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MHD > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What do semilunar valves function depend on?

A

cusps and attachements

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2
Q

What do atrioventricular valves function depend on?

A

apparatus

-leaflets + annulus, chordae tendinae, papillary muscles, ventricle wall

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3
Q

Bicuspid aortic valve

A
  1. leads to earlier aortic stenosis(50-60’s)
    - infective endocarditis
  2. underlying aortopathy
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4
Q

What is the most common valvular abnormality?

A

valvular degeneration due to calcification

  • wear and tear
  • dystrophic calcification
  • chronic injury-hyperlipidemia, HTM, inflammation
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5
Q

What does calcific aortic stenosis lead to?

A
  1. calcified masses within aortic cusp prevent cusp opening and obstruct outflow
  2. increased gradient pressure across valve
  3. concentric LVH
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6
Q

What are symptoms of aortic stenosis?

A

congestive heart failure
myocardial ischemia
syncope

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7
Q

What is mitral valve prolapse?

A

enlarged, redundant, floppy leaflets
balloon into the atrium during systole

  • thinning of fibrosa
  • expansion of spongiosa via deposition of myxomatous (mucoid) material
  • 3% of population
  • young women
  • majority asymptomatic-midsystolic click
  • minority with nonspecific symptoms: chest pain, dyspnea, fatigue, depression, anxiety
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8
Q

Rare, serious complications of mitral valve prolapse

A
  • infective endocarditis
  • mitral insufficiency
  • stroke/systemic infact-embolism of leaflet or atrial thrombia
  • arrhythmias
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9
Q

What is infective endocarditis?

A

Destructive inflammation of cardiac valves and endocardium
Infection
-bacterial most common

Vegetations

  • thrombotic debris, fibrin, inflammatory cells, microorganisms
  • large, bulky,
  • destructive
  • erosive
  • fribable–>embolize
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10
Q

What is acute infective endocarditis vs. subacute infective endocarditis?

A

Acute:

  • highly virulent micro-organisms
  • usually previous normal valve
  • rapide, severe destruction of vavle
  • 50% mortality
  • Staph Aureus

Subactue

  • low virulence organism
  • affect previously deformed valve
  • recovery with appropriate treatment
  • strep viridans
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11
Q

What type of patients are at risk for endocarditis and what are the portals of entry?

A

At risk: valvular disease, prosthetic valves, immunodeficient, diabetic, IV drug users, alcoholics
Portals of entry: infection elsewhere, dental or surgical procedures with bacteremia, injection of contaminated material into blood stream, occult source-gut, oral caviity, trivial injury

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12
Q

How do you diagnose infective endocarditis? What are the treatments

A

clinical suspicion
blood cultures
echocardiogram

Treatments:
IV antibiotics
surgery
prophylaxis with antibiotics for those at high risk

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13
Q

What are the complications that can occur with endocarditis?

A

cardiac

  • valve insufficiency or stenosis
  • abscess
  • valve dehiscence or paravalvular leak in prosthetic valves

Emboli

  • brain
  • kidney
  • spleed
  • lungs

Immunologic
-glomerulonephritis

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14
Q

What are some visible symptoms with endocarditis?

A
  • splinter hemorrhage in nailes
  • osler nodes-painful
  • conjunctival petechiae
  • janeway lesions
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15
Q

What are three things that can cause non infected vegetations?

A
  1. nonbacterial thrombotic endocarditis
  2. endocarditis of system lupes erythematous
    - liebman-sacks endocarditis
  3. acute rheumatic fever
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16
Q

What do the vegetations look like in nonbacterial thrombotic endocarditis (marantic endocarditis) ? Who gets marantic endocarditis?

A

sterile thrombi (vegetations)

  • small
  • non-destructive
  • loosely attached
  • local-little effect on valve itself
  • systemic-emboli and infarcts
Who:
Patients prone to hypercoagulable states
a. Sepsis
b. Cancer (Mucinous adenocarcinomas)
c. Burns
d. Indwelling catheters (endocardial trauma)
17
Q

What do the vegetations look like in endocarditis of systemic lupus erythematosus (libman-sacks endocarditis)

A
  1. sterile vegetations
    - mitral and tricuspid valves, chords
    - small
  2. consequence of immune complex deposition and associated inflammation
  3. valvulitis
    - leads to subsequent fibrosis, valve deformity
18
Q

What is the pathogenesis of acute rheumatic fever?

A

immune response to strep A streptococci which cross-react with host tissue

  • antibodies directed against M proteins of strep cross-react with self antigens in the heart
  • CD4 T cells specific for strep peptides react with cardiac self proteins
  • prodcued cytokines activate macrophages
19
Q

What are the manifestations of acute rheumatic fever?

What is Jones Criteria?

A

Major: migratory polyarthritis- large joints, carditis (pancarditis), subcutaneous nodules, erythema marginatum of skin, sydenham chorea
Minor: fever, arthralgia, elevated acute-phase reactants

Jones Criteria:
Preceding strep A infection+
2 major or 1
major and 2 minor

20
Q

What are aschoff bodies seen in acute rhuematic fever?

A
  • T lymphocytes
  • plasm cells
  • Macrophage=anitschkow cells (caterpillar cells)
  • multinucleated cells

(mini granulomas)

21
Q

What type of vegetations do you see in rheumatic fever endocarditis?

A

1-2 mm vegitations

left sided heart valves

22
Q

What happens to in rheumatic fever endocarditis?

A

organization of inflammation
aggressive fibrosis
obliteration of normal leaflet structure
terbulence induced by ongoing valve deformities–>addtional fibrosis

23
Q

What happens in chronic rheumatic valvular disease?

A

valve leaflet fibrosis fusion

  • fish mouth or buttonhole stenosis
  • cords short, thick, fused
24
Q

Which valve is most commonly involved in chronic rheumatic valvular heart disease?

A

mitral vavle alone 65-70%
aortic and mitral 25%
tricuspid and pulmonary valves-rare

25
Q

What is carcinoid tumor? How does it relate to heart disease?

A

neuroendocrine tumor
-GI tract, tracheobronchial tree
secretes bioactive products
-serotonin (5 hydroxytryptamine)

  1. Right sided heart failure
  2. Plaque like thickening of endocardium and valves
    - mucopolysaccharide matrix
  3. Correlation of serotonin levels with right sided heart disease
26
Q

What is a myxoma? What happens if you have a myxoma?

A 
most common primary tumor of the heart in adults
90% atria 
L:R 4:1 
-gelatinous -appearing tumor 
-attached to atrial wall through stalk
  1. Ball-valve obstruction
    - moves into or through AV valves during systole
    - position dependent
  2. Fever and malaise
    - elaboration of Interleukin-6
  3. embolization

MHD (81 decks)

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