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1 STEP Cardio pathology > Valvular patho 12/03 > Flashcards

Valvular patho 12/03 Flashcards

1
Q

What causes reumatic fever?

A

A beta-hemolytic streptococci infection of pharynx (pharyngitis).

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2
Q

When occurs reumatic fever?

A

2-3 week after A beta-hemolytic streptococci infection .

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3
Q

Which valves are affected the most by acute reumatic fever?&raquo_space;>

A

Mitral>aortic>tricuspid.

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4
Q

What changes of mitral valve are in early and late lesion in acute reumatic fever?

A

Early - MV regurgitation. Late - MV stenosis.

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5
Q

What is Aschoff bodies? What disease?

A

Granuloma with giant cells. Acute reumatic fever.

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6
Q

What is Anitschkow cells? What disease?

A

Enlarged macrophages with ovodi, wavy, rod-like nucleus. Acute reumatic fever.

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7
Q

What lab. diagn. is increased in blood in acute reumatic fever?

A

Increased antistreptolysin O (ASO) titers or anti-DNase B titers.

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8
Q

What hypersinsitivity type is in acute reumatic fever?

A

II hypersensitivity.

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9
Q

Why accurs reumatis fever after body contacts with streptococci (mechanism)?

A

Due to molecular mimicry. Antibodies to streptococci M proteins cross-react with self antigens.

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10
Q

What is treatment/prophypaxis of acute reumatic fever?

A

Penicilin.

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11
Q

J(heart)NES - what are clinical symptoms and disease?

A

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.

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12
Q

How results valvular lesions?

A

Stenosis or regurgitation.

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13
Q

Where are founded Aschoff bodies?

A

In myocardium when myocarditis by acute reumatic fever.

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14
Q

Where are founded Anitschkow cells?

A

In myocardium when myocarditis by acute reumatic fever.

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15
Q

What are nonspecific clinical symptoms of acute reumatic fever?

A

Fever, increased ESR.

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16
Q

What is Syndenham chorea?

A

Rapid, involuntary muscle movements.

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17
Q

Acute reumatic fever can complicate to ?

A

Chronis reumatic fever.

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18
Q

What is morphology of chronic reumatic fever?

A

Valvular stenosis with ,,fish-mouth appearance”.

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19
Q

What is the most often affected valve in chronic reumatic fever? What changes?

A

Mitral valve. Thickening of chordae tendinea and cusps.

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20
Q

What are complications of chronic reumatic fever?

A

Infectious endocarditis.

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21
Q

What is second most often involved valve in chronic reumatic fever? What changes?

A

Aortic. Leads to fusion of the commissures.

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22
Q

In what age presents aortic stenosis?

A

> 60.

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23
Q

Aortic stenosis is due to ………

A

Fibrosis and caltification from ,,wear and tear”.

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24
Q

How many cups are in normal and abnormal aortic valve?

A

Normal - 3; Abnormal - 2.

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25
Q

Which sound is hear in aortic stenosis?

A

Crescendo-desrescendo.

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26
Q

Systolic ejection ……………… is followed by ……………… in aortic stenosis.

A

Click

Crescendo-desrescendo.

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27
Q

Why there could be a prolonged asymptomatic stage in aortic stenosis?

A

Because of cardiac compensation.

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28
Q

What disease can results in aortic stenosis?

A

Chronic rheumatic valve disease.

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29
Q

What are diffecences in aortic stenosis and aortic stenosis caused by rheumatic fever?

A

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.

30
Q

What are 3 complications in aortic stenosis?

A

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).

31
Q

What produce damaged RBCs in aortic stenosis?

A

Schistocytes.

32
Q

Why arises (2) aortic regurgitation?

A
  1. Aortic root dilation;

2. Valve damage (e.g. infectious endocarditis).

33
Q

What is the most common cause of aortic regurgitation?

A

Aortic root dilation.

34
Q

Clinical features of aortic regurgitation.

A
  1. Early, blowing diastolis murmur.
  2. Hyperdynamic circulation due to increased pulse pressure.
  3. LV dilaton and eccentric hypertrophy.
35
Q

What LV hypertrophy is in aortic stenosis and regurgitation?

A

Stenosis - concentric.

Regurgitation - eccentric.

36
Q

What happens to diastolic and systolic pressure in aortic regurgitation?

A

Diastolic decreases due to regurgitaiton.

