12.5 A

Question 1

What is valvular stenosis?

Answer 1

the failure of a valve to open completely

Question 2

What is valvular insufficiency?

Answer 2

failure of a valve to close completely, thereby allowing reversed flow

Question 3

What is functional regurgitation?

Answer 3

the incompetence of a valve stemming from an abnormality in one of its support structures

Question 4

Functional regurgitation could be thought of as a ____ valve defect.

Answer 4

secondary

Question 5

What is mixed valvular stenosis?

Answer 5

stenosis with regurgitation

Question 6

What is combined valvular stenosis?

Answer 6

involvement of more than one valve

Question 7

The most frequent cause of aortic stenosis is what?

Answer 7

dystrophic calcification of an anatomically normal or congenitally bicuspid aortic valve

Question 8

The most frequent cause of aortic insufficiency is what?

Answer 8

dilation of the ascending aorta related to hypertension, atherosclerosis, or aging

Question 9

The most common cause of mitral stenosis is what?

Answer 9

rheumatic heart disease

Question 10

The most common cause of mitral insufficiency is what?

Answer 10

myxomatous degeneration (prolapse)

Question 11

Infective endocarditis can cause what valvular heart disease?

Answer 11

mitral or aortic regurgitation

Question 12

What is the most common of all valvular abnormalities?

Answer 12

calcific aortic stenosis

Question 13

The typical age of onset for aortic valvular stenosis of an anatomically normal valve is what?

Answer 13

60-80

Question 14

The typical age of onset for aortic valvular stenosis of a bicuspid aortic valve is what?

Answer 14

40-60

Question 15

Bicuspid aortic valves likely experience stenosis early because…

Answer 15

they incur more mechanical stress than normal tricuspid valves

Question 16

Rheumatic aortic differs from calcific aortic stenosis with regards to what morphological feature?

Answer 16

rheumatic aortic stenosis often has a commissural fusion

Question 17

Aortic stenosis leads to what other complication related to the pressure build up it incites?

Answer 17

left ventricular hypertrophy

Question 18

Myxomatous degeneration is associated with what valvular heart disease?

Answer 18

mitral valve prolapse

Question 19

How is mitral valve prolapse typically treated?

Answer 19

• it is usually asymptomatic

- anti-microbial prophylaxis is recommended during dental procedures to prevent endocarditis

Question 20

Mitral valve prolapse has what symptoms and complications?

Answer 20

usually asymptomatic although there is a slightly increased risk of sudden death due to arrhythmia

Question 21

Mitral valve prolapse puts one at greater risk for endocarditis because of what?

Answer 21

because flow is abnormal, creating eddies that lead to fibrin deposition and that fibrin is capable of catching bacteria in the blood stream

Question 22

Rheumatic fever can follow what sort of infection?

Answer 22

group A streptococci

Question 23

Describe the pathogenesis of rheumatic fever?

Answer 23

• group A streptococci infection
• molecular mimicry results in cross reaction to myocardial tissue
• chronic inflammatory response to myocardial tissue
• deformity and damage

Question 24

Sydenham’s chorea is a diagnostic feature of what disease?

Answer 24

rheumatic fever

Question 25

What are aschoff bodies?

Answer 25

distinctive lesions in the heart of those suffering from rheumatic fever

Question 26

What are anitschkow cells?

Answer 26

large histiocytes with abundant basophilic cytoplasm that are part of aschoff bodies

Question 27

Describe aschoff bodies

Answer 27

distinct foci of fibrinoid necorsis surrounded by lymphocytes and macrophages

Question 28

Describe the joint involvement of rheumatic fever.

Answer 28

acute, non-specific, migratory arthritis, especially in the knees

Question 29

Describe the skin involvement of rheumatic fever.

Answer 29

subcutaneous nodules or erythema marginatum

Question 30

What are erythema marginatum?

Answer 30

giant aschoff bodies presenting as a rash in rheumatic fever patients

Question 31

Rheumatic fever affects what systems?

Answer 31

- heart - joints - skin - arteries

Question 32

How does rheumatic fever affect the arteries?

Answer 32

hypersensitivity angitis

Question 33

What are the cardinal anatomic changes of the mitral valve in rheumatic heart disease?

Answer 33

- leaflet thickening - commissural fusion and shortening - thickening and fusion of the tendinous cords

Question 34

What are the features of rheumatic heart disease?

Answer 34

- pulmonary congestion andedema - hemorrhage and infarction - hyperplasia of pulmonary arteries - hemosiderosis - fibrosis of alveolar septa - right-sided heart failure

Question 35

What are the two categories of infective endocarditis?

Answer 35

acute and sub-acute

Question 36

What are some major risk factors for infective endocarditis?

Answer 36

- drug use - artificial valves - valvular dysfunction - rheumatic heart disease

Question 37

What is acute versus sub-acute endocarditis?

Answer 37

- acute is typically caused by infection of a previously normal heart valve by a highly virulent organism - sub-acute is caused by less virulent organisms and cause infections of deformed valves that are less destructive

Question 38

What are the clinical criteria for infective endocarditis?

Answer 38

- positive blood cultures - EKG findings - new valvular regurgitation or murmur

Question 39

Which organism is most commonly implicated in acute infective endocarditis?

Answer 39

staph aureus

Question 40

What is the HACEK group?

Answer 40

a group of bacteria known to cause endocarditis

Question 41

What is a ring abscess?

Answer 41

the abscess created by endocarditis vegetations eroding the underlying myocardium

Question 42

What are Osler nodes?

Answer 42

subcutaneous nodules in the pulp of the digits seen in endocarditis

Question 43

What are Janeway lesions?

Answer 43

erythematous or hemorrhagic non-tender lesions on the palms or soles seen in endocarditis

Question 44

What are Roth spots?

Answer 44

retinal hemorrhages seen in endocarditis

Question 45

The most common contaminant of blood cultures is what organism?

Answer 45

coag-neg Staph

Question 46

The most common reason for blood culture contamination is what?

Answer 46

failure to adequately decontaminate the skin

Question 47

Describe the vegetations seen in endocarditis.

Answer 47

fibrin, inflammatory cells, and bacteria

Question 48

Endocarditis most commonly affects what valves?

Answer 48

aortic and mitral

Question 49

Septic emboli result from what heart disease?

Answer 49

endocarditis

Question 50

What is the viridans group?

Answer 50

a group of low virulence strep that are known to cause aub-acute endocarditis

Question 51

What are the cardiac complications of infectious endocarditis?

Answer 51

- valvular insufficiency or stenosis - myocardial abscess with possible wall perforation - suppurative pericarditis - dehiscence of an artificial valve

Question 52

Left sided endocarditis lesions are more likely to cause what embolic complications?

Answer 52

systemic embolism in the brain, spleen kidney, etc.

Question 53

Right sided endocarditis lesions are more likely to cause what embolic complications?

Answer 53

- osler' nodes - janeway lesions - roth spots - lung involvement

Question 54

What is non-bacterial thrombotic endocarditis?

Answer 54

- involves the precipitation of small amounts of fibrin and other blood components on the valve leaflets - vegetations are sterile

Question 55

Non-bacterial thrombotic endocarditis is most common in what sorts of individuals?

Answer 55

debilitated ones with cancer or sepsis; those with hypercoagulable states

Question 56

When you see endocarditis vegetations on the underside of a valve, your first thought should be what?

Answer 56

lupus