Valvular Heart Disease Flashcards
What do semilunar valves function depend on?
cusps and attachements
What do atrioventricular valves function depend on?
apparatus
-leaflets + annulus, chordae tendinae, papillary muscles, ventricle wall
Bicuspid aortic valve
- leads to earlier aortic stenosis(50-60’s)
- infective endocarditis - underlying aortopathy
What is the most common valvular abnormality?
valvular degeneration due to calcification
- wear and tear
- dystrophic calcification
- chronic injury-hyperlipidemia, HTM, inflammation
What does calcific aortic stenosis lead to?
- calcified masses within aortic cusp prevent cusp opening and obstruct outflow
- increased gradient pressure across valve
- concentric LVH
What are symptoms of aortic stenosis?
congestive heart failure
myocardial ischemia
syncope
What is mitral valve prolapse?
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
Rare, serious complications of mitral valve prolapse
- infective endocarditis
- mitral insufficiency
- stroke/systemic infact-embolism of leaflet or atrial thrombia
- arrhythmias
What is infective endocarditis?
Destructive inflammation of cardiac valves and endocardium
Infection
-bacterial most common
Vegetations
- thrombotic debris, fibrin, inflammatory cells, microorganisms
- large, bulky,
- destructive
- erosive
- fribable–>embolize
What is acute infective endocarditis vs. subacute infective endocarditis?
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
What type of patients are at risk for endocarditis and what are the portals of entry?
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
How do you diagnose infective endocarditis? What are the treatments
clinical suspicion
blood cultures
echocardiogram
Treatments:
IV antibiotics
surgery
prophylaxis with antibiotics for those at high risk
What are the complications that can occur with endocarditis?
cardiac
- valve insufficiency or stenosis
- abscess
- valve dehiscence or paravalvular leak in prosthetic valves
Emboli
- brain
- kidney
- spleed
- lungs
Immunologic
-glomerulonephritis
What are some visible symptoms with endocarditis?
- splinter hemorrhage in nailes
- osler nodes-painful
- conjunctival petechiae
- janeway lesions
What are three things that can cause non infected vegetations?
- nonbacterial thrombotic endocarditis
- endocarditis of system lupes erythematous
- liebman-sacks endocarditis - acute rheumatic fever
What do the vegetations look like in nonbacterial thrombotic endocarditis (marantic endocarditis) ? Who gets marantic endocarditis?
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)
What do the vegetations look like in endocarditis of systemic lupus erythematosus (libman-sacks endocarditis)
- sterile vegetations
- mitral and tricuspid valves, chords
- small - consequence of immune complex deposition and associated inflammation
- valvulitis
- leads to subsequent fibrosis, valve deformity
What is the pathogenesis of acute rheumatic fever?
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
What are the manifestations of acute rheumatic fever?
What is Jones Criteria?
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
What are aschoff bodies seen in acute rhuematic fever?
- T lymphocytes
- plasm cells
- Macrophage=anitschkow cells (caterpillar cells)
- multinucleated cells
(mini granulomas)
What type of vegetations do you see in rheumatic fever endocarditis?
1-2 mm vegitations
left sided heart valves
What happens to in rheumatic fever endocarditis?
organization of inflammation
aggressive fibrosis
obliteration of normal leaflet structure
terbulence induced by ongoing valve deformities–>addtional fibrosis
What happens in chronic rheumatic valvular disease?
valve leaflet fibrosis fusion
- fish mouth or buttonhole stenosis
- cords short, thick, fused
Which valve is most commonly involved in chronic rheumatic valvular heart disease?
mitral vavle alone 65-70%
aortic and mitral 25%
tricuspid and pulmonary valves-rare
What is carcinoid tumor? How does it relate to heart disease?
neuroendocrine tumor
-GI tract, tracheobronchial tree
secretes bioactive products
-serotonin (5 hydroxytryptamine)
- Right sided heart failure
- Plaque like thickening of endocardium and valves
- mucopolysaccharide matrix - Correlation of serotonin levels with right sided heart disease
What is a myxoma? What happens if you have a myxoma?
most common primary tumor of the heart in adults 90% atria L:R 4:1 -gelatinous -appearing tumor -attached to atrial wall through stalk
- Ball-valve obstruction
- moves into or through AV valves during systole
- position dependent - Fever and malaise
- elaboration of Interleukin-6 - embolization
