Valvular Heart Disease

Question 1

What happens in Regurgitant flow?

Answer 1

Results in volume overload in the affected chamber

valve lesions

Question 2

What happens in Shunted flow?

Answer 2

Leads to pressure and volume overloads

Question 3

What are the Disorders of cardiac conduction?

Answer 3

Arrhythmias leads to decrease in contraction frequency and effective cardiac output

Question 4

What happens if there is a rupture in heart or major vessel?

Answer 4

 Leads to exsanguination, hypotensive shock & death

Question 5

What results in valvular heart disease?

Answer 5

Result in stenosis or insufficiency (regurgitation) or both

Question 6

Define stenosis

Answer 6

• failure of a valve to open completely 

impedes forward blood flow

Question 7

What leads to insufficiency?

Answer 7

failure of a valve to close

completely leads to allowing reversed blood flow (backflow)

Question 8

What leads to murmurs?

Answer 8

Abnormal flow through diseased valves

Question 9

What is Calcific Aortic Stenosis?

Answer 9

 A degenerative valve disease
 Most common cause of aortic stenosis
 Age related wear and tear
 Age related arteriosclerosis (

Question 10

What is the morphology seen in Calcific Aortic Stenosis?

Answer 10

Heaped-up calcified masses on the outflow side of the cuspus which may protrude into the sinuses of Valsalva

Question 11

What are the consequences seen in calcific aortic stenosis?

Answer 11

 Angina – hypertrophied myocardium tends to be ischemic
 Syncope – poor perfusion of the brain
 CHF – because of systolic & diastolic dysfunction
 Eventually cardiac decompensation

Question 12

What is the morphology seen in Myxomatous Mitral Valve Degeneration?

Answer 12

 Characterized by ballooning or
prolapse of mitral leaflets
 Enlarged, redundant, thick &
rubbery affected leaflets
 Tendinous cords – elongated,
thinned & occasionally ruptured

Question 13

What is the histological features seen in Myxomatous Mitral Valve Degeneration?

Answer 13

Thinning of fibrosa layer of the valve
 Extension of middle spongiosa layer with increased
deposition of mucoid material

Question 14

What are the complications seen in Myxomatous Mitral Valve Degeneration?

Answer 14

Mitral regurgitation
 CHF
 Increased risk of infective endocarditis & SCD
 Embolism leads to stroke or other systemic infarction

Question 15

Define Rheumatic fever (RF)

Answer 15

an acute, immunologically

mediated, multisystem inflammatory disease

Question 16

How does rheumatic fever occur

Answer 16

 Occurs after an episode of group A β-hemolytic streptococcal infection

Question 17

How is RHD characterized?

Answer 17

 Characterized principally by deforming fibrotic valvular

disease

Question 18

RHD is the only cause of______

Answer 18

acquired mitral stenosis

Question 19

What are the features seen in Aschoff bodies?

Answer 19

– collections of lymphocytes,
scattered plasma cells & plump activated
macrophages called Anitschkow cells

Question 20

What are the features seen in Anitschkow cells

Answer 20

abundant cytoplasm & nuclei with central chromatin condensed to form a slender,
wavy ribbon (caterpillar cells)

Question 21

What are the Consequences of Rheumatic Heart Disease?

Answer 21

 Cardiac murmurs
 Cardiac hypertrophy and dilation
 CHF
 Arrhythmias
 Thromboembolic complications
 Increased risk of subsequent infective endocarditis

Question 22

What is Infective Endocarditis (IE)?

Answer 22

Characterized by microbial infection of heart valves or
mural endocardium, often with destruction of the
underlying cardiac tissues resulting in bulky, friable
vegetations composed of necrotic debris, thrombus
and organisms

Question 23

What are Acute Endocarditis?

Answer 23

 Highly virulent organism (staphylococcus aureus)
 Previously normal valve
 Destructive lesions
 Substantial morbidity and mortality even with
appropriate treatment

Question 24

What are Subacute Endocarditis?

Answer 24

 Organisms of low virulence
 Previously abnormal valve
 Insidious onset – protracted course – recovery with
appropriate antibiotics

Question 25

What is the causative organism causing IE?

Answer 25

 Previously damaged valves Strep. viridans
 Staph. Aureus – both deformed & healthy valves
 HACEK group ( Haemophilus, Actinobacillus,
Cardiobacterium, Eikenella and Kingella)
 Gram negative bacilli & fungi – rare cases
 10% of cases  no organism can be isolated from the
blood (“culture-negative” endocarditis)

Question 26

 Most important condition predisposing to endocarditis

is______________

Answer 26

seeding of blood with microbes

Question 27

What is the morphology seen in IE?

Answer 27

 Aortic & mitral valves – commonest sites
 Tricuspid valves – I.V. drug abuse
 Friable, bulky & destructive vegetations containing fibrin,
inflammatory cells & microorganisms on heart valves
 Vegetations – single or multiple, may involve > one valve

Question 28

What are the Features caused by

microemboli?

Answer 28

1. Petechiae
2. Nail bed hemorrhages (Splinter hemorrhages)
3. Retinal hemorrhages (Roth spots)
4. Painless palm/sole erythematous lesions (Janeway lesions)
5. Painful finger tip nodules (Osler nodes)

Question 29

What is the diagnosis for microemboli?

Answer 29

 Positive blood cultures

 Echocardiographic findings

Question 30

What are the complications seen in the microemboli?

Answer 30

 Glomerulonephritis with hematuria, albuminuria or
renal failure
 Septicemia
 Arrhythmias
 Systemic embolization

Question 31

How is Nonbacterial thrombotic endocarditis (NBTE) characterized?

Answer 31

 Characterized by deposition of small sterile thrombi
on the leaflets of the cardiac valves
 Valvular lesions are sterile
 Usually on previously normal valves

Question 32

What is the morphology seen in the NBTE?

Answer 32

 Sterile, nondestructive &
small vegetations
 May be single or multiple
 Bland thrombus without inflammation or valve
damage