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04. Cardiovascular Pathology > 8. Valvular Heart Disease > Flashcards

8. Valvular Heart Disease Flashcards

1
Q

Definition of valvular stenosis and insufficiency

A

Valvular diseases come to clinical attention due to stenosis (failure of a valve to open completely) &/or insufficiency (failure of a valve to close completely, permitting reversed flow); they may involve single or multiple valves, and may result from primary valvular damage or abnormalities in its support structures (papillary muscles, valve rings)

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2
Q

Causes of valvular stenosis & insufficiency

A
  1. Congenital abnormality
  2. Degenerative calcification
  3. Myxomatous degeneration
  4. Rheumatic heart disease
  5. Infective endocarditis
  6. Dilation of valve ring
  7. Abnormalities of tensor apparatus
  8. Carcinoid syndrome
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3
Q

How does congenital abnormality result in valvular stenosis &/or insufficiency

A
  1. Congenitally bicuspid aortic valve (predisposes to degenerative calcification)
  2. Results in: aortic stenosis
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4
Q

How does degenerative calcification result in valvular stenosis &/or insufficiency

A
  1. Occurs with ‘wear and tear’ of valves with ageing
  2. Leads to degeneration accompanied by passive or
    dystrophic accumulation of calcium salts on valves
  3. Results in: aortic stenosis
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5
Q

How does myxomatous degeneration result in valvular stenosis &/or insufficiency

A
  1. Usually in young female adults
  2. Due to degeneration of collagen support of valves
    (attenuation of collagenous fibrosa layer accompanied by thickening of spongiosa layer by deposition of myxomatous material)
  3. Occasionally, associated with inherited disorders of connective tissue including Marfan syndrome
  4. Valves become ‘floppy’ and prolapsed
  5. May also involve chordate tendineae rupture
  6. Results in: mitral insufficiency
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6
Q

How does rheumatic heart disease result in valvular stenosis &/or insufficiency

A
  1. Immune disorder following group A Streptococcal infection in children due to cross-reactive antibodies formed against Streptococcal M protein
  2. Antibodies cross react with self-antigens in the heart
  3. Leads to a post-inflammatory scarring (progressive fibrosis of heart valve leaflets leading to scarring, fusion & calcification)
  4. Results in: affects all 4 valves
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7
Q

How does Infective endocarditis result in valvular stenosis &/or insufficiency

A
  1. Infection of heart valves leading to inflammatory scarring & distortion
  2. Results in: affects all 4 valves
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8
Q

How does Dilation of valve ring result in valvular stenosis &/or insufficiency

A
  1. Aneurysms secondarily dilating heart valve rings
  2. Syphilitic aortitis
  3. Results in: aortic insufficiency, mitral insufficiency
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9
Q

How does Abnormalities of tensor apparatus result in valvular stenosis &/or insufficiency

A
  1. Papillary muscle rupture post-myocardial infarct
  2. Chordae tendineae rupture in myxomatous degeneration
  3. Ventricular dilation (in heart failure or dilated cardiomyopathy) leading to papillary muscles being pulled downwards & outwards
  4. Results in: mitral insufficiency
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10
Q

How does Carcinoid syndrome result in valvular stenosis &/or insufficiency

A
  1. Caused by carcinoid tumours elaborating vasoactive
    substances (serotonin, kallikrein, bradykinin, histamine, prostaglandins, tachykinins)
  2. Results in distinctive cardiovascular lesions (firm plaque-like endocardial fibrous thickenings) alongside other systemic symptoms (episodic flushing of skin, cramps, nausea, vomiting, diarrhea)
  3. Typically affects right heart as vasoactive substances are inactivated in their passage through the lungs by enzymes (e.g. monoamine oxidase)
  4. Can affect left heart in rare occasions (right-to-left heart shunt, carcinoid tumour metastasis to lungs)
  5. Results in: affects tricuspid & pulmonary valves
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11
Q

Causes of mitral valve stenosis

A

Rheumatic heart disease

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12
Q

Pathological effects & consequences of mitral valve stenosis

A
  1. Left atrial dilation with increased risk of fibrillation & mural thrombus formation
  2. Pulmonary hypertension & edema
  3. Right ventricular hypertrophy & eventual cor pulmonale
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13
Q

Causes of mitral valve insufficiency

A
  1. Mitral valve prolapse (myxomatous degeneration of mitral valve, ‘floppy valve’ syndrome)
  2. Rheumatic heart disease
  3. Papillary muscle ischemia
  4. Dilation of mitral valve ring (in Marfan syndrome)
  5. Infective endocarditis
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14
Q

Pathological effects & consequences of mitral valve insufficiency

A
  1. Atrial fibrillation
  2. Left ventricular failure
  3. Severe pulmonary congestion & edema in cases of
    acute mitral incompetence
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15
Q

Causes of aortic valve stenosis

A
  1. Calcified aortic stenosis
  2. Rheumatic heart disease
  3. Infective endocarditis
  4. Congenitally bicuspid aortic valve
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16
Q

Pathological effects & consequences of aortic valve stenosis

A
  1. Left ventricular hypertrophy & failure
  2. Predisposition to myocardial ischemia (due to
    hypertrophied myocardium)
  3. Sudden cardiac death
17
Q

Causes of aortic valve insufficiency

A
  1. Dilation of ascending aorta (usually due to hypertension & aging)
  2. Rheumatic heart disease
  3. Infective endocarditis
  4. Dilation of valve ring (syphilitic aortitis, aortic aneurysm)
18
Q

Pathological effects & consequences of aortic valve insufficiency

A
  1. Left ventricular hypertrophy & failure

2. Predisposition to myocardial ischemia

19
Q

Causes of tricuspid & pulmonary valve disease

A
  1. Rheumatic heart disease (rarely involves TV & PV)
  2. Right-sided infective endocarditis (secondary to IV drug abuse)
  3. Carcinoid syndorme

04. Cardiovascular Pathology (11 decks)

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