Valvular heart disease

Question 1

What is stenosis and what problem does it cause?

Answer 1

Heart valves become rigid, they do not allow sufficient flow and cause high blood pressure

Question 2

What is regurgitation or insufficiency?

Answer 2

The valves are floppy and allow backflow

Question 3

What can happen if the rate of development for valvular heart disease is slow?

Answer 3

The heart can compensate by increasing the size of the left ventricle and the vasculature that accompanies it

Question 4

On what side do most valve diseases occur?

Answer 4

The left side

Question 5

What is the most common of all valvular abnormalities?

Answer 5

Calcific aortic stenosis

Question 6

At what age does it occur?

Answer 6

Usually around 70-90 but can occur between 50-70 if there is a congenital defect

Question 7

What is a genetic defect of valves that we discussed?

Answer 7

Bicuspid aortic valves

Question 8

Abnormalities of what structure frequently accompany bicuspid aortic valve? What is a major site of calcific deposits?

Answer 8

Aortic wall, the raphe

Question 9

What type of degeneration is seen in calcific aortic stenosis and what accumulates causing the calcification?

Answer 9

Wear and tear, see a buildup of calcium salt hydroxyapatite

Question 10

What is the end result of calcific aortic stenosis?

Answer 10

There is a narrowing of the aortic valve and the heart works harder causing concentric ventricular hypertrophy. Over time the heart becomes ischemic because there is insufficient vasculature to support the tissue

Question 11

What is mitral valve prolapse?

Answer 11

Mitral valve leaflets are floppy and prolapse into the atrium during systole

Question 12

What will be heard during the heart beat in mitral valve prolapse?

Answer 12

A mid-systolic click

Question 13

What is myxomatous?

Answer 13

When connective tissue is irritated and makes a mucoid fluid

Question 14

Grossly, what will you see in mitral valve prolapse?

Answer 14

The valve ballooning into the atrium, also known as hooding

Question 15

What will be seen microscopically?

Answer 15

Thickening of the spongiosa layer and deposition of mucoid material

Question 16

What disorders and gene defects is mitral valve prolapse associated with?

Answer 16

Marfan syndrome and defects in FBN-1

Question 17

Those defects lead to excess?

Answer 17

TGF-beta

Question 18

Rheumatic fever occurs following?

Answer 18

Infection by streptococcal pharyngitis or strep throat

Question 19

During the active phase of rheumatic fever, people get?

Answer 19

Acute rheumatic carditis

Question 20

Rheumatic fever is the most common cause of?

Answer 20

Mitral valve stenosis

Question 21

What type of plaque forms in response to rheumatic fever? These are caused by?

Answer 21

MacCallum’s plaques, caused by regurgitant jets of blood flow in the mural endocardium

Question 22

What will be present histologically in the heart following rheumatic fever?

Answer 22

Caterpillar cells and Aschoff bodies

Question 23

Which valve is usually involved with chronic rheumatic heart disease?

Answer 23

Mitral valve

Question 24

Severe mitral stenosis is a result of?

Answer 24

Rheumatic heart disease

Question 25

What are the results of mitral stenosis?

Answer 25

The left atrium dilates and there may be formation of a mural thrombi which can embolize

Question 26

What bacteria usually causes acute endocarditis? What hearts does it affect and describe the course of the illness.

Answer 26

Staph aureus, can affect all hearts and this usually occurs rapidly

Question 27

What bacteria usually causes subacute bacterial endocarditis? Describe the course. What hearts does it affect?

Answer 27

Strep viridians. Affects deformed hearts, more protracted course than acute

Question 28

What bacteria typically cause prosthetic valve endocarditis?

Answer 28

Coagulase negative staphylococci

Question 29

What is marantic endocarditis?

Answer 29

A form of nonbacterial thrombotic endocarditis

Question 30

Who gets nonbacterial thrombotic endocarditis?

Answer 30

Those who are debilitated and in a hyper coagulable state

Question 31

What happens in Trosseau’s Syndrome?

Answer 31

A patient has spontaneous thrombi

Question 32

Libman Sacks endocarditis is seen in those with what disease?

Answer 32

Lupus

Question 33

Libman Sacks endocarditis has the presence of what microscopically?

Answer 33

Hematoxylin bodies