Valvular patho 12/03 Flashcards
What causes reumatic fever?
A beta-hemolytic streptococci infection of pharynx (pharyngitis).
When occurs reumatic fever?
2-3 week after A beta-hemolytic streptococci infection .
Which valves are affected the most by acute reumatic fever?»_space;>
Mitral>aortic>tricuspid.
What changes of mitral valve are in early and late lesion in acute reumatic fever?
Early - MV regurgitation. Late - MV stenosis.
What is Aschoff bodies? What disease?
Granuloma with giant cells. Acute reumatic fever.
What is Anitschkow cells? What disease?
Enlarged macrophages with ovodi, wavy, rod-like nucleus. Acute reumatic fever.
What lab. diagn. is increased in blood in acute reumatic fever?
Increased antistreptolysin O (ASO) titers or anti-DNase B titers.
What hypersinsitivity type is in acute reumatic fever?
II hypersensitivity.
Why accurs reumatis fever after body contacts with streptococci (mechanism)?
Due to molecular mimicry. Antibodies to streptococci M proteins cross-react with self antigens.
What is treatment/prophypaxis of acute reumatic fever?
Penicilin.
J(heart)NES - what are clinical symptoms and disease?
Acute reumatic fever.
J - Joints (migratory polyarthritis);
(Heart) - Pancarditis;
Endocarditis - vegetations along lines of closure –> regurgitation.
Myocarditis - Aschoff bodies, Anitschkow cells, fibrinoid material.
Pericarditis.
N - Nodules in skin (subcutaneus);
E - Erythema marginatum (evanescent rash with ring margin).
S - Sydenham chorea.
How results valvular lesions?
Stenosis or regurgitation.
Where are founded Aschoff bodies?
In myocardium when myocarditis by acute reumatic fever.
Where are founded Anitschkow cells?
In myocardium when myocarditis by acute reumatic fever.
What are nonspecific clinical symptoms of acute reumatic fever?
Fever, increased ESR.
What is Syndenham chorea?
Rapid, involuntary muscle movements.
Acute reumatic fever can complicate to ?
Chronis reumatic fever.
What is morphology of chronic reumatic fever?
Valvular stenosis with ,,fish-mouth appearance”.
What is the most often affected valve in chronic reumatic fever? What changes?
Mitral valve. Thickening of chordae tendinea and cusps.
What are complications of chronic reumatic fever?
Infectious endocarditis.
What is second most often involved valve in chronic reumatic fever? What changes?
Aortic. Leads to fusion of the commissures.
In what age presents aortic stenosis?
> 60.
Aortic stenosis is due to ………
Fibrosis and caltification from ,,wear and tear”.
How many cups are in normal and abnormal aortic valve?
Normal - 3; Abnormal - 2.
Which sound is hear in aortic stenosis?
Crescendo-desrescendo.
Systolic ejection ……………… is followed by ……………… in aortic stenosis.
Click
Crescendo-desrescendo.
Why there could be a prolonged asymptomatic stage in aortic stenosis?
Because of cardiac compensation.
What disease can results in aortic stenosis?
Chronic rheumatic valve disease.
What are diffecences in aortic stenosis and aortic stenosis caused by rheumatic fever?
In rheumatic fever there are Mitral stenosis + fusion of Aortic valve commissures.
In aortic stenosis - only aortic valve is affected. Fibrosis and caltification. 2 cups instead of 3.
What are 3 complications in aortic stenosis?
Concentric left ventricular hypertrophy –> HF.
Angina and syncope with exercise (due to decreased blood flow).
Microangiopathic hemolytic anemia. (due to damages RBCs when they go through damaged valve).
What produce damaged RBCs in aortic stenosis?
Schistocytes.
Why arises (2) aortic regurgitation?
- Aortic root dilation;
2. Valve damage (e.g. infectious endocarditis).
What is the most common cause of aortic regurgitation?
Aortic root dilation.
Clinical features of aortic regurgitation.
- Early, blowing diastolis murmur.
