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MHD block 4 > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

Semilunar valves

A

Aortic and pulmonary valves
3 cusps
Function depends on integrity and coordinated movements of cusps and attachments

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2
Q

Atrioventricular valves

A

Tricuspid and mitral
Competency depends on integrity of valve “apparatus”
• Leaflets + annulus, chordae tendinae, papillary muscles, ventricular wall

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3
Q

Valve histology/structure

A 
Connective tissue core:
varies in density
• (spongiosa, fibrosa, reticularis)
• Collagen
• Elastic fibers (each varies in amount of collagen and elastin)

lined on both sides by endocardium

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4
Q

stenotic

A

valve is unable to open normally, leads to volume or pressure overload

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5
Q

regurgitant/insufficient

A

valve leaflets don’t close completely leading to backflow of blood

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6
Q

Bicuspid Aortic Valve

A

Prevalence 1% (one of the most common)

2 cusps
• One larger with midline raphe*
• Incomplete embryonic separation

increased risk of Aortic Stenosis (50’s-60’s)
• Infective endocarditis

Underlying aortopathy (has higher risk of dissections and aneurysms)

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7
Q

most common valvular abnormality

A

Valvular Degeneration 
due to Calcification

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8
Q

Valvular Degeneration 
due to Calcification is caused by

A

“wear and tear” small injuries heal with a little fibrosis and a little calcification and begins to add up over time
Dystrophic calcification

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9
Q

Valvular Degeneration 
due to Calcification affects which valves

A

can affect any of the valves

aortic valve calcification is the most serious and can lead to aortic stenosis

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10
Q

Valvular Degeneration 
due to Calcification risk factors

A

Chronic injury – hyperlipidemia, HTN, inflammation

similar to atherosclerosis risks

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11
Q

progression of aortic calcification

A 
Calcified masses within aortic cusps
Prevent cusp opening 
Outflow obstruction
Increased pressure gradient across valve
Concentric LVH
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12
Q

symptoms of aortic calcification

A
  • Congestive heart failure
  • Myocardial ischemia
  • Syncope
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13
Q

Mitral Valve Prolapse
 aka

A

Myxomatous Degeneration of Mitral Valve

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14
Q

mitral valve prolapse characteristics

A

Enlarged, redundant, floppy leaflets
Balloon into atrium during systole
 (may cause damage to atrium)

  • histologic: Thinning of fibrosa
  • Expansion of spongiosa* via deposition of myxomatous (mucoid) material) (makes the valve rubbery)
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15
Q

Mitral Valve Prolapse is more commonly seen in patients with what syndrome

A

marfan syndrome

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16
Q

signs and symptoms of mitral valve prolapse

A

Majority asymptomatic, incidental finding (no long term complications)
Midsystolic click

Minority with nonspecific symptoms
Chest pain, dyspnea, fatigue, depression, anxiety

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17
Q

mitral valve prolapse is most commonly found in

A

young women (3% of the population)

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18
Q

complications of mitral valve prolapse

A

Rare, serious complications (3% of patients)
Infective endocarditis
Mitral insufficiency
Stroke/systemic infarct (due to Embolism of leaflet or atrial thrombi)
Arrhythmias

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19
Q

why is endocarditis commonly found with valve injuries

A

any time there is injury to the endocardium, there is some fibrin deposits creating a place for bacteria to atttach

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20
Q

Infective Endocarditis definition

A

Destructive inflammation of cardiac valves and endocardium

Infection (Bacterial most common)

21
Q

hallmark finding of infective endocarditis

A

vegetation - an abnormal outgrowth upon a body part; specifically : any of the warty excrescences on the valves of the heart that are composed of various tissue elements including fibrin and collagen and that are typical of endocarditis

22
Q

characteristics of Vegetations of 
Infective Endocarditis

A 
Thrombotic debris, fibrin,  inflammatory cells, microorganims
Large, bulky
Destructive (acute inflammation) 
Erosive
Friable (weakly attached can Embolize)
23
Q

characteristics of acute infective endocarditis

A 
Highly virulent micro-organisms
Usually previous normal valve
Rapid, severe destruction of valve
50% mortality
Staphylococcus aureus
24
Q

characteristics of subacute endocarditis

A 
Low virulence organism
Affect previously deformed valve
Recovery with appropriate treatment
Streptococcus viridans
less severe symptoms
may have a new murmur
25
Q

patients at higher risk for infective endocarditis

A 
Valvular disease
Prosthetic valves
Immune deficient
Diabetic
Intravenous drug abusers
Alcoholics
26
Q

portals of entry of infective endocarditis

A

Infection elsewhere
Dental or surgical procedures with bacteremia
Injection of contaminated material into bloodstream
Occult source (gut, oral cavity, trivial injury)

27
Q

Infective Endocarditis diagnosis

A 
Clinical suspicion (chest pain, SOB, new murmur)
Blood cultures (will be bacteremic)
Echocardiogram (ultrasound of heart valves)
28
Q

