Cardiac Valvular disase and vasculitis (CVIII) Flashcards
(102 cards)
1
Q
what causes mitral valve stenosis
A
Acute Rheumatic fever (ARF)
2
Q
what causes acquired stenosis
A
chronic recurrent rheumatic valvular disease
3
Q
what is acquired stenosis
A
Failure of a valve to open completely
4
Q
what kind of disase is Acute rheymatic fever
A
systemic diase usually in children
5
Q
what does Acute Rheumatic fever usually follow
A
Group A beta-hemolytic streptococcal pharyngitis
6
Q
what does Acute rheumatic fever lead to
A
Myocarditis Pericarditis Arthralgia Arthrisits erythema marginatum (skin rash) Subcutaneous nodules
7
Q
what microscoppically characterizes the myocarditis vauses by Acute rheumatic fever
A
aschoff bodies
8
Q
what are aschoff bodies
A
collection of mononuclear inflammatory cells and fibroblasts (grnulomatous inflammation)
9
Q
what does Recurrent bouts of RF lead to
A
severe fibrosis and calcification of the mitral valve and other heart valves
- (stenosis)
10
Q
why does RF lead to fibrosis and calcifiation of the mitral valve and other heart valves
A
production of antibodies against streptoccal bacteria
- cross reacts with antigens in the heart, joints, and others
11
Q
what causes pericarditis in RF
A
Fibrinous
12
Q
what causes endocarditis in RF
A
sterile vegetations
13
Q
what is Regurgitation
A
Valves that fail to close completely allowing backflow of blood
14
Q
what can cause Mitral valve regurgitation
A
IHD
Endocarditius
15
Q
what is mitral valve prolapse
A
leaflets balloon into the left atrium during left ventricular contract
16
Q
how common is mild prolapse of the valve
A
common at 5-10%
17
Q
what level of prolapse is needed to cause Regurgitation
A
severe prolapse
18
Q
what can be caused by severe regurgitation by prolapse
A
chest pain
Palpitation
19
Q
what are some complications of a severe prolapse
A
Endocarditis Mitral regurgitation Thoromboemboli atrial fibrillation Sudden death (rare) potential complication
20
Q
what is seen in severe prolapse to the valve
A
vavle cusps are large
Microscoppically show fragmentation
loss of collagen
- myxomatous degeneration histolofy
21
Q
what causes floppy mitral valve
A
Isolated abnormality
systemic conective tissue disease (marfan)
22
Q
what causes aortic valve stenosis
A
Fibrosis and calcifiaction
23
Q
what may lead to fibrosis and calcification of the aortic valve
A
chronic rheumatic valvular disease (also affects mitral valve)
old people
24
Q
what may predisopse one to aortic valve stenosis
A
Bicuspid aortic valve
- tends to be calciiced and fibrosed at 40 year old
25
what can lead to aortic valve regurgitation
Valve cusp destruction (endocarditis)
myxomatous degeneration/ weakened vavlve cusps
dilation of aortic root
26
what causes aortic valve cusp distruction
infectious endocarditis
| Rheynatic heat disaese
27
what causes dialtion of the aortic root
Media of the aorta degenerating
28
what are predisposing factors of infective endocarditis
```
Intracardiac shunts
Valvular disease
Prosthetic valvues (10-20% of all IE cases)
IV drug abuse
immune suppression
diabetes mellitus
```
29
what causes ineffective Endocarditis
```
Endocardial/endothelial injury (Blood flow)
fibrin thrombi (hypercoaguability)
organisms in the blood (sepsis)
```
30
what is infective endocarditis
bacterial infect of heart valve (also can be fungus)
31
Clinical manifestations of infective endocarditis
```
Fever
heart murmur
fatigue
anemia
arthralgia
myalgia
splinter hemorrhages (nail bed)
roth spots (retinal hemorrhages, not specific to IE)
```
32
Complications of infective endocarditis
Rupture of chordae tendineae
spread of infetion to myocardium or aorta
thromboembolism with infarction
septic thrombi with metastatic abscesses