- Hyperdynamic circulation due to increased pulse pressure.
- LV dilaton and eccentric hypertrophy.
What LV hypertrophy is in aortic stenosis and regurgitation?
Stenosis - concentric.
Regurgitation - eccentric.
What happens to diastolic and systolic pressure in aortic regurgitation?
Diastolic decreases due to regurgitaiton.
Systolic increses due to increased stroke volume.
What are changes in pulse when aortic regurgitation?
Bounding pulse (water-hammer pulse), pulsating nail bed (Quincke pulse), head bobbing.
Where is measured Quincke pulse and in what disease presents?
It is pulsating nail bed. In aortic regurgitation.
How is described mitral valve prolapse?
Ballooning of MV into left atrium during systole.
Mitral valve prolapse is due to ………………
Myxoid degeneration of valve. Etiology is unknown.
How presents mitral valve prolapse?
Incidental mid-systolic click followed by a regurgitation murmur. Ususaly asymptomatic.
What are complications of mitral valve prolapse?
They are rare, but include infectious endocarditis, arrhythmia, severe mitral regurgitation.
Usually mitral regurgitation arises ar complication of ……………
Mitral valve prolapse.
Mitral regurgitation 4 causes?
Infectious endocarditis, LV dilation, acute rheumatic heart disease, papillary muscle rupture after MI.
2 clinical features of mitral regurgitation?
Holosystolic ,,blowing” murmur. Louder with squatting and expiration.
Results in volume overload and left sided HF.
What is the main reason of mitral stenosis?
Chronic rheumatic valve disease.
What are 2 clinical features of mitral stenosis?
- Opening snap followed by diastolic rumble.
2. Volume overload –> dilaton of left atrium.
Dilation of left atrium in mitral stenosis results in ……?
Pulmonary congestion –> pulmonary edema and alveolar hemorrhage.
Pulmonary hypettension –> right side HF.
Atrial fibrillation with risk of mural thrombi.
What is endocarditis?
Inflammation of endocardium that lines the surface of cardiac valves.
What is the most common m/o in endocarditis?
Strep. viridans.
How affect valves strep. viridans?
It infects already damaged valves. Small vegetations, don’t destroy the valve.
How affect valves staph. aureus?
It infects normal valves. Large vegetations destoy valve.
Low virulence m/o?
Strep. viridans.
High virulence m/o?
Staph. aureus.
What m/o cause damage of normal valves?
Staph. aureus.
What m/o cause damage of damaged valves?
Strep. viridans.
What people mostly gets infected by staph. aureus?
IV drug abusers.
What is the most commonly affected valve by staph. aureus?
Tricuspid.
What m/o is associated with prosthetic valves damage?
Staph. epidermidis.
What valves damage Staph. epidermidis?
Prosthetic valves.
Patient has colorectal carcinoma. Which m/o will cause endocarditis?
Strep. bovis.
What m/os associated with negative blood cultures?
HACEK - Haemophilus, Aggregatibacter (Actinobacillus), Cardiobacterium, Eikenella, Kingella.
4 clinical features of endocarditis?
- Fever - due to bacteremia.
- Murmur - due to vegetations.
- Janeway lesions, Osler nodes, Roth spots, splinter hemorrhages in nail bed - due to embolization of septic vegetations.
- Anemia - due to chronic inflammation.
What is Janeway lesions?
Erythematous nontender lesions on palms and soles.
What is Osler nodes?
Tender lesions on fingers or toes.
What is Roth spots?
White centered retinal hemorrhage.
What are 3 laboratory findings of endocarditis?
- Positive blood cultures.
- Anemia
- Transesophageal echoEKG - lesions on valves.
What endocarditis is in SLE?
Noninfectious. Libman-Sacks endocarditis.
What valve is affected in SLE?
Mitral valve –> regurgitation.
Why appears noninfectious thrombotic endocarditis?
Due to hypercoagulable state or underlying adenocarcinoma.
What valve is affected in noninfectious thrombotic endocarditis?
Mitral valve –> regurgitation.
