complications)

Answer 8

Usually CHRONIC rheumatic heart disease
Opening snap followed by diastolic rumble
V overload can lead to pulmonary HTN/congestion/hemorrhage and RHF
Also stretch of wall can lead to atrial fibrillation/thrombi