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IMED3001 > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What are the histological layers of the valves?

A

Endothelium lining both sides

Either atrialis or ventricularis

Spongiosa

Fibrosa

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2
Q

What does the fibrosa of the valve contain?

A

Dense collagenous layer, close to outflow surface

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3
Q

What does the spongiosa of the valve contain?

A

Central core of loose connective tissue

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4
Q

What is contained within the ventricularis/atrialis?

A

Elastin layer below inflow surface

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5
Q

What is valvular stenosis?

A

Narrowing with failure to open completely thereby impeding forward flow.

This can coexist with incompetence

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6
Q

What is valvular incompetence?

A

Failure to close properly thereby allowing reversed flow.

This can coexist with stenosis

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7
Q

How are valvular problems detected?

A

Abnormal heart sounds or murmurs

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8
Q

What affects the consequences of valve dysfunction?

A

The degree of valve involvement

Degree of impairment

How fast it develops

Rate and quality of compensatory mechanism

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9
Q

What typically causes valvular stenosis?

A

Myocardial Infarction

Dilated cardiomyopathy causes valve ring to widen up creating a larger hole and the valve can’t close it

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10
Q

What causes Mitral Valve stenosis?

A

Post inflammatory scarring

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11
Q

How can valve stenosis result in injury to endocardium?

A

High speed jets can damage the lining of the heart that they push against

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12
Q

What is functional regurgitation?

A

Dilation of the heart stretches valve ring and creates a bigger hole and valve can’t close across the bigger hole

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13
Q

How much of valvular diseases are caused by acquired valvular stenosis?

A

Acquired valvular stenosis accounts for 2/3rds of vavlular diseases.

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14
Q

What are the major causes of mitral valve stenosis?

A

Post inflammatory scarring (Rheumatic Heart Disease)

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15
Q

What are the major causes of Mitral regurgitation?

A

Abnormalities of leaflets and commissures (Mitral valve prolapse)

Abnormalities of tensor apparatus (Rupture of papillary muscle)

Abnormalities of LV cavity and or annulus (LV enlargement)

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16
Q

What are the major causes of aortic valve stenosis?

A

Post inflammatory scarring

Calcification of aortic valve

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17
Q

What are the major causes of aortic valve regurgitation?

A

Post inflammatory scarring

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18
Q

What are the major causes of aortic disease?

A

Degenerative dilation and collagen diseases

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19
Q

What causes mitral stenosis?

A

Rheumatic fever is the leading cause

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20
Q

Who is more likely to get mitral valve stenosis?

A

2 thirds of patients with mitral stenosis are female

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21
Q

What are signs/symptoms of mitral valve stenosis?

A

Atrial fibrillation due to thrombi

Haemoptysis (coughing up blood)

Pulmonary congestion and hypertension

Right ventricular hypertrophy

Heart murmur

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22
Q

What type of murmur is seen with mitral valve stenosis?

A

Loud first heart sound, normal second heart sound followed by an
opening snap

Rumbling diastolic murmur

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23
Q

What causes mitral incompetence?

A

Myxoid degeneration (floppy valve): 5 - 10%

Rheumatic fever

Dilation of valve ring

Papillary muscle fibrosis, rupture

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24
Q

What are the symptoms of mitral incompetence?

A

Little effect with prolapse but 3% of patients affected due to chordae rupture may have thrombosis and atrial fibrillation.

