Valvular Heart Disease

Question 1

Valvular stenosis:

Answer 1

Failure of valve to open completely

Question 2

Result of valvular stenosis (2):

Answer 2

• Impedes forward flow

- Causes pressure overload behind the valve

Question 3

Valvular insufficiency:

Answer 3

Failure of valve to close completely

Question 4

Result of valvular insufficiency (2):

Answer 4

• Allows reverse flow

- Causes volume overload behind the valve

Question 5

Functional regurgitation:

Answer 5

Valve incompetence due to pathology in support structures

- E.g. annular dilation secondary to chamber dilation

Question 6

Most common valvular abnormality:

Answer 6

Calcific aortic stensosis

Question 7

Calcific aortic stenosis is more common/happens earlier when:

Answer 7

Aortic valve is congenitally bicuspid

Question 8

Calcific aortic stenosis - clinical findings (3):

Answer 8

• Causes concentric LV hypertrophy (pressure overload)
• May cause systolic and diastolic dysfunction
• Angina, syncope and CHF may occur

Question 9

Myxomatous degeneration of the mitral valve causes:

Answer 9

Mitral valve prolapse

Question 10

Histology of myxomatous degeneration of the mitral valve (3):

Answer 10

• Attenuation of collagenous fibrosa layer (thinned)
• Thickening of spongiosa layer
• Deposition of mucoid (myxomatous) material in the leaflets

Question 11

Mitral valve prolapse on physical exam (2):

Answer 11

• Mid-systolic click (leaflets prolapse –> atrium)

- May have late systolic or holosystolic murmur

Question 12

Aschoff bodies are pathognomic for:

Answer 12

Acute rheumatic fever

Question 13

Aschoff bodies are composed of (3):

Answer 13

• T lymphocytes
• Occasional plasma cells
• Plump macrophages (Anitschkow cells)

Question 14

Acute rheumatic fever - type of necrosis seen in endocarditis:

Answer 14

Fibrinoid necrosis

Question 15

MacCallum plaques (2):

Answer 15

• Subendocardial lesions seen in acute rheumatic fever

- Irregular subendocardial thickening usually in left atrium

Question 16

Acute rheumatic fever - major manifestations (5):

Answer 16

J: Migratory polyarthritis of the large joints
O: Carditis
N: Subcutaneous nodules
E: Erythema marginatum of the skin
S: Sydenham chorea

Question 17

Acute rheumatic fever - lab findings (2):

Answer 17

Antibodies to:

• Streptolysin O
• DNAse B

Question 18

Main deformation cause by chronic rheumatic heart disease:

Answer 18

Mitral stenosis

Question 19

Infective endocarditis:

Answer 19

Invasion by a microbe –> formation of vegetations with destruction of underlying tissue

Question 20

Most common cause of native valve endocarditis:

Answer 20

Staph aureus

Question 21

Usual sites for infective endocarditis (2):

Answer 21

• Aortic valve

- Mitral valve

Question 22

Artificial valves that require long-term anticoagulation:

Answer 22

Mechanical valves

Question 23

Major failure mode of bioprostheses:

Answer 23

Structural deterioration