Valvular Heart Disease

Question 1

What are the role of the semilunar valves?

Answer 1

aortic and pulmonary; maintain unidirectional flow

Question 2

What are the AV valves?

Answer 2

mitral and tricuspid

Question 3

Where do the AV valves attach to the wall?

Answer 3

free margins attached to ventricular wall via chordae tendinae and papillary muscls

Question 4

What is valvular stenosis?

Answer 4

failure of a valve to open completely; usually a chronic process affecting a valve cusp

Question 5

What is insufficiency of valvular heart disease?

Answer 5

failure to close completely;
functional regurgitation: valvular incompetence due to disruption of supporting structures; -aorta root dilation-left ventricle dilation
and
intrinsical disease of valve cusps

Question 6

What are the major causes of valvular disease?

Answer 6

congenital causes (bicuspid aortic valve-most common)
aquired causes
(stenosis of aortic valve, insufficiency of aortic valve: dilation of ascending aorta related to HTN and aging)
MItral valve (stenosis: rheumatic heart disease
Insufficiency: myxomatous degeneration)
Stenoses are more frequent than insufficiencies

Question 7

What is calcific valvular disease?

Answer 7

dystrophic calcification, damage caused by wear and tear complicated by desposits of calcium phosphate
distinct from atherosclerosis

Question 8

What are the clinical effects of calcific valvular disease?

Answer 8

LV: increased pressure causes hypertrophy

• angina, ischemia and CHF
• syncope
• CHF often leading to death within two years

Question 9

HOw do you treat clacific aortic stenosis?

Answer 9

valve replacement

Question 10

What are the symptoms, relation of mitral annular calcification?

Answer 10

in women greater than 60 years old, usually doesn’t affect function but site for thrombi /infection

Question 11

What are the role of myxomatous degeneration of mitral valve prolapse?

Answer 11

very common; 3% adults, young women, usually no complications and fx of marfan and other hereditary disorders

Question 12

What ar ethe clinical fx of myxomatous mitral valve?

Answer 12

asymptomatic with mid systolic click
complication suncommon but infective endocarditis, mitral insufficiency, thrombi on atrail surface, arrythmias and sudden death

Question 13

Wha tis the most important complication of rheumatic fever?

Answer 13

progression to chronic valvular dysfunction, mitral stenosis

Question 14

What is the morphology of acute rheumatic fever?

Answer 14

pancarditis (affect all 3 layers)
pericaritis
myocarditis with aschoff bodies
endocarium and left sided valves with fibrinoid necrosis
sunbendocardial plaques

Question 15

What is an aschoff body?

Answer 15

foci of swollen eosinophilic collagen, surrounded by T lymphocytes, plasma cells and plump macrophages

Question 16

What is the pathogenesis of rheumatic heart disease?

Answer 16

hypersensitivity rxn inducd by group a strep
antibodies against M protein cross react with glycoprotein antigens in heart
genetic susceptibility

Question 17

What is the infective endocarditis morphology?

Answer 17

acute and subacute endocarditis, friable large bluky vegetations
fibrin and inflammatory cells
mitral valve and aortic valve common site
may cause ring abscess

Question 18

What is the duke criteria?

Answer 18

bacterial endocarditis;
major:
positive blood culture
echocardiographic findings
new valve regurgitation
minr:
predisposing heart lesion
fever
uncommon finding resulting from septic emboli

Question 19

What are the complications of baacterial endocarditis?

Answer 19

valvular insufficiency or stenosis
myocardial abscess and possible perforation
vegetations break off
glomerulonphritis

Question 20

What is nonbacterial thrombotic endocarditis?

Answer 20

depositions of small masses of fibrin platelets and other blood products on leaflet

Question 21

What is libman-sacks endocarditis?

Answer 21

non-infectve vegetations
SLE; primary antiphospholipid syndrome
may have intense inflammation

Question 22

What is carcinoid heart disease?

Answer 22

cardiac manifestation of carcinoid tumor

505 OF PATIENTS WITH CARRINOID SYNDROME PLAQUE LIKE FIBROSIS OF RIGHT HEART ENDOCARDIUM AND VALVES

Question 23

What are the complicationss of artifical valves?

Answer 23

thromboembolic complications
infective endocarditis

i bioprothesis
structural deterioration
infective endocarditis

Question 24

What do you see on physical exam of aortic stenosis?

Answer 24

sustained LV impulse, no LV displacement
pulsus parvus et tardus of the carotid impulse
absent A2 or paraoxically split A2
murmur is systolic cresendo

Question 25

What are the mean survival rates of aortic stenosis pts from different symptoms?

Answer 25

angina->5yrs
syncope->3yrs
CHF->2yrs

Question 26

What ar ethe causes of aortic regurgitation?

Answer 26

congenital
endocarditis
rheumatic
dilation of aortic root including anuerysm, inflammation, dissction, symphilis

Question 27

What is the presentation of aortic regurgitation?

Answer 27

dyspnea on exertion
fatiue
decrease excercie tolerance
chest pain
hyperdynamic pulse
widened pulse pressure

Question 28

What is the treatment of aortic regurgiation?

Answer 28

acute–> surgical emergency
chronic severe
asymptomatic with normal LVEF - periodic echos and reduce afterload
asymptomatic and low LVEF or symptomatic and normal LVEF —> surgery and valve replacemet

Question 29

What are the causes o mitral valve regurgitation?

Answer 29

myxomatous disease (MVP)
rhemuatic vlave
endocarditis
ceft leaflet(Congenital)

ischemic CM
dilated CM
hypertrophic CM

Question 30

What is the physical cause associated with all of the causes of mitral valve regurgitationa functionally?

Answer 30

volume overload state

which is well tolerated until severe; when seere regurgitation develops slowsly

Question 31

What are the symptoms of acute mitral regurgitation?

Answer 31

normal LA size and compliance
high left atrial pressure
pulmonary venous pressure up
pulmonary congestion
prominent V waves
medical emergency

Question 32

What are the signs of chronic mitral regurgitation?

Answer 32

increased left atrial size and compliance
increased left ventricular size
eventual systolic dysfunction

Question 33

What is the treatment for mitral regurgitaiton?

Answer 33

acute: diuretic and vasodilators and consider emergent surgery
chronic: asymptomatic monitor
if symptomatic repair or replacement valve
if there is severe left ventricular dyfunction often little can be done

Question 34

What are the causes of mitral steonsis?

Answer 34

rheumatic fever is most common
other rare causes
endocarditis
calcification
congenital stenosis

Question 35

What are the symptoms of mitral valve stenosis?

Answer 35

dyspnea and reduced excercise capacity

right sided heart failure

Question 36

What are the treatment of mtiral valve stenossis?

Answer 36

diuretics for sxs, with afib tx beta blockers, digoxin or calcium channel blockers
vlavle replacement or balloon valvuloplasty