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Pathoma - Cardiac Pathology > Valvular Disorders > Flashcards

Valvular Disorders Flashcards

1
Q

What are the four valves of the heart?

A
  • Tricuspid
  • Mitral
  • Pulmonary
  • Aortic
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2
Q

What two pathologies do valvular lesions generally result in?

A

Stenosis (decreased caliber of the valve orifice) or regurgitation

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3
Q

What is Acute Rheumatic Fever?

A

Systemic complication of pharyngitis due to group A beta-hemolytic streptococci

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4
Q

When does Acute Rheumatic Fever occur? Who does it target?

A

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

Molecular mimicry

-Bacterial M protein resembles proteins in human tissue (meromycin)

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6
Q

What is diagnosis of Acute Rheumatic Fever based upon?

A

Jones Criteria

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7
Q

What are the Jones Criteria (generally)?

A

-Evidence of prior group A beta-hemolytic streptococcal infection (e.g., elevated ASO or anti-DNase B titers) with presence of major and minor criteria.

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8
Q

What are the minor Jones criteria?

A

Non-specific and include:

  • Fever
  • Elevated ESR
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9
Q

What are the 5 major Jones criteria?

A
  1. Migratory polyarthritis
  2. Pancarditis
  3. Subcutaneous nodules
  4. Erythema marginatum
  5. Sydenham chorea
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10
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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11
Q

What is Pancarditis?

A

All three layers of heart inflamed

  1. Endocarditis
  2. Myocarditis
  3. Pericarditis
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12
Q

What is involved in ARF endocarditis?

A
  • Mitral valve is involved more commonly than aortic valve.

- Characterized by small vegetations along lines of closure that lead to regurgitation

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13
Q

What is involved in ARF myocarditis?

A

-Aschoff bodies that are characterized by foci of chronic inflammation, reactive histiocytes with slender, wavy nuclei (Anitschkow cells), giant cells, and fibrinoid material

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14
Q

What is the most common cause of death during the acute phase of rheumatic fever?

A

Myocarditis!

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15
Q

What do Aschoff bodies contain?

A

Anitschkow cells (caterpillar nucleus)

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16
Q

What is involved in ARF pericarditis?

A

Leads to friction rub and chest pain

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17
Q

What is erythema marginatum?

A

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

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18
Q

What is sydenham chorea?

A

Rapid, involuntary movements

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19
Q

What may happen with longer term Acute Rheumatic Fever?

A
  • Acute attack usually resolves
  • May progress to chronic rheumatic heart disease
  • Repeat exposure to group A beta-hemolytic streptococci results in relapse of the acute phase and increases risk for chronic disease
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20
Q

What is chronic rheumatic heart disease?

A

-Valve scarring that arises in consequence of rheumatic fever

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21
Q

What does the valve scarring of chronic rheumatic heart disease result in?

A

Stenosis with a classic ‘fish-mouth’ appearance

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22
Q

What does Chronic Rheumatic Heart disease almost always involve?

A

Mitral Valve

–> this leads to thickening of the chordae tendineae and cusps

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23
Q

What does Chronic Rheumatic Heart disease occasionally involve?

A

Aortic Valve

–> leads to fusion of the commissures

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24
Q

What valves are involved in Chronic Rheumatic Heart disease?

A

Mitral and Aortic

-Other valves are less commonly involved

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25
Q

What is the major complication of chronic rheumatic heart disease?

A

Infectious endocarditis

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26
Q

What is the pneumonic for the major JONES criteria?

A 
J - joint, migratory polyarthritis
O - heart problems (endo, myo, peri)
N - subcutaneous nodules
E - erythema marginatum
S - sydenham chorea
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27
Q

What is aortic stenosis?

A

Narrowing of the aortic valve orific

28
Q

What causes aortic stenosis?

A

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

29
Q

When does aortic stenosis present?

A

Late adulthood (>60 years)

30
Q

What hastens disease onset for Aortic Stenosis?

A

Bicuspid aortic valve (two cusps doing the work of one!)

  • It also increases risk
  • A normal aortic valve has three cusps and fewer cusps results in increased “wear and tear” on each cusp
31
Q

What may Aortic Stenosis arise as a complication of?

A

Chronic Rheumatic Valve disease

-It usually coexists with mitral stenosis

32
Q

What trait distinguishes rheumatic fever aortic stenosis from normal “wear and tear”?

A

Fusion of the aortic valve commissures

33
Q

What happens during the asymptomatic stage of Aortic Stenosis?

A
  • Cardiac compensation is what leads to this prolonged asymptomatic stage
  • A murmur can be heard!!
34
Q

What murmur is heard for Aortic Stenosis?