Systolic increses due to increased stroke volume.

37
Q

What are changes in pulse when aortic regurgitation?

A

Bounding pulse (water-hammer pulse), pulsating nail bed (Quincke pulse), head bobbing.

38
Q

Where is measured Quincke pulse and in what disease presents?

A

It is pulsating nail bed. In aortic regurgitation.

39
Q

How is described mitral valve prolapse?

A

Ballooning of MV into left atrium during systole.

40
Q

Mitral valve prolapse is due to ………………

A

Myxoid degeneration of valve. Etiology is unknown.

41
Q

How presents mitral valve prolapse?

A

Incidental mid-systolic click followed by a regurgitation murmur. Ususaly asymptomatic.

42
Q

What are complications of mitral valve prolapse?

A

They are rare, but include infectious endocarditis, arrhythmia, severe mitral regurgitation.

43
Q

Usually mitral regurgitation arises ar complication of ……………

A

Mitral valve prolapse.

44
Q

Mitral regurgitation 4 causes?

A

Infectious endocarditis, LV dilation, acute rheumatic heart disease, papillary muscle rupture after MI.

45
Q

2 clinical features of mitral regurgitation?

A

Holosystolic ,,blowing” murmur. Louder with squatting and expiration.
Results in volume overload and left sided HF.

46
Q

What is the main reason of mitral stenosis?

A

Chronic rheumatic valve disease.

47
Q

What are 2 clinical features of mitral stenosis?

A
  1. Opening snap followed by diastolic rumble.

2. Volume overload –> dilaton of left atrium.

48
Q

Dilation of left atrium in mitral stenosis results in ……?

A

Pulmonary congestion –> pulmonary edema and alveolar hemorrhage.
Pulmonary hypettension –> right side HF.
Atrial fibrillation with risk of mural thrombi.

49
Q

What is endocarditis?

A

Inflammation of endocardium that lines the surface of cardiac valves.

50
Q

What is the most common m/o in endocarditis?

A

Strep. viridans.

51
Q

How affect valves strep. viridans?

A

It infects already damaged valves. Small vegetations, don’t destroy the valve.

52
Q

How affect valves staph. aureus?

A

It infects normal valves. Large vegetations destoy valve.

53
Q

Low virulence m/o?

A

Strep. viridans.

54
Q

High virulence m/o?

A

Staph. aureus.

55
Q

What m/o cause damage of normal valves?

A

Staph. aureus.

56
Q

What m/o cause damage of damaged valves?

A

Strep. viridans.

57
Q

What people mostly gets infected by staph. aureus?

A

IV drug abusers.

58
Q

What is the most commonly affected valve by staph. aureus?

A

Tricuspid.

59
Q

What m/o is associated with prosthetic valves damage?

A

Staph. epidermidis.

60
Q

What valves damage Staph. epidermidis?

A

Prosthetic valves.

61
Q

Patient has colorectal carcinoma. Which m/o will cause endocarditis?

A

Strep. bovis.

62
Q

What m/os associated with negative blood cultures?

A

HACEK - Haemophilus, Aggregatibacter (Actinobacillus), Cardiobacterium, Eikenella, Kingella.

63
Q

4 clinical features of endocarditis?

A
  1. Fever - due to bacteremia.
  2. Murmur - due to vegetations.
  3. Janeway lesions, Osler nodes, Roth spots, splinter hemorrhages in nail bed - due to embolization of septic vegetations.
  4. Anemia - due to chronic inflammation.
64
Q

What is Janeway lesions?

A

Erythematous nontender lesions on palms and soles.

65
Q

What is Osler nodes?

A

Tender lesions on fingers or toes.

66
Q

What is Roth spots?

A

White centered retinal hemorrhage.

67
Q

What are 3 laboratory findings of endocarditis?

A
  1. Positive blood cultures.
  2. Anemia
  3. Transesophageal echoEKG - lesions on valves.
68
Q

What endocarditis is in SLE?

A

Noninfectious. Libman-Sacks endocarditis.

69
Q

What valve is affected in SLE?

A

Mitral valve –> regurgitation.

70
Q

Why appears noninfectious thrombotic endocarditis?

A

Due to hypercoagulable state or underlying adenocarcinoma.

71
Q

What valve is affected in noninfectious thrombotic endocarditis?

A

Mitral valve –> regurgitation.

1 STEP Cardio pathology (8 decks)

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