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CV wk1 and wk2 > Valvular heart disease pathology > Flashcards

Valvular heart disease pathology Flashcards

1
Q

Essential vs Secondary Hypertension

A

Hypertension BP >140/90

Essential = Primary: 90%

  1. Idiopathic
  2. Medication or other causes

Secondary:

  1. Renal disease
  2. Endocrine
  3. Cardiovascular
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2
Q

Pathogenesis of hypertension

A

Sustained pressure overload on the LV leads to concentric hypertrophy of myofibers

Additional sarcomeres/myofibrils added to existing cardiomyocytes

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3
Q

Microscopic evaluation of hypertrophy

A
  1. Nuclei actually get bigger “boxcar”

2. Hypertrophied one has additional sarcomeres making it thicker

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4
Q

Clinical manifestations of systemic hypertension

A
  1. Often silent “Silent Killer”

2. Can manifest w/ headache or dizziness

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5
Q

Complications of systemic hypertension (LV)

A
  1. Atherosclerosis/aneurysm
  2. Cerebral vascular disease
    a. Ischemic: arteriolosclerosis
    b. Hemorrhage
  3. Kidney: Key cause of “chronic renal disease”; often along with diabetic renal
    disease
    a. Arteriolosclerosis
    b. Glomerulosclerosis
  4. Congestive heart failure (pulmonary edema
    and eventual right heart failure)
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6
Q

Pulmonary hypertension (RV) cause

A
  1. Left HF (any cause)
  2. Congenital heart disease
  3. Cor Pulmonale (RHF) - emhysema, ILD, or bronchiectasis
  4. Pulmonary vessel disease like emboli
  5. Chest movement alterations
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7
Q

What complications happen downstream in Rheumatic HD ?

  • what type of infection?
  • results of that infexn?
  • how does the infxn present?
A
  • Valves can’t open (stenosis) or close (regurgitation) normally … can progress to heart failure

Susceptibility to infective endocarditis –> inflammation following infxn

“Passive” Congestion of liver = nutmeg liver, ascites and lower leg edema

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8
Q

Runt valve that doesn’t work very well called what?

A

Hypoplastic valve

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9
Q

3 types of developmental/congenital valves? Cause what problems?

A
  1. Hypoplastic valve.
  2. Unicuspid aortic valve
  3. Bicuspid aortic valve

Problems:

  1. Reduced outflow, leading to ventricular hypertrophy
  2. Increased turbulence, leading to valve thickening and stenosis
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10
Q

Abnormal valves at increased risk for what?

A
  1. Nodular calcification and fibrosis
  2. Vegetation formation
  3. Infection
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11
Q

Most common cause of isolated mitral regurgitation

A

Myxomatous degeneration (mitral valve prolapse)

Note: names for valve changes:

  1. Ballooning
  2. Tenting
  3. Myxomatous degeneration
  4. Hooding
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12
Q

Complications of MV prolapse?

A
  1. Asymptomatic
  2. Regurgitation
  3. Infective endocarditis
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13
Q

Clinical correlations for Calcific Aortic Stenosis

A
  1. Increased demand for myocardial oxygen in the hypertrophied ventricle
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14
Q

How do you get rheumatic fever?

A

Strep pyogenes infection… Get antibodies against M protein of Group A strep cross-react with body’s own glycoproteins

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15
Q

Criteria for Rheumatic fever diagnosis

A

Major criteria:

  1. Heart: “pancarditis”
  2. Joints: Migratory polyarthritis
  3. Skin: erythema and subcutaneous nodules
  4. CNS: Sydenham chorea

Minor criteria:

  1. Fever
  2. Arthralgias
  3. Elevated APR

& Evidence of Ab against antistreptolysin O

Recall the pyogenies bakers picture

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16
Q

What does an Aschoff body indicate?

A

Rheumatic Fever

17
Q

Endocarditis

A

inflammation of endocardium / valves and eventual fibrosis due to rheumatic heart disease

Valve cant open or close normally => heart failure
Susceptibility to infective endocarditis

18
Q

What are vegetations? Etiology? Complications?

A
  1. Sterile/non-bacterial thrombotic endocarditis (clot formation on valve) or infective endocarditis
  2. Etiology: Damaged valve from Lupus or RHD
  3. Complications:
    - Embolism
    - Valve function deficits
    - can become infected
19
Q

What is the most common bacteria for infectious endocarditis?

A

Strep viridans

20
Q

What are some risk factors for endocarditis?

A

Introduce bugs via:

  1. Dental procedures
  2. Surgical procedures
  3. Venous access for catheterization
  4. Inravenous drug abuse
21
Q

Cor Pulmonale

A

Pulmonary heart disease :
the enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance or high blood pressure in the lungs (pulmonary hypertension).

note - Right ventricle will commonly be thick in Pulmonary HTN

22
Q

Causes of Cor pulmonale (other than the major Lt sided HF)

A
  • Pulmonary Parenchyma Disease
    • Pulmonary Vessel Disease
    • Chest Movement Alterations
23
Q

incidence and long term implications of a bicuspid aortic value.

A
  • Pretty common
  • Asymptomatic until you get accelerated wear and tear
  • Problems:
    ○ Reduced outflow, leading to ventricular hypertrophy
    ○ Increased turbulence, leading to valve thickening and stenosis (biggest problem)
24
Q

What happens to the chordae tendinea with respect to rheumatic HD?

A

. Chordae Tendinea: fibrosis, fusion, and shortening

- fish mouth stenosis

CV wk1 and wk2 (31 decks)

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