100314 valvular disease Flashcards Preview

CV > 100314 valvular disease > Flashcards

Flashcards in 100314 valvular disease Deck (32):
1

which are more frequent: stenoses or insufficiencies

stenoses

2

dystrophic calcification

damage caused by wear and tear complicated by deposits of calcium phosphate

risk factors: hyperlipidemia, HTN, inflammation

3

ex of dystrophic calcification

calcific aortic stenosis
mitral annular calcification

4

what is the most common of all valvular abnormalities

calcific aortic stenosis

5

calcific aortic stenosis in 5th or 6th decade of life suggests

bicuspid or unicuspid valves

6

morphology of calcific aortic stenosis

heaped up calcified masses in cusps, primarily at bases

free cuspal edges NOT involved

no fusion of commisures

7

mitral annular calcification

degenerative calcific deposits on fibrous ring at base of valve

usually doesn't affect valve fxn
but are sites for thrombi or infec

8

myxomatous degeneration of mitral valve (prolapse)

very common (3% of adults)
young women
one or both leaflets are enlarged, hooded, floppy

mid systolic click

9

rheumatic fever causative agent

group A Strep pyogenes-pharyngitis

10

most important complication of rheumatic fever

progression to chronic valvular dysfxn (mitral stenosis)

11

acute rheumatic fever affects what

pancarditis

bread and butter pericarditis (fibrinous)
myocarditis with Aschoff bodies
endocardium and left sided valves with fibrinoid necrosis and verrucae
subendocardial MacCallum plaques

12

what is the classic lesion of acute rheumatic fever

Aschoff body (foci of swollen eosinophilic collagen surrounded by T lymphocytes, plasma cells and plump macrophages)

plump macrophages are called Anitschkow cells or caterpillar cells

13

chronic rhuamtic heart disease

inflam and fibrosis leads to...
thickened valve leaflets
fusion of commissures (fishmouth)
fusion and thickening of chordae tendineae

14

what is the major effect of chronic rheumatic heart disease

mitral stenosis

15

diagonsis of rheumatic fever

jones criteria

preceding group A strep infec and 2 major manifes or (1 major and 2 minor)

16

major manifestations for rheumatic fever

migratory polyarthritis
carditis (percardial friction rub, weak heart sounds, tachycardia, arrhythmia)
subcutaneous nodules - rare
erythema marginatum of skin -rare
sydenham chorea

17

two forms of infective endocarditis

acute-highly virulent organism, normal valve, 50% mortality, requires surgery

subacute-low virulence, deformed valve, less destructive lesions, respond to antibiotics

18

causes of infective endocarditis

more common in pts with cardiovascular abnormalities

host factors-neutropenia, immunodeficiency, malignancy, diabetes, alcholics, IV drugs users

19

organism in 50-60% of cases of infected deformed valves

strep viridans

20

most common causative agent for infective endocarditis in IV drug users

staph aureus

21

morphology of acute and subacute infective endocarditis

friable, large bulky destructive vegetations
fibrin, inflam cells and bacteria (less often fungi)
may erode myocardium--leading to ring abscess

22

Duke criteria for bacterial endocarditis

major:
positive blood cultures
echo findings (valve related mass or abscess)
new valvular regurg (new murmur on auscultation)

minor:
predisposing heart lesion or IV drug abuser
fever
umcommon findings resulting from septic emboli, which are bits of vegetations that fly off (petechiae, splinter hemorrhages, Janeway lesions in palsm and soles, Osler nodes in digits, Roth spots in retina

23

complications of bacterial endocarditis

valvular insufficency or stenosis and possible heart failure

myocardial abscesses and possible performation

vegetations breaking off leading to embolic complications

glomeruloneprhitis (immune complexes)

24

nonbacterial thrombotic endocarditis

depositions of fibrin, platelets and other blood products (RBC) on leaflets

often in debilitated pts
may result in emboli

25

pathogenesis/etiology of nonbacterial thrombotic endocarditis

hypercoagulable states
associated with mucin producing adenocarcinomas
endocardial trauma

26

morphology of noninfec thrombotic endocarditis

nondestructive, noninflammatory, small (1-5 mm)
along lines of closure

27

Libman Sacks endocarditis

non infec vegetation

from SLE
mitral and triscupid valves involved
antiphospholipid antibodies present

28

morphology of Libman Sacks endocarditis

either or both sides of leaflets
may also be on endocardium
may have intense inflam

29

ex of vegetative endocarditis

rheumatic heart disease
infective endocarditis
nonbacterial thrmbotic endocarditis
Libman Sacks endocarditis

30

carcinoid syndrome

flushing, cramps, nausea, vomiting diarrhea

31

carcinoid heart disease

cardiac manifestation of the systemic syndrome caused by carcinoid tumors

in 50% of pts with carcinoid syndrome- plaque like fibrosis of R heart endocardium and valves

32

complications of artifical valves

mechanical prosthesis: thromboemboli, infective endocarditis

bioprothesis: structural deterioration, infective endocarditis