valvular dysfunction and CHF (regurgitation)
33
length of acute and subacute endocarditis
Acute is short,
| subacute is longer
34
what causes acute and subacute endocarditis
Acute is a virulent organisms (Staphylococcus auresus)
| subacute is low virulences(strptococcus viridans)
35
vegetatation of acute and subacute endocarditis
Acute is large friable vegetation
| Subacute is small
36
vale shape before acute and subacute endocarditis
Acute was previously normla
| subacute was previously abnormal
37
tissue distruction of acute and subacute endocarditis
Acute has prominent tissue destruction
| subactue is less tissue destruction
38
what is the most important factor that may cause infective endocarditis
prosthetic valve
39
why does hypercoaguability tend to lead to infective endocarditis
bacteria like to eat what is made from hypercoaguability
40
what are some side causes of Infective endocardium
mess with papillary trends
| occlusion via bacteria
41
what are the causes of vasculities
```
Infection
Immunologic mechanisms
Radiation
Trauma
Caustic susbstance
Unknown
```
42
what is vasculitis
Infection of the vessel wall
43
what vasculitis is for large vessel
```
Giant cell (temporal) arteritis
Takayasu arteritis
```
44
what vasculitis is for medium vessel
```
Polyarteritis nodosa (Classic)
Kawasaki syndrome
```
45
what vasculitis is for small vessels
Microscopic polyarteritis
| Granulomatosis with polyangiitis (wegener granulomatosis
46
what could lead to an immune complex forming in immune mediated vasculitis
Reaction to drugs or viruses
47
what can lead to immune-mediated pathogenesis
Immune complexes
Antineutrophilic cytoplasmic antibodies
Anti-endothelial cell antibodies
Cell-mediated immune mechanisms
48
what is ANCA associated wtith in immune mediate vasculitis
Microscopic polyangiitis
| Wegener granulomatosis
49
what are the types of antineutrophilic cytoplasmic antibodies that lead to immune-mediated vasculitis
Anti-myeloperoxidase
| Anti-proteinase-3
50
what does anti-myloperoxidase ANCA lead to
perinuclear localization (microscopic polyarteritis)
51
what does Anti-proteinase-3 lead to
diffuse cytoplasmic distribution (wegener's granulomatosis)
52
what causes Giant cell (temporal arteritis
Unknown
| (t-cell mediated maybe)
53
what are the clinical signs of giant cell arteritis
```
Fever
weight loss
headache
visual problems (blindness
claudiction of jaw (weak jaw )
pain and tenderness over temporal artery
polymyalgia rheumatica
```
54
who tends to get griant cell (temporal arteritis
over age of 50
55
pathology of Giant Cell (remporal) arteries
- Granulomatous inflammation with giant cells
- fibrosis
- eventualy causes narrowing of vessel lumen with decreased blood flow to affected tissues
56
what causes problems in giant cell (temporal) arteries
elastic lamina breaks down so stuff gets inside vessel and blocks things
57
what causes Takayasu Arteritis
Unknown, similar to temporal arteritis
58
who tends to get takayasu arteritis
Younger people
| more femailes
59
what are the clinical signs of takayasu arteritis
Weak arm pulses (pulseless disease)
visual disturbances
Neurologic manifestations
60
Patholgoy of takayasu arteritis
Involves aortic arch and branches
Intimal fibrosis
Granulomatous inflammation withfibrosis
61
what does takayasu arteritis do to the aortic arch
thickening of the walls reduces flow to branches
62
what causes polyarteritis nodosa
Unknown
63
hep b and polyarteritis nodosa
30% had hep B surface antigen in serum
| mow 8% due to immunization
64
Clinical signs of polyarteritis nodosa
```
Fever
weight loss
hematuria
renal failure
hypertension
abdominal pain
melenena
```
65
is it easy to diagnose polyarteritis nodosa