LA enlargement

Acute LV failure with dilation if there is rupture of papillary muscle

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25
What does the heart murmur associated with mitral incompetence sound like?
Mild systolic click (but can be quite variable) Systolic - holosystolic Systolic - musical
26
What happens during mitral valve prolapse?
Interchordal ballooning or hooding of mitral leaflets which are enlarged rubbery and thick. The chordae tendinae can become large thinned or ruptured Annular dilation Thinning of the fibrosa and thickening of the spongiosa and deposition of myxoid material
27
What happens to valve tissue layers during a prolapse?
Fibrosa is thinned Spongiosa is thickened Myxoid is deposited
28
What are some secondary changes that result from a mitral valve prolapse?
Fibrous thickening of leaflets Thickening of LV endocardial surface Thickening of mural endocardium (LV or atrium) Thrombi on atrial surface of leaflets Focal calcifications at the base of posterior mitral leaflet Mid or late systolic click or mumor
29
What causes aortic stenosis?
Degenerative calcification (common) [Old age causes calcification] Rheumatic aortic valve disease
30
What are the clinical features of aortic stenosis?
Small pulse LV hypertrophy Angina Syncope LV failure Sudden death
31
What are the types of murmurs caused by aortic stenosis?
Ejection systolic murmur
32
What happens to mobility of the cusps of valves with age?
The leaflets become less mobile
33
Can heart muscles also become calcified? What problems can that cause?
Yes, it causes conduction problems
34
What causes aortic incompetence?
Severe hypertension Rheumatic fever Dilation of aortic root Rheumatoid arthritis Ankylosing spondylitis
35
What causes dilation of aortic root?
Old age Syphilis
36
What are the clinical features of aortic incompetence?
Wide pulse pressure with collapsing pulse LV hypertrophy Angina LV failure Heart murmurs
37
What are the types of murmurs seen in aortic incompetence?
Mid diastolic (Austin Flint) Opening snap Third heart sound
38
What are the types of rheumatic fever?
Acute (good prognosis) Chronic (bad prognosis, endocardial inflammation, fibrosis, and deformity)
39
What proteins mimic the heart cells in rheumatic fever?
M proteins on strep pyogenes cell wall
40
What kind of disorder is rheumatic fever?
Immune mediated connective tissue disorder characterised by fibrinoid necrosis
41
What are aschoff bodies?
Cardiomyocytes undergo fibrinoid necrosis and macrophages as well as some lymphocytes (T lymphocytes [Looks a bit like a granuloma]
42
What are macrophages found in aschoff bodies known as?
Anitschkow cells
43
What does acute rheumatic fever affect?
Pancarditis: Endocarditis (small focal areas of fibrinoid necrosis) Myocarditis (Aschoff nodules, may have LV dilation, functional mitral incompetence and LV failure) Pericarditis (fibrinous or serofibrinous type)
44
Where are aschoff nodules located?
In the myocardium
45
What does rheumatic fever also affect?
Joint pain, polyarthritis Erythema marginatum Subcutaneous nodules Chorea (in the CNS)
46
What criteria are followed by acute rheumatic fever?
Diagnosis by Jones criteria
47
What are some complications of chronic rheumatic fever?
Fusion of valve commissure Thickening of valve cusps, fibrosis, and vascular proliferation Shortening, fusion and thickening of the chordae tendinae
48
What is the shortening, fusion, and thickening of the chordae tendinae called?
Button hole or fish mouth deformity
49
What is infective endocarditis?
Infection of heart valves or the mural endocardium by a microbe with formation of vegetations
50
Who is most commonly affected by infective endocarditis?
Most commonly affects people with previously damaged valves and artificial valves
51
What predisposes people to IE?
Neutropenia Immunodeficiency Immunosuppression Indwelling catheters IV drug users Dental or other surgery in patients with damaged valves
52
What are the clinical forms of IE?
Acute endocarditis Subacute endocarditis
53
What causes acute endocarditis?
Caused by virulent organisms (eg. staph aureus)
54
Who typically get acute endocarditis?
Affects people with normal and abnormal hearts with large vegetations, vavlular destruction, myocardial abscesses. 10 - 20% of cases
55
What kind of bacteria cause subacute endocarditis?
Less virulent bacteria (strep viridans)
56
How well do antibiotics treat subacute endocarditis?
50 - 60% of cases they work
57
What kind of bacteria infect normal healthy valves?
S. Aureus
58
What kind of bacteria infect deformed valves?
S. Aureus
59
What kind of bacteria infect IV drug users?
S. Aureus
60
What kind of bacteria infect prosthetic valves?
S. Epidermidis
61
What kind of bacteria infect native previously damaged or abnormal valves?
Streptococcus viridans
62
What gram negative bacteria also infect heart valves?
HACEK group
63
What gram positive bacteria besides strep and staph infect heart valves?
Enterococci
64
Can fungi also cause valve diseases?
Yes
65
What are vegetations of IE?
Colonies of bacteria embedded in fibrin and inflammatory cells.
66
Where do vegetations of IE form?
Over areas where there is a high pressure gradient (incompetent valves, PDA, VSD)
67
What are potential complications that can be triggered by vegetations of IE?
They may break off and cause septic embolism (metastatic abscesses)
68
What criteria are used to assess IE?
Duke's criteria Glomerulonephritis Major: Blood culture positive, valve related mass or abscess Minor: Vascular lesions (due to emboli) including arterial petechiae, subungual/splinter haemorrhages, emboli, septic infarcts, mycotic aneurysms, intracranial haemorrhage, janeway lesions, Oster nodes, retinal haemorrhages
69
What are the clinical features of IE?
Acute febrile illness with swinging temperature Changing heart murmur Heart failure
70
What are janeway lesions?
Janeway lesions are non-tender, small erythematous or haemorrhagic macular or nodular lesions on the palms or soles only a few millimeters in diameter that are indicative of infective endocarditis.
71
What is an erythema?
Erythema (from the Greek erythros, meaning red) is redness of the skin or mucous membranes, caused by hyperemia (increased blood flow) in superficial capillaries
72
What are osler's nodes?
Osler's nodes are painful, red, raised lesions found on the hands and feet.
73
What are roth spots?
retinal haemorrhage
74
What are the heart complications that can arise from infective myocarditis?
Valve perforation, incompetence Myocardial abscess
75
What are the emboli-related complications that can arise from IE?
Bland - CVA, MI, splenic or renal infarct. Septic - can cause abscesses
76
What are the microemboli-related complications that can arise from IE?
Focal glomerulonephritis Roth's spots in retina Petechiae Splinter haemorrhages in nail bed
77
What are the complications that can arise from circulating immune complexes found in IE?
They can cause focal or diffuse GlomeruloNephritis
78
Other complications of IE?
FInger clubbing and splenomegaly
79
What are the types of vegetations of heart valves?
Rheumatic heart disease vegetations Infective endocarditis vegetations Nonbacterial thrombotic endocarditis (bland vegetations at line of closeure of the valves) Libman-Sachs endocarditis (occassionally seen in SLE)
80
What are some complications of prosthetic valves?
Thrombosis/thromboembolism Anti-coagulant related haemorrhage Prosthetic valve endocarditis Structural deterioration Inadequate healing (paravalvular leak) Exuberant healing (obstruction) Haemolysis
81
What is the probability that a prosthetic valve will have complications within 10 years?
60%
82
What are the types of prosthetic valves?
Mecahnical Tissue TAVI (Transcatheter Aortic Valve Implantation)

IMED3001 (46 decks)

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