Infective Endocarditis Complications

A

Cardiac

  • Valve insufficiency or stenosis
  • Abscess
  • Valve dehiscence or paravalvular leak in prosthetic valves

Emboli (Brain, Kidney, Spleen, Lungs)

Immunologic
- Glomerulonephritis

29
Q

clinical signs of infective endocarditis

A

splinter hemorrhage
osler nodes (painful on palms and soles)
Conjunctival petechiae
Janeway lesion

30
Q

treatment for infective endocarditis

A

Treatment
IV antibiotics
Surgery

Prophylaxis with antibiotics for those at high risk

31
Q

list the 3 types of NONINFECTED Vegetations

A

Nonbacterial Thrombotic Endocarditis (Marantic Endocarditis)

Endocarditis of System Lupus Erythematosus (Liebman-Sacks Endocarditis)

Acute Rheumatic Fever

32
Q

characteristics of the vegetations in Nonbacterial Thrombotic Endocarditis 
(Marantic Endocarditis)


A 
sterile thrombi (vegetations)
small
non-destructive
loosely attached (easier to embolize)
33
Q

which patients get nonbacterial thrombotic endocarditis

A

pts who are very sick

Marantic - Greek marantikos = “wasting away”
Patients prone to hypercoagulable states -Sepsis, Cancer
(Mucinous adenocarcinomas)
Burns
Indwelling catheters (Lead to endocardial trauma)

34
Q

clinical affects of a nonbacterial thrombotic endocarditis

A

Local - Little effect on valve itself

Systemic
Emboli
Infarcts

35
Q

describe the vegetations in Endocarditis of System Lupus Erythematosus 
(Libman-Sacks Endocarditis)

A

Sterile
mitral and tricuspid valves, chords
small

36
Q

what causes Endocarditis of System Lupus Erythematosus 
(Libman-Sacks Endocarditis)

A

immune complex deposition and associated inflammation

“Valvulitis” leads to subsequent fibrosis, valve deformity

37
Q

Rheumatic Fever occurs after what infection

A

Few weeks (10days to 6 weeks) after Group A (B-hemolytic) streptococcal pharyngitis (treatment of strep throat can prevent)

38
Q

pathogenesis of acute rheumatic fever

A

Immune response to group A Streptococi which CROSS-REACT with host tissues
• Antibodies directed against M proteins of strep cross-react with self-antigens in the heart
• CD4+ T cells specific for streptococcal peptides react with cardiac self proteins (Produced cytokines activate macrophages)

39
Q

Acute Rheumatic Fever major manifestations

A 
Migratory polyarthritis, large joints
Carditis (Pancarditis)
Subcutaneous nodules
Erythema marginatum of skin
Sydenham chorea (involuntary purposeless, rapid movements, St. Vitus’ dance)
40
Q

acute rheumatic fever minor manifestations

A

Fever
Arthralgia (joint pain w/o inflammation)
Elevated acute-phase reactants

41
Q

what is needed to diagnose acute rheumatic fever

A

Jones criteria:
Preceding group A Strep infection
 +

2 Major Manifestations

or
1 Major and 2 Minor Manifestations

42
Q

acute rheumatic fever affects which layers of the heart

A

its pancarditis therefore it affects all the layers
Pericarditis
Myocarditis
Endocarditis

43
Q

Aschoff Bodies

A

unique to rheumatic fever

T lymphocytes
plasma cells
macrophages
Anitschkow cells (caterpillar cells, macrophages with nuclei that look like caterpillars)
Multinucleated cells

similar to a mini granuloma

44
Q

vegetations in rheumatic fever endocarditis are mostly seen where

A

on the left sided heart valves

45
Q

what happens after the initial acute rheumatic fever endocarditis

A

Organization of inflammation
Fibrosis
Obliteration of normal leaflet structure

Turbulence induced by ongoing valve deformities additional fibrosis

46
Q

Chronic Rheumatic Valvular Disease

A

results from rheumatic fever
Valve leaflet fibrosis, fusion
Fish mouth or buttonhole stenosis
Cords short, thick, fused

Mitral valve most commonly involved
Alone in 65-70%
Aortic and mitral valves - 25%
Tricuspid, pulmonary valves - rare

47
Q

Carcinoid Tumor

A

Neuroendocrine tumor most commonly in the GI tract, tracheobronchial tree

Secretes bioactive products
*Serotonin (5-hydroxytryptamine)
Kallikrein, Bradykinin, Histamine, Prostaglandins, Tachykinins

Episodic flushing of skin, cramps, nausea, vomiting, diarrhea

48
Q

Carcinoid Heart Disease

A

Right side of heart
Plaque-like thickening of endocardium and valves
Muchopolysacharide matrix - coats tricuspid valve and RV
marked intimal thickening of endocardium
Correlation of serotonin levels with right sided heart disease

MHD block 4 (9 decks)

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