Valvular Heart Disease Flashcards
stenosis
- failure of heart valve to open completely
- almost always due to injury to the tissue of the cusps/leaflets
- usually a chronic process
regurgitation
•insufficiency, incompetence •failure of valve to close completely •may be due to injury to valve cusps/leaflets or injury to the annulus and supporting tissue •may be acute or chronic
functional regurgitation
•regurgitation caused by dilatation of the valvular annulus in the setting of ventricular dilatation •usually in he absence of any abnormality of the valve leaflets •when he valve annulus is dilated, the leaflets are further apart and can’t close completely
murmur
•abnormal heart sound caused by abnormal blood flow
jet lesion
•focal endocardial fibrosis caused by an abnormal stream (“jet”) of blood directed toward that area through a regurgitant valve
causes of aortic stenosis
- degenerative fibrocalcific (“senile”) aortic valve disease 2. congenitally bicuspid aortic valve with degeneration 3. postinflammatory (rheumatic) valve disease
causes of aortic regurgitation
- diseases that dilate the aorta (aortitis, aortic medial degeneration) 2. congenitally bicuspid aortic valve 3. postinflammatory (rheumatic) valve disease 4. infective endocarditis
causes of mitral stenosis
- postinflammatory (rheumatic) valve disease (99% of cases of mitral stenosis) 2. radiation valvulopathy (due to radiation therapy to thorax) 3. other rare disorders
causes of mitral regurgitation
- myxomatous mitral valve degeneration (floppy mitral valve) with mitral valve prolapse 2. postinflammatory (rheumatic) valve disease 3. infective endocarditis 4. papillary muscle rupture (due to myocardial infarction) 5. annular dilatation (due to ischemic heart disease with secondary left ventricular dilation, dilated cardiomyopathy, or other causes of of left ventricular dilatation) 6. annular calcification
degenerative fibrocalcific (“senile”) aortic valve disease
- non inflammatory
- aortic valve stenosis
- age related - >80 yo
- dystrophic calcification on sinus side of valve
- minimal to no commissural fusion, mild fibrosis
- mitral valve is normal or shows annular calcification (in area where there is continuity between the aortic valve annulus and the mitral valve annulus)
- physiologic consequences: stenosis with or without regurgitation, increased pressure gradient across valve, left ventricular hypertrophy without dilatation due to pressure overload, CHF, sudden cardiac death, increased risk for infective endocarditis
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calcific stenosis of bicuspid aortic valve
congenitally bicuspid aortic valve
- non-inflammatory
- aortic stenosis
- 1-2 % of the population
- two unequal sided cusps
- dystrophic calcification on sinus side of valve occurs, very similar to degenerative fibrocalcific aortic valve disease (of a tricuspid aortic valve) but at an accelerated rate, with most patients presenting about a decade sooner (in their 50s)
- these patients also have a congenital ascending aortopathy (abnormal ascending aorta) and a re prone to developing ascending aortic aneurysms and dissections in addition to developing aortic valvular stenosis
- physiologic consequences: same as with degenerative fibrocalcific aortic valve disease - stenosis with or without regurgitation, increased pressure gradient across valve, left ventricular hypertrophy without dilatation due to pressure overload, CHF, sudden cardiac death, increased risk for infective endocarditis
mitral valve prolapse
- non inflammatory
- mitral valve regurgitation
- redundant leaflet tissue balloons back into left atrium during systole
- affects 5-10 % of population, especially women
- myxomatous degenration of leaflet tissue, thinning of collagen layer. long chordae
- common in Marfan syndrome
- 3% of patients develop complications
- infective endocarditis
- mitral regurgitation
- stroke or systemic infarct, from thrombi that form on surface of redundant leaflets
- arrhythmias - physiologic consequences: regurgitation, left ventricular hypertrophy and dilatation due to volume overload, left atrial dilatation, increased risk for left atrial thrombus formation and systemic embolism, increased risk for atrial and ventricular arrhythmias (due to chamber dilatation), increased risk for infective endocardtitis
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- mital valve prolapse
- Fragmentation of the collagen in the valve leaflet
- Deposition of mucopolysaccharides (myxoid or myxomatous degeneration)
mitral valve annular calcification
•mitral regurgitation
*non inflammatory
- chiefly seen in elderly women
- no inflammation, valve leaflets mildly affected
- physiologic consequences: regurgitation, calcific particles may break loose and embolize, increased rsik for infective endocarditis, sudden cardiac death from conduction syste involvement
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rheumatic fever
- systemic autoimmune disease following group A beta hemolytic streptoccoccal pharyngeal infection
- autoimmune reaction, due to formaion of antibodies to bacterial antigens that cross react with normal tissue antigens
- acute rheumatic fever is a disease of childhood
symptoms of rheumatic fever
- fever, migratory polyarthritis, (one joint after another becomes sore), and sometime cardiac symptoms, occurring a few weeks to a few months after having strep throat
- diagnosis established by Jones criteria: evidence of streptococcal infection and presence of sufficient major and minor criteria
- less than 1% of patients die acutley
- disease is reactivated with each new strep infection
- heart failure occurs decades later
- decreased in US, but making a comeback, globally 15-20 millionnew cases/year
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- Marfan’s syndrome
- mitral valve prolapse
acute rheumatic heart disease - “pancarditis”
- myocarditis with Aschoff bodies
- pericarditis, usually fibrinous
- endocarditis, with small non-infectios vegetations (verrucae)