VHD patho

Question 1

What’s VHD?

Answer 1

Any disease involving one or more of the cardiac valves. They may be congenital or acquired.

Question 2

What’s the cause of mitral stenosis?

Answer 2

The most common is rheumatic endocarditis (found in the rheumatic fever).

Question 3

The pathogenies of MS?

Answer 3

Fibrous fusion of the valve cusps causing decreased diameter of mitral
orifice (Normally; it is 25-30 mms).

Question 4

What cause Mitral regorge?

Answer 4

Rheumatic endocarditis
Myocardial ischemia
Myxomatous degeneration of the mitral cusps.
Functional dilatation of the valve ring

Question 5

What cause the aortic stenosis?

Answer 5

Rheumatic endocarditis.
Calcific atherosclerosis.
Congenital stenosis (valvular or subvalvular???).

Question 6

What cause the aortic regorge?

Answer 6

1. Rheumatic endocarditis
2. Syphilitic aortitis (Dilatation of the root of aorta and aortic ring).
3. Congenital malformed aortic valve (as Bicuspid aortic valve).
4. Myxomatous degeneration of the cusps

occurs in case of:
a) Marfan’s syndrome. b) Ankylosing spondylitis

Question 7

What cause marfan’s syndrome?

Answer 7

genetic dominant trait of C.T. synthesis.

Question 8

What are the C/P of marfan?

Answer 8

The patients are unusually tall &thin having long limbs & long thin fingers.

Question 9

What are the complications of marfans

Answer 9

Aortic incompetence and aortic aneurysm.
Effects on eyes, hard palate, lungs, dura surrounding the spinal cord, and skeleton.

Question 10

What is ankylosing spondylitis?

Answer 10

Chronic inflammatory disease of the spine with involvement of peripheral joints and
non-articular structures.

Question 11

What cause of tricuspid stenosis?

Answer 11

Rheumatic endocarditis:
Carcinoid syndrome (Carcinoid valvular endocarditis)
Realising of serotonin» right side of heart»fibrosis thickening and stenosis» affect endo lining the inner of my-cardial

Question 12

What cause the Tricuspid regorge?

Answer 12

Functional dilatation of tricuspid valve ring

Rheumatic endocarditis

Atypical verrucous endocarditis associated w SLE

Question 13

What cause the pulmonary stenosis?

Answer 13

The opposite of aorta
Congenital
Carcinoid (for right side)
RE rare

Question 14

What cause the PI?

Answer 14

Functional dilatation of the valve ring; 2ry to severe pulmonary hypertension. ?????
Atypical verrucous endocarditis: seen in SLE
Rheumatic endocarditis (Rare)
Congenital valve deformity (Rare).

Question 15

What’s the commonest affected valve in rheumatic VHD?

Answer 15

mitral valve only and 2nd combined mitral & aortic
Rare in the right side of the heart

Question 16

What happened in earliest lesions of R VHD?

Answer 16

Fibrinoid necrosis يبدأ C.T tissue يتقطع ويتحول إلى فايبرين
الجسم يعامل الفايبرين على أساس انه جسم غريب ويبدا يشغل الجهاز المناعي
antibody complexes are deposited in the BV walls along with fibrin
of the valvular C.T.) راح تسبب oedema & infiltration by lymphocytes, plasma, macrophages & PNLs مهمة النيتروفيل

Question 17

How about the later and late in RVHD?

Answer 17

Later: Destruction of the valvular endothelium + formation of
vegetations كثيرة صغيرة ناشفة لازقة شكل قرنبيط متكونة من platelets & fibrin
Late:healing by fibrosis

Question 18

What’s the two type of (non) rheumatic VHD?

Answer 18

acute and subacute infective endocarditis

Question 19

The affected valve of AIE?

Answer 19

Any intact valve اهم شيء يكون سليم

Question 20

Describe the gross of AIE?

Answer 20

Vegetations on valvular endocardium characterized by: 1. Large. 2. Polypoid. 3. Friable.

Question 21

What you see in LM of AIE?

Answer 21

The endothelium ulcerated >infiltrated by acute inflammatory cells> vegetations فيها كل شيء ومن ضمنها ال high virulent bacterial colonies مثل الستاف وهذا الشيء راح يسبب formation of pus> no granulation مافي فرصة انه يتعافى> acute sudden damage> acute heart failure and sudden death

Question 22

The affected valve of subacute?

Answer 22

Any previously diseased (e.g. by rheumatic fibrosis) or congenitally
malformed valve.

Question 23

The gross pic of subacute?

Answer 23

Vegetations on valvular endocardium characterized by: 1. Large. 2. Polypoid. 3. Friable.

Question 24

LM of subacute?

Answer 24

chronic rheumatic valvulitis but together with low grade bacteria
Vegetations> granulation tissue> gradual damage> chronic HF and treatable condition

Question 25

What is the effects of mitral valve prolapse

Answer 25

The cusps of the mitral valve move back into the LA during the ventricular contraction,
therefore, the valve tissue became more stretchy causing valve leakage.
Associated mitral incompetence or regurge.