A

Systolic ejection click followed by a crescendo-decrescendo murmur

35
Q

What are three complications of Aortic Stenosis?

A
  1. Concentric left ventricular hypertrophy - may progress to cardiac failure
  2. Angina and syncope with exercise
  3. Microangiopathic hemolytic anemia
36
Q

What causes angina and syncope with exercise in Aortic Stenosis?

A

Limited ability to increase blood flow across the stenotic valve leads to decreased perfusion of the myocardium and brain

37
Q

What causes microangiopathic hemolytic anemia in Aortic stenosis?

A

RBCs are damaged (producing schistocytes) while crossing the calcified valve.

38
Q

What is the treatment for Aortic Stenosis?

A

Valve replacement after onset of complications

39
Q

What is Aortic Regurgitation?

A

Back flow of blood from the aorta into the left ventricle during diastole.

40
Q

What causes Aortic Regurgitation?

A

Arises due to aortic root dilation (e.g. syphilitic aneurysm and aortic dissection) or valve damage (eg infectious endocarditis)

41
Q

What is the most common cause of Aortic Regurgitation?

A

Isolated root dilation (sometimes from aortic aneurysm)

42
Q

What murmur is caused by Aortic Regurgitation?

A

Early, blowing diastolic murmur (caused by the blood flowing backward across the valve)

43
Q

What are the clinical features of Aortic Regurgitation?

A
  1. Murmur

2. Hyperdynamic circulation due to increased pulse pressure!

44
Q

Why is there an increased pulse pressure with aortic regurgitation?

A

-Diastolic pressure decreases due to regurgitation, while systolic pressure increases due to stoke volume

45
Q

What symptoms does a patient with Aortic Regurgitation present with?

A
  • Bounding pulse (water-hammer pulse)
  • Pulsating nail bed (Quincke pulse)
  • Head bobbing
46
Q

What does Aortic Regurgitation cause?

A
  • LV dilation

- Eccentric hypertrophy (due to volume overload)

47
Q

What is the treatment for Aortic Regurgitation?

A

Valve Replacement once LV dysfunction develops

48
Q

What is Mitral Valve Prolapse?

A

Ballooning of mitral valve into left atrium during systole

49
Q

What percentage of US adults have Mitral Valve Prolapse?

A

2-3%

50
Q

What causes Mitral Valve Prolapse?

A

Myxoid degeneration (accumulation of ground substance) of the valve making it floppy.

51
Q

What is the etiology of Mitral Valve Prolapse?

A

Unknown

-May be seen in Marfan syndrome or Ehlers-Danlos syndrome

52
Q

What type of murmur does MVP usually present with?

A
  • Incidental mid-systolic click (opening a paracheute) followed by a regurgitation murmur
  • Usually asymptomatic
53
Q

What happens if a patient with MVP squats?

A

-Click and murmur will become softer with squatting (increased systemic resistance decreases left ventricular emptying)

54
Q

What complications are associated with Mitral Valved Prolapse?

A
  • Infectious Endocarditis
  • Arrhythmia
  • Severe Mitral Regurgitation
55
Q

What is the treatment for Mitral Valve Prolapse?

A

Valve Replacement

56
Q

What is Mitral Regurgitation?

A

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

57
Q

What usually causes Mitral Regurgitation?

A

Usually arises as a complication of mitral valve prolapse
-Other causes include LV dilation (e.g. left sided cardiac failure), Infective Endocarditis, Acute Rheumatic Heart Disease (this disease prefers mitral valve), papillary muscle rupture after MI

58
Q

What murmur is associated with Mitral Regurgitation?

A

Holosystolic “blowing” murmur

59
Q

When does the Mitral Regurgitation murmur get louder?

A
  • Louder with squatting (increased systemic resistance decreases left ventricular emptying)
  • Expiration (increased return to left atrium)
60
Q

What does Mitral Regurgitation result in long term?

A

Volume overload and left-sided heart failure

61
Q

What is mitral stenosis?

A

Narrowing of mitral valve orifice

62
Q

What usually causes mitral stenosis?

A

Chronic rheumatic valve disease (prefers mitral valve)

63
Q

What murmur is associated with mitral stenosis?

A

Opening snap followed by diastolic rumble

64
Q

What damage does volume overload cause in mitral stenosis?

A

Dilation of the left atrium

65
Q

What does dilation of the left atrium cause in mitral stenosis?

A
  1. Pulmonary congestion with edema & alveolar hemorrhage
  2. Pulmonary hypertension and eventual right-sided heart failure
  3. Atrial fibrillation with associated risk for mural thrombi

Pathoma - Cardiac Pathology (7 decks)

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