no, multiple parts of the body invovled
66
Pathology of polyarteritis nodosa
haphazard and segmental involvement of medium and small muscular arties
67
acute leasions from polyareitis nodosa shows what
fibrinoid necrosis, thrombosis, neutrophils, and aneuysms
68
what happens with healing of Polyarteritis nodosa
predominance of macrophages and plasma cells
| progressive fibrous scarring
69
where is polyarteritis nodosa found
```
Kidney
heart
liver
Gi tract
= most common to least common
```
70
how does polyarteritis nodosa show itself in the kidney
Blood in urine from blockage of kidney vessels
71
what is the key sign of polyarteritis nodosa
Renal failure
72
other name for Kawasaki disease
Mcocutaneous lymph node syndrome
73
what may cause kawasaki disease
anti-endothelial antibody triggered by viral infection
74
who tends to get kawasaki disase
Infants and young children
75
clinical signs of kawasaki disaese
Fever
mucous membrane erythema (eyes/mouth)
skin rash
cervical lymphadenopathy
76
does kawasaki disease spread easily
no, self limiting
77
pathology of kawasaki disesaes
Coronary artery vasculitis
78
how does one treat kawasaki disease
Immunosuppressants
79
what causes microscopic polyangiitis
Antigen-antibody complexes
80
what are the clinical signs of micrscopic polyangiitis
```
Fever
rash
joint swelling
pleural effusion
pulmonary infiltrates
myocarditis
GI bleeding
renal failure
PResence of circulating anti-neutrophilic cytoplasmic antibodies (MPO-ANCA)
```
81
what would micrscopic polyangiitis preciptate
Drugs
microoganisms
Foreign proteins
tumorproteins
82
what vessels does micrscopic polyangiitis involved
arterioles
capilaries
Venules
83
microscopic Polyangiitis pathology
Fribrinoid
necrosis
neutrophils (leukocytoclasic vasculitis
84
what is leukocytoclastic vasculitis
eating of th eblood vessels by tons of white blood cells
| - blood vessels dissappear
85
what is granulomatosis with polyangiitis
wegener granulomatosis
86
what causes granulomatosis with polyangiitis
Abnormal expression of proteinase 3 on endo cell surface
| Followed by ANCA binding and neutrophil activation
87
what does binding of ANCA to proteinase 3 on the endo cell surface lead to
damage to endothelium and vessel
88
what are the clinical signs of granulomatosis with polyangiitis
presence of anti-neurophilic cytoplasmic antibodies direct aginast proteinase 3
89
what does granulomatosis with polyangiitis involve
Sinuses
lungs
kidneys
- cavities in the body
90
what does granulomatosis with polyangiitis lead to
Necrotizing granulomas w
| vasculitis with fibrinoid necrosis
91
how can granulomatosis with polyangiitis affect the gingiva
strawberry gingivitus due to high inflammation
92
what causes Thromboangiits obliterans (buerger disease
Endothelial injury from substance in Cigs
93
clinical signs of thromboangiitis obliterans
```
Cig smoking
less than 35 years old
pain in extremities
ischemic ulcers
gangrene
```
94
Pathology of throboangiitis obliterans
Vasculitis with thrombosis
95
what does Thromboangiitis obliterans affect
Small arties
96
what is an intimal tear in dissecting aortic hematoma
Split between mid and outer 1/3 of the media
97
what can happen to the mdia of a dissecting aorta hematoma
Normal or have degeneration
98
what complications can dissection aortic hematoma lead to
rupture - hemorrhage
| Brnach obstruction
99
what are the predisposing conditiosn for dissection aortic hematoma
Hypertension
| connective tissue disorders (marfan)
100
what is type A dissection
cending aorta in isolation (type I) and as as part of a more extenisve disection (type II)
101
what is type B disection
after the take off of the great vessels
102
what causes more problems, type A or type B dissection
Type A
