Valvular Disorders Flashcards
What is acute rheumatic fever? What organisms cause it and who does it affect? What process causes it?
Systemic complication of pharyngitis due to group A beta hemolytic streptococci. Affects children 2 - 3 weeks after an episode of streptococcal pharyngitis. Caused by molecular mimicry; bacterial M protein resembles proteins in human tissue
How is acute rheumatic fever diagnosed?
Based on Jones crtiteria
What are the components of the major criteria for diagnosing acute rheumatic fever?
- Migratory polyarthritis
- Pancarditis
- Subcutaneous nodules
- Erythema marginatum
- Syndeham chorea
Which structure is involved in Endocarditis in Jones criteria?
Mitral valve is more commonly involved than aortic valve. Characterized by small vegetations along lines of closure that lead to regurgitation
How is acute rheumatic fever diagnosed?
Based on Jones crtiteria with evidence of prior groud A beta-hemolytic streptococcal infecition (elevated ASO or anti-DNAse B titers) with the presence of major and minor criteria
Which structure is involved in Endocarditis in Jones criteria?
Mitral valve is more commonly involved than aortic valve. Characterized by small vegetations along lines of closure that lead to regurgitation
What is myocarditis characterized by in Jones criteria? What is the most common cause of death during the acute phase?
With Aschoff bodies that are characterized by foci of chronic inflammation, reactive histiocytes with slender wavy nuclei (Anitschkow cells), giant cells, and fibrinoid material. Myocarditis
What types of pancarditis are involved in the Jones criteria?
Endocarditis, Myocarditis, Pericarditis (leads to friction rub and pleuritis)
What does chronic rheumatic heart disease cause? Which structures are involved?
Results in stenosis with a classic ‘fish mouth ‘ appearance. Almost always involves the mitral valve, leads to thickening of chordae tendinae and cusps. Occassionally involve
What does chronic rheumatic heart disease cause? Which structures are involved? What are the complications it causes?
Results in stenosis with a classic ‘fish mouth ‘ appearance. Almost always involves the mitral valve, leads to thickening of chordae tendinae and cusps. Occassionally involves the aortic valve. Leads to fusion of the commissures. Complications include infectious endocarditis.
What is aortic stenosis? When does it present and what causes it?
Narrowing of the aortic valve orifice. Usually due to fibrosis and calcification from wear and tear. May also arise as a consequence of chronic rheumatic valve disease. Presents in late adulthood (> 60 years).
What is the difference between stenosis due to wear and tear and that of rheumatic disease?
Rheumatic disease has coexisting mitral stenosis and fusion of the aortic valve commissures.
What is heard on auscultation for aortic stenosis? What causes this presentation?
Cardac compensation leads to a prolonged asymptomatic stage during which a systolic ejection click is followed by a crescendo-descrescendo murmur.
What are the three complications of aortic stenosis? How is it treated?
- Concentric left ventricular hypertrophy 2. Angina and syncope with exercise 3. Microangiopathic hemolytic anemia (schistocytes). Valve replacement after onset of complications.
What is aortic regurgitation? What causes it? How is it treated?
Backflow of blood from the aorta into the left ventricle during diastole. Arises due to aortic root dilation (e.g. syphilitc aneurysm and aortic dissection or valve damage. Most common cause is isolated root dilation. Treatment is valve replacement once LV dysfunction develops.
What is aortic regurgitation? What causes it? How is it treated?
Backflow of blood from the aorta into the left ventricle during diastole. Ariswes due to aortic root dilation (e.g. syphilitc aneurysm and aortic dissection) or valve damage. Most common cause is isolated root dialtion. Treatment is valve replacement once LV dysfuntion develops.
What are the three clinical features of arotic regurgitation?
- Early blowing dyastolic murmur
- Hyperdynamic circulation due to increased pulse pressure
- Results in LV dialtion and ECCENTRIC hypertrophy due to volume overload
How does pulse pressure increase during aortic regurgitation?
Diastolic pressure decreases due to regurgitation, while systolic pressure increases due to increased stroke volume. Presents with a bounding pulse (water-hammer pulse), pulsating nail bed (Quincke pulse) and head bobbing.
What is mitral valve prolapse? What causes it? WHat syndromes is it associated with? How is it treated?
Ballooning of mitral valve into left atrium during systole. Seen in 2-3% of US adults. Due to myxoid degeneration of the valve making it floppy. Marfan syndroms or Ehlers-Danlos syndrome
How does mitral valve prolapse present on auscultation? How can the sound be modified? What are the complications of MVP?
Presents with an incidental mid-systolic click followed by a regurgitation murmur and is usually asymptomatic. Clock and murmur become softer with squatting (increased systemic resistanc decreases left ventricular emptying). Rare but include infectious endocarditis, arrythmia and severe mitral regurgitation
What are the clinical features of mitral regurgitation?
- Holosystolic blowing murmur which gets louder with squatting (increased systemic resistance decreases left ventricular emptying) and expiration (increased return to left atrium). Results in volume overload and left-sided heart failure
What is mitral regurgitation? What usually causes it?
Reflux of blood from the left ventricle into the left atrium during systole. Usally arises as a complicaation of MVP. Other causes include LV dilatation, infective endocarditis, acute rheumatic heart disease, paipllary muscle rupture after an MI
What is mitral stenosis and what causes it?
Narrowing of the mitral valve orifice. Usually due to chronic rheumatic valve disease.
What are the clinical features of mitral stenosis?
- Opening snap followed by a diastolic rumble 2. Volume overload which leads to a dilatation of the left atrium
What are the clinical features of mitral stenosis?
- Opening snap followed by a diastolic rumble 2. Volume overload which leads to a dilatation of the left atrium
In Mitral Stenosis what does dilatation of the left atrium result in?
- Pulmonary congestion with edema and alveolar hemorrhage 2. Pulmonary HTN and eventual right-sided heart failure 3. Atrial fibrillaition with associated risk for mural thrombi
