Valvular Heart Disease (Gebska)

Question 1

competence of these valves relies on the proper function of leaflets, the tendinous cords, and the attached papillary muscles

Answer 1

mitral and tricuspid valves

Question 2

competence of these valves relies on the integrity and coordinated movements of the cuspids

Answer 2

aortic and pulmonic (semilunar) valves

Question 3

layer of the cardiac valves that is characterized by a dense collagenous core at the outflow surface, connected to the vascular supporting structures

Answer 3

fibrosa

Question 4

layer of the cardiac valves that is characterized by a central core of loose, proteoglycan-rich connective tissue that facilitates intreactions between stiff collagen and elastic layers

Answer 4

spongiosa

Question 5

layer of the cardiac valves that is elastin rich and is situated on the inflow surface

Answer 5

ventricularis or atrialis

Question 6

most abundant cells in the heart valves, that synthesize extracellular matrix (ECM) and matrix metalloproteases (MMPs)

Answer 6

valvular interstitial cells

Question 7

this type of valve pathology is the key feature in rheumatic heart disease

Answer 7

fibrotic thickening

Question 8

Which of these statements regarding valve pathology and disease is FALSE?

A. fibrotic thickening is the key feature in rheumatic heart disease

B. aortic stenosis is commonly caused by nodular calcification that begins in interstitial cells

C. every type of valve disease can be either congenital or acquired

D. insufficiency refers to failure of the valve to open completely, which impedes forward flow

E. functional mitral regurgitation is a type of secondary insufficiency

Answer 8

D. This is the definition of stenosis. Insufficiency refers to regurgitation or “leaky valve” and may be primary (as in the case of mitral valve prolapse) or secondary (e.g., the mitral valve leaflets are normal but another condition is causing incompetence)

Question 9

mitral or aortic insufficiency most often leads to this type of overload

Answer 9

volume

Question 10

aortic stenosis most often leads to this type of overload

Answer 10

pressure

Question 11

All of the following statements regarding calcific aortic stenosis are true EXCEPT: A. It is the most common valvular abnormality B. It is caused by age-associated “wear and tear” as well as recurrent chronic injury (hyperlipidemia, HTN, inflammation, etc) C. Congenitally abnormal valves are prone to infective endocarditis D. Statins are not helpful in treating it E. Tricuspid valves incur greater mechanical stress than bicuspid valves, which may explain their accelerated stenosis

Answer 11

E. The opposite is true - bicuspid valves incur greater mechanical stress than normal tricuspid valves

Question 12

mutations in this gene are associated with congenital aortic stenosis, which leads to increased risk of infective endocarditis

Answer 12

NOTCH1

Question 13

hypertrophied myocardium tends to be ischemic due to diminished microcirculatory perfusion, leading to ____ even in the absence of coronary artery disease

Answer 13

angina

Question 14

the onset of symptoms of aortic stenosis is accompanied by a steep drop off in survival rate, with ____ being a symptom associated with best prognosis and _____ associated with worse prognosis.

Answer 14

angina; syncope and heart failure

Question 15

degenerative calcific deposits in the mitral valve typically develop in the ____ _____.

Answer 15

fibrous annulus

Question 16

___ ____ calcifications usually do not affect valvular function but can lead to regurgitation, stenosis and arrhythmias.

Answer 16

mitral annular

Question 17

immunologically mediated, multisystem inflammatory disease, classically occurring 10 days - 6 weeks after a group A strep pharyngitis, that can eventually lead to mitral valve stenosis

Answer 17

acute rheumatic fever (AF)

Question 18

though patients test negative for strep A by the time RF begins, antibodies to streptococcal enzymes like ____ and ____ may be detected in patient’s serum

Answer 18

streptolysin O and DNase B

Question 19

which of these is NOT a MAJOR diagnostic factor of rheumatic fever?

A. Polyarthritis

B. Arthralgia

C. Erethyma marginatum

D. Sydenham chorea

E. Subcutaneous nodules

Answer 19

B. Arthralgia is a minor, nonspecific diagnostic factor. In order to make a RF diagnosis, you need either:

2 major factors (which include all other foils + pancarditis; “CANCER” pneumonic)

OR

1 major + 2 minor criteria (e.g., arthralgia, fever, leukocytosis)

Question 20

the target treatment of a mitral valve that has sustained culmulative damage over time, as in the case of rheumatic heart disease, is replacement of the valve.

Answer 20

False. Aortic valves are replaced - favored treatment for mitral valves is repair via MV percutaneous balloon valvulplasty.

Question 21

which of these is NOT a condition associated with vegetative valve disease? A. rheumatic heart disease B. Infective endocarditis C. laplace’s endocarditis D. nonbacterial thrombotic (marantic) endocarditis E. libman-sacks endocarditis

Answer 21

C

Question 22

most chronic rheumatic heart disease involves:

A. mitral valve alone

B. mitral and aortic valves

C. aortic valve alone

D. tricuspid valve

E. pulmonic valve

Answer 22

A. mitral valve dysfunction is involved about 40% of the time, with mitral and aortic valve being involved another 40% - however, the aortic valve is never involved without mitral valve dysfunction first, which is why A is the more correct answer. The aortic valve alone is involved about 20% or the time, with the tricuspid valve involved occasionally and the pulmonic valve never.

Question 23

____ stenosis characteristically affects the free edge of the cusp, while ____ stenosis characteristically has a “fish mouth” appearance.

Answer 23

aortic; mitral (both forms of stenosis include fibrotic depositions that have a “candle wax” appearance on gross observation)

Question 24

condition associated with Marfan’s and the fibrillin-1 gene that is characterized by ballooning of the mitral valve back into the left atrium during systole

Answer 24

mitral valve prolapse

Question 25

Which of these is NOT a characteristic of carcinoid syndrome?

A. It is a disorder characterized by flushing, diarrhea, dermatitis and bronchoconstriction

B. It is caused by serotonin releasing tumors that cause fibrosis

C. About 50% of patients with liver metastasis will develop it

D. It classically affects the left side of the heart

Answer 25

D. Carcinoid heart disease characteristically involves the right side of the heart, though under special conditions (e.g., patent foramen ovale or atrial septal defect) the left side may be involved.

Question 26

refers to marked thickening of the spongiosa layer that is the most common cause of pure mitral valve insufficiency

Answer 26

myxomatous degeneration