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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
Q

What does the heart murmur associated with mitral incompetence sound like?

A

Mild systolic click (but can be quite variable)

Systolic - holosystolic
Systolic - musical

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26
Q

What happens during mitral valve prolapse?

A

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

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27
Q

What happens to valve tissue layers during a prolapse?

A

Fibrosa is thinned

Spongiosa is thickened

Myxoid is deposited

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28
Q

What are some secondary changes that result from a mitral valve prolapse?

A

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

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29
Q

What causes aortic stenosis?

A

Degenerative calcification (common) [Old age causes calcification]

Rheumatic aortic valve disease

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30
Q

What are the clinical features of aortic stenosis?

A

Small pulse

LV hypertrophy

Angina

Syncope

LV failure

Sudden death

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31
Q

What are the types of murmurs caused by aortic stenosis?

A

Ejection systolic murmur

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32
Q

What happens to mobility of the cusps of valves with age?

A

The leaflets become less mobile

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33
Q

Can heart muscles also become calcified? What problems can that cause?

A

Yes, it causes conduction problems

34
Q

What causes aortic incompetence?

A

Severe hypertension

Rheumatic fever

Dilation of aortic root

Rheumatoid arthritis

Ankylosing spondylitis

35
Q

What causes dilation of aortic root?

A

Old age

Syphilis

36
Q

What are the clinical features of aortic incompetence?

A

Wide pulse pressure with collapsing pulse

LV hypertrophy

Angina

LV failure

Heart murmurs

37
Q

What are the types of murmurs seen in aortic incompetence?

A

Mid diastolic (Austin Flint)

Opening snap

Third heart sound

38
Q

What are the types of rheumatic fever?

A

Acute (good prognosis)

Chronic (bad prognosis, endocardial inflammation, fibrosis, and deformity)

39
Q

What proteins mimic the heart cells in rheumatic fever?

A

M proteins on strep pyogenes cell wall

40
Q

What kind of disorder is rheumatic fever?

A

Immune mediated connective tissue disorder characterised by fibrinoid necrosis

41
Q

What are aschoff bodies?

A

Cardiomyocytes undergo fibrinoid necrosis and macrophages as well as some lymphocytes (T lymphocytes

[Looks a bit like a granuloma]

42
Q

What are macrophages found in aschoff bodies known as?

A

Anitschkow cells

43
Q

What does acute rheumatic fever affect?

A

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
Q

Where are aschoff nodules located?

A

In the myocardium

45
Q

What does rheumatic fever also affect?

A

Joint pain, polyarthritis

Erythema marginatum

Subcutaneous nodules

Chorea (in the CNS)

46
Q

What criteria are followed by acute rheumatic fever?

A

Diagnosis by Jones criteria

47
Q

What are some complications of chronic rheumatic fever?

A

Fusion of valve commissure

Thickening of valve cusps, fibrosis, and vascular proliferation

Shortening, fusion and thickening of the chordae tendinae

48
Q

What is the shortening, fusion, and thickening of the chordae tendinae called?

A

Button hole or fish mouth deformity

49
Q

What is infective endocarditis?

A

Infection of heart valves or the mural endocardium by a microbe with formation of vegetations

50
Q

Who is most commonly affected by infective endocarditis?

A

Most commonly affects people with previously damaged valves and artificial valves

51
Q

What predisposes people to IE?

A

Neutropenia

Immunodeficiency

Immunosuppression

Indwelling catheters

IV drug users

Dental or other surgery in patients with damaged valves

52
Q

What are the clinical forms of IE?

A

Acute endocarditis

Subacute endocarditis

53
Q

What causes acute endocarditis?

A

Caused by virulent organisms (eg. staph aureus)

54
Q

Who typically get acute endocarditis?

A

Affects people with normal and abnormal hearts with large vegetations, vavlular destruction, myocardial abscesses. 10 - 20% of cases

55
Q

What kind of bacteria cause subacute endocarditis?

A

Less virulent bacteria (strep viridans)

56
Q

How well do antibiotics treat subacute endocarditis?

A

50 - 60% of cases they work

57
Q

What kind of bacteria infect normal healthy valves?

A

S. Aureus

58
Q

What kind of bacteria infect deformed valves?

A

S. Aureus

59
Q

What kind of bacteria infect IV drug users?

A

S. Aureus

60
Q

What kind of bacteria infect prosthetic valves?

A

S. Epidermidis

61
Q

What kind of bacteria infect native previously damaged or abnormal valves?

A

Streptococcus viridans

62
Q

What gram negative bacteria also infect heart valves?

A

HACEK group

63
Q

What gram positive bacteria besides strep and staph infect heart valves?

A

Enterococci

64
Q

Can fungi also cause valve diseases?

A

Yes

65
Q

What are vegetations of IE?

A

Colonies of bacteria embedded in fibrin and inflammatory cells.

66
Q

Where do vegetations of IE form?

A

Over areas where there is a high pressure gradient (incompetent valves, PDA, VSD)

67
Q

What are potential complications that can be triggered by vegetations of IE?

A

They may break off and cause septic embolism (metastatic abscesses)

68
Q

What criteria are used to assess IE?

A

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
Q

What are the clinical features of IE?

A

Acute febrile illness with swinging temperature

Changing heart murmur

Heart failure

70
Q

What are janeway lesions?

A

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
Q

What is an erythema?

A

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
Q

What are osler’s nodes?

A

Osler’s nodes are painful, red, raised lesions found on the hands and feet.

73
Q

What are roth spots?

A

retinal haemorrhage

74
Q

What are the heart complications that can arise from infective myocarditis?

A

Valve perforation, incompetence

Myocardial abscess

75
Q

What are the emboli-related complications that can arise from IE?

A

Bland - CVA, MI, splenic or renal infarct.

Septic - can cause abscesses

76
Q

What are the microemboli-related complications that can arise from IE?

A

Focal glomerulonephritis

Roth’s spots in retina

Petechiae

Splinter haemorrhages in nail bed

77
Q

What are the complications that can arise from circulating immune complexes found in IE?

A

They can cause focal or diffuse GlomeruloNephritis

78
Q

Other complications of IE?

A

FInger clubbing and splenomegaly

79
Q

What are the types of vegetations of heart valves?

A

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
Q

What are some complications of prosthetic valves?

A

Thrombosis/thromboembolism

Anti-coagulant related haemorrhage

Prosthetic valve endocarditis

Structural deterioration

Inadequate healing (paravalvular leak)

Exuberant healing (obstruction)

Haemolysis

81
Q

What is the probability that a prosthetic valve will have complications within 10 years?

A

60%

82
Q

What are the types of prosthetic valves?

A

Mecahnical

Tissue

TAVI (Transcatheter Aortic Valve Implantation)

IMED3001 (46 decks)

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