Valvular Heart Disease Pathology

Question 1

what is the central valve in the surgical view of the heart valves?

Answer 1

aortic valve

Question 2

name the three portions of the anterior leaflet of the mitral valve

Answer 2

A1,A2,A3

Question 3

name the three portions of the posterior leaflet of the mitral valve

Answer 3

P1, P2, P3

Question 4

what is the most repairable portion of the mitral valve

Answer 4

P2 of the posterior leaflet

Question 5

name the three cusps of the aortic valve

Answer 5

right coronary cusp, non coronary cusp, left coronary cusp

Question 6

which of s3/4 gallop is normal in children and young adults

Answer 6

S3

Question 7

what causes a rub sound?

Answer 7

rubbing together of visceral and parietal pericardial layers of the heart

Question 8

what is the cause of a systolic ejection click?

Answer 8

high pitched sound of the aortic or pulmonic valve opening, occurs after S1

Question 9

what is the cause of a systolic non ejection click?

Answer 9

high pitched sound of the closure of the mitral valve

Question 10

what is the cause of a snap?

Answer 10

short high frequency sound after S2…due to sudden arrest of the opening of the mitral or tricuspid valves

Question 11

is mitral regurg murmur diastolic or systolic?

Answer 11

systolic

Question 12

is mitral stenosis murmor diastolic or systolic?

Answer 12

diastolic

Question 13

is aortic stenosis murmur diastolic or systolic?

Answer 13

systolic

Question 14

is aortic regurgitation murmur diastolic or systolic?

Answer 14

diastolic

Question 15

what is the usual cause of a bicuspid aortic valve?

Answer 15

congenital anomaly

Question 16

which two cusps of the aortic valve usually fuse to cause bicuspid aortic valve?

Answer 16

Left coronary and right coronary cusps

Question 17

what is another issue you can have related to the aorta with a bicuspid aortic valve?

Answer 17

often have dilated ascending aorta…needs to be repaired at 4.5 cm compared to usual 5 cm

Question 18

what is the usual cause of mitral valve prolapse?

Answer 18

valve collagen and elastic fibers fragment leading to gel like substance that is much more stretchy than the normal mitral valve

Question 19

what is the degneration of tissue called in mitral valve prolapse?

Answer 19

myxomatous degeneration

Question 20

clinically, what is mitral valve prolapse most often related to?

Answer 20

infective endocarditis

Question 21

what is the treatment for mitral valve prolapse? what is treatment dependent on?

Answer 21

treatment decisions are made based on the extent of mitral regurgitation…if severe enough then you will repair or replace the mitral valve

Question 22

what is the causative agent of rhemuatic heart disease/

Answer 22

group a beta hemolytic strep

Question 23

after you have strep…what follows that leads to rheumatic heart disease?

Answer 23

acute rheumatic fever…systemic infection of heart joints NS and skin

Question 24

how many layers of the heart are affected in acute rheumatic fever?

Answer 24

endocardium myocardium pericardium

Question 25

what layer of the heart remains affected after acute rheumatic fever and what layrers resolve?

Answer 25

endocardium remains affected and myocardium and pericardium resolve

Question 26

explain the physiology behind rheumatic heart disease

Answer 26

antibodies are made against group A beta hemolytic strep and these antibodies cross react with heart tissues (type 2 immune response)

Question 27

what happens histologically in the myocardium with acute rheumatic fever?

Answer 27

granulomas appear in the myocardium

Question 28

what are the granulomas in the myocardium called with acute rheumatic fever?

Answer 28

aschoff bodies

Question 29

what is a unique cell type in the granulomas of the myocardium with acute rheumatic fever?

Answer 29

macrophages that look like owl eyes...anischkow cells

Question 30

following acute rheumatic fever...what process leads to chronic rheumatic heart disease?

Answer 30

repair and fibrosis of the valves

Question 31

what uniquely happens to valves in chronic rheumatic heart disease?

Answer 31

the cusps of the valve/leaflets often fuse together

Question 32

define how infective endocarditis occurs

Answer 32

usually bacterial infection of the endocardial tissue of the heart with a strong preference for mitral and aortic valves

Question 33

what organism usually causes acute bacterial endocarditis?

Answer 33

virulent organism like staph A

Question 34

what group of people are more susceptible to acute bacterial endocarditis

Answer 34

IV drug users

Question 35

what is the difference between acute and subacute bacterial endocarditis?

Answer 35

acute uses virulent organisms while subacute does not...subacute has longer progression of disease

Question 36

what type of organism is usually involved with subacute bacterial endocarditis

Answer 36

less virulent like strep viridans

Question 37

in acute bacterial endocarditis what is the status of the heart valve prior to infection? what about in subacute?

Answer 37

normal valve for acute and abnormal valve for subacute

Question 38

describe the pathophys steps in acute bacterial endocarditis...

Answer 38

normal valve with injury leads to thrombus..bacteremia of virulent pathogen then gets into thrombus and able to adhere and colonize...leads to acute inflammation and ultimately necrosis of the valve

Question 39

does acute or subacute bacterial endocarditis lead to necrosis of the valve?

Answer 39

acute!

Question 40

what is a common side effect associated with acute and subacute bacterial endocarditis? why?

Answer 40

emboli...infarcts and abscesses because of the thrombus formation

Question 41

what is a vegetation? and what disease is it common in?

Answer 41

an infected clot...common in acute and subacute bacterial endocarditis

Question 42

name the culture negative organisms that can play role in infective endocarditis

Answer 42

``` Haemophilus Aggregatibacter Cardiobacterium Eikenella Kingella ```

Question 43

what is the treatment of infective endocarditis?

Answer 43

prolonged IV and oral antibiotics and surgery to remove vegetation and or repair the valves

Question 44

what is the most common cause of acquired vascular disease in developed world?

Answer 44

calcified vascular disease

Question 45

what type of valve does calcified vascular disease commonly include?

Answer 45

usually the left heart valves...commonly a bicuspid aortic valve

Question 46

what are the clinical causes of calcified vascular disease?

Answer 46

can be aortic stenosis or mitral stenosis/regurg

Question 47

what is the treatment for calcified vascular disease?

Answer 47

valve replacement

Question 48

define NBTE

Answer 48

non bacterial thrombotic endocarditis

Question 49

what is the physiology of NBTE?

Answer 49

non bacterial thrombotic endocarditis leads to coagulation and vegetation around valves of the heart...usually aortic and mitral

Question 50

what is the pathophysiology of the carcinoid tumor?

Answer 50

neuroendocrine cells make abnormally large amounts of serotonin that induce fibrosis around heart valves

Question 51

which valves are usually affected by carcinoid tumor?

Answer 51

right side!! pulmonic and tricuspid