Valvular Heart Disease & HTN

Question 1

Describe the microscopic appearance of the myofibers in the setting of cardiac myocyte hypertrophy.

Answer 1

• Enlargement of myocytes
• No additional myocytes created
• you do get more sarcomeres, myofibrils

Question 2

Name the most common form of hypertension

Answer 2

Essential HTN

- idiopathic

Question 3

What are the effects of chronic hypertension on the appearance and function of the heart?

Answer 3

Hypertrophy and/or dilation of the heart

Question 4

Define cor pulmonale

Answer 4

Right heart failure

Question 5

Give examples of underlying causes (excluding left heart failure) of cor pulmonale

Answer 5

• Pulmonary parenchyma disease (emphysema, institial lung disease, bronchiectasis)
• Pulmonary Vessel Disease (PE, 1ary pulm HTN, sleep apnea)
• Chest movement alterations (kyphoscoliosis, obesity, neuromuscular)

Question 6

Discuss the incidence and long term implications of a bicuspid aortic value.

Answer 6

1 in 50-100 people

Asymptomatic until later in life with accelerated wear and tear

• Reduced outflow => ventricular hypertrophy
• Increased turbulence => valve thickening & stenosis (BIGGEST problem)

Question 7

Identify the most common causes of aortic stenosis in (a) patient 70 years old.

Answer 7

a)

b)

Question 8

Describe the key features of rheumatic heart disease with respect to the valve leaflets, chordae tendinae, and the effects on the functionality of the valve.

Answer 8

VL: fibrosis, fusion, calcification

CT: fibrosis, fusion, shortening

Leads to stenosis and regurgitation

Question 9

List several complications of rheumatic heart disease.

Answer 9

• Valves can’t open or close (stenosis, regurg)
• Can progress to HF
• Susceptible to infective endocarditis

Question 10

Name the most commonly affected valves in rheumatic heart disease.

Answer 10

Mitral (65-75%)

Aortic, usually with MV (25%)

Question 11

Distinguish the two major classes of cardiac valve vegetations and their causes.

Answer 11

Non-bacterial thrombotic endocarditis:

• thrombus formation in valve
• No organism involved
• Causes: RHD, SLE, hypercoag state

Infectious endocarditis:

• 1ary infection of normal/damaged valve
• Causes: bacteria (skin, oral, GI), fungi, viruses

Question 12

List examples of the bacteria commonly associated with infectious endocarditis

Answer 12

• S. aureus

- Strep. viridans

Question 13

Describe the propensity of bacteria commonly associated with infectious endocarditis to infect normal versus abnormal valves and how the bacteria may gain access to the valves.

Answer 13

a

Question 14

List possible complications of cardiac valve vegetations.

Answer 14

a