Valvular heart disease Flashcards
name and locate the heart valves
- atrioventricular valves: tricuspid (right), Mitral (left)
- pulmonary (right atrium –> pulmonary artery)
- aortic (left atrium –> aorta)
2 main types of valvular heart disease
- valvular stenosis: narrowing of valve orifice –> limits amount of blood flowing through
- valvular incompetence: failure of non-return function –> valvular regurgitation
2 main consequences of valvular heart disease
- reduction in CO (–> exercise intolerance, left ventricular hypertrophy –> left ventricular failure, sudden death)
- infection eg infective endocarditis
4 types of left heart valvular disease
- mitral stenosis
- mitral reguritation
- aortic stenosis
- aortic regurgitation
describe mitral stenosis and risk factors 2
thickening of valve leaflets with calcification and closure of commisures
occurs with age related calcification, rheumatic heart disease
is rheumatic heart disease often a cause for valvular heart conditions? why?
not in UK. yes in developing world. associated with poor nutrition and overcrowding
3 complications of mitral stenosis and symptoms of each
- heart failure: oedema, breathlessness, blue discolouration
- atrial fibrillation: ‘fluttering atrium’ –> clot risk –> stroke
- infective endocarditis
risk factors for mitral regurgitation 5
- rheumatic heart disease
- bacterial endocarditis
- mitral valve prolapse (2-5% of UK population have this)
- ischaemic heart disease –> rupture of papillary muscle/ chordae tendonii
- cardiomyopathy (enlargement of heart muscle)
compliations of mitral regurgitation 3
same as mitral stenosis:
- heart failure: oedema, breathlessness, blue discolouration
- atrial fibrillation: ‘fluttering atrium’ –> clot risk –> stroke
- infective endocarditis
risk factors for aortic stenosis 3
- congenital bicuspid valve
- degenerative calcification
- rheumatic heart disease
consequence on heart of aortic stenosis
obstruction to left ventricular flow
causes of aortic regurgitation 8
- rheumatic heart disease
- hypertension
- syphilis
- Marfan’s syndrome
- Ehler’s Danlos syndrome
- osteogenesis imperfecta
- idiopathic aortic root dilation
- endocarditis
Pathophysiologically, what can cause aortic regurgitation other than valve dysfunction
incompetence or dilation of aortic root
describe symptoms of Marfan syndrome and faulty gene which causes it
Fibrillin 1 gene
tall, elongated head, wide forehead, high arch palate, retinal problems
enlarged aorta and floppy valves –> aortic aneurysm
2 types of right heart valvular disease
tricuspid stenosis
tricuspid regurgitation
most common cause of tricuspid stenosis/ regurgitation
rheumatic heart disease
other causes of tricuspid regurgitation
RHD, congenital heart disease, endocarditis secdonary to IV drug abuse –> VALVULAR ENLARGEMENT
what causes rheumatic heart disease
acute rheumatic fever (occurs 2-3 weeks after group A streptococcal infection in throat)
age group at risk of rheumatic heart disease
5-15yo
pathology of cardiac complications of rheumatic heart disease
strep A infection (throat)
–> antibodies made in lymph nodes
–> antibodies against strep A also attack body’s own cells eg in endocardium, where they cause vegetations to form on valvles
= ANTIBODY CROSS REACTIVITY
4 areas of rheumatic fever effects and examples of each
- heart: pericarditis, myocardititis, endocerditis
- joints: flitting polyarthritis
- skin: subcutaneous nodules and skin rashes (erythema marginatum)
- arteries: arteritis
name and describe the histological hallmark
Aschoff body. contents 3:
- swollen eosinophilic collagen
- macrophages
- lymphocytes
long-term effects of rheumatic fever
> 95% recover completely
BUT 10-15% have chronic scarring of mitral valve cusps over 50 yrs –> thickened valve cusps, fuses commisures of cusps –> mitral stenosis
define infective endocarditis (IE)
acute or chronic disease resulting from infection of focal area of endocardium
