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Flashcards in 12.5 A Deck (56):
1

What is valvular stenosis?

the failure of a valve to open completely

2

What is valvular insufficiency?

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

3

What is functional regurgitation?

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

4

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

secondary

5

What is mixed valvular stenosis?

stenosis with regurgitation

6

What is combined valvular stenosis?

involvement of more than one valve

7

The most frequent cause of aortic stenosis is what?

dystrophic calcification of an anatomically normal or congenitally bicuspid aortic valve

8

The most frequent cause of aortic insufficiency is what?

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

9

The most common cause of mitral stenosis is what?

rheumatic heart disease

10

The most common cause of mitral insufficiency is what?

myxomatous degeneration (prolapse)

11

Infective endocarditis can cause what valvular heart disease?

mitral or aortic regurgitation

12

What is the most common of all valvular abnormalities?

calcific aortic stenosis

13

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

60-80

14

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

40-60

15

Bicuspid aortic valves likely experience stenosis early because...

they incur more mechanical stress than normal tricuspid valves

16

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

rheumatic aortic stenosis often has a commissural fusion

17

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

left ventricular hypertrophy

18

Myxomatous degeneration is associated with what valvular heart disease?

mitral valve prolapse

19

How is mitral valve prolapse typically treated?

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

20

Mitral valve prolapse has what symptoms and complications?

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

21

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

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

22

Rheumatic fever can follow what sort of infection?

group A streptococci

23

Describe the pathogenesis of rheumatic fever?

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

24

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

rheumatic fever

25

What are aschoff bodies?

distinctive lesions in the heart of those suffering from rheumatic fever

26

What are anitschkow cells?

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

27

Describe aschoff bodies

distinct foci of fibrinoid necorsis surrounded by lymphocytes and macrophages

28

Describe the joint involvement of rheumatic fever.

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

29

Describe the skin involvement of rheumatic fever.

subcutaneous nodules or erythema marginatum

30

What are erythema marginatum?

giant aschoff bodies presenting as a rash in rheumatic fever patients

31

Rheumatic fever affects what systems?

- heart
- joints
- skin
- arteries

32

How does rheumatic fever affect the arteries?

hypersensitivity angitis

33

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

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

34

What are the features of rheumatic heart disease?

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

35

What are the two categories of infective endocarditis?

acute and sub-acute

36

What are some major risk factors for infective endocarditis?

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

37

What is acute versus sub-acute endocarditis?

- 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

38

What are the clinical criteria for infective endocarditis?

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

39

Which organism is most commonly implicated in acute infective endocarditis?

staph aureus

40

What is the HACEK group?

a group of bacteria known to cause endocarditis

41

What is a ring abscess?

the abscess created by endocarditis vegetations eroding the underlying myocardium

42

What are Osler nodes?

subcutaneous nodules in the pulp of the digits seen in endocarditis

43

What are Janeway lesions?

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

44

What are Roth spots?

retinal hemorrhages seen in endocarditis

45

The most common contaminant of blood cultures is what organism?

coag-neg Staph

46

The most common reason for blood culture contamination is what?

failure to adequately decontaminate the skin

47

Describe the vegetations seen in endocarditis.

fibrin, inflammatory cells, and bacteria

48

Endocarditis most commonly affects what valves?

aortic and mitral

49

Septic emboli result from what heart disease?

endocarditis

50

What is the viridans group?

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

51

What are the cardiac complications of infectious endocarditis?

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

52

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

systemic embolism in the brain, spleen kidney, etc.

53

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

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

54

What is non-bacterial thrombotic endocarditis?

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

55

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

debilitated ones with cancer or sepsis; those with hypercoagulable states

56

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

lupus