Flashcards in CV lecture 3- Cardiac Valvular Disease and Vasculitis Deck (62):
Acquired mitral valve stenosis is usually caused by what?
usually due to chronic (recurrent) rheumatic valvular disease
what is mitral valve stenosis?
failure of a valve to open completely, obstructing forward flow
what strain of bacteria is usually responsible for acquired stenosis?
Group A β-hemolytic Streptoccocal pharyngitis
mitral valve stenosis usually effects what group of people?
(only 20% of cases are in adults)
what are the clinical features of Acute rheumatic fever (ARF)?
arthritis (often polyarthritis)
erythema marginatum (skin rash)
The myocarditis caused by ARF is characterized microscopically by _______ bodies
what are the 3 types of Rheumatic Carditis?
Pericarditis – fibrinous
Endocarditis – sterile vegetations
Myocarditis – Aschoff bodies
what are the microscopic characteristics of Aschoff bodies?
- mononuclear cells and fibroblasts
- form of granulomatous inflammation
Recurrent bouts of acute rheumatic fever lead to __________ and ____________
mitral valve stenosis
______________ refers to a valve that fails to close completely, allowing backflow of blood
what is Mitral valve prolapse?
a condition in which the leaflets balloon into the left atrium during left ventricular contraction (systole)
what are the THREE causes of mitral valve regurgitation?
1) Ischemic heart disease
2) Infective endocarditis
3) Floppy mitral valve (severe MV prolapse)
floppy mitral valve (sever MV prolapse) can be isolated or part of ___________ syndrome
what are the characteristics of floppy mitral valve (Sever MV prolapse)?
- the valve cusps are large and microscopically show fragmentation
- separation and loss of collagen
_____________ degeneration is the name given when mitral valves separate and lose collagen
what are the possible complications of floppy mitral valve syndrome?
- MV regurgitation
- sudden death (rare)
_____________ Stenosis is caused by fibrosis and calcification
Aortic Valve Stenosis
what is the effect on the heart from fibrosis and calcification during aortic valve stenosis?
reduce the valve cusp mobility
what are the 3 types/causes of Aortic valve stenosis?
- Chronic rheumatic valvular disease
- Degenerative (senile)
- Congenital bicuspid valve
which form of Aortic valve stenosis is more common in younger people?
Congenital bicuspid valve
- much younger initial onset (40-50 years)
what are the 3 causes of Aortic Valve Regurgitation?
- Valve cusp destruction
- Weakened valve cusps
- Dilation of the aortic root
what 2 conditions can cause valve cusp destruction (and lead to Aortic valve regurgitation)?
rheumatic heart disease
myxomatous degeneration (from Marfan syndrome) will lead to the weakening of what structure?
(causes aortic valve regurgitation)
Weakened valve cusps
A Dilation of the ________ can occur as a result of degeneration of the media of the aorta
dilation of the aortic root
name the predisposing factors for infective endocarditis:
- intracardiac shunts
- valvular disease
- prosthetic valves (10-20% of all IE cases)
- IV drug abuse
- immune suppression
- diabetes mellitus
what 3 factors have been identified in the pathogenesis of infective endocarditis?
1) endocardial/endothelial injury (blood flow)
2) fibrin thrombi
3) organisms in the blood (sepsis)
list the clinical signs of infective endocarditis:
Splinter hemorrhages; Roth spots (retinal hemorrhages)
where are "splinter hemorrhages" found in patients with infective endocarditis?
in the nail beds
which form of infective endocarditis affects previously normal heart valves?
which form effects previously abnormal valves?
normal valves- ACUTE infective endocarditis
previously abnormal valves- SUBacute infective endocarditis
what are some complications of infective endocarditis?
1) valvular regurgitation
2) rupture of chordae tendineae
3) contiguous spread of infection
4) thromboembolism – “splinter hemorrhages” of fingernails
5) septic emboli with abscesses
what are the causes of vasculitis?
what are the 2 diseases that lead to "large vessel" vasculitis?
Giant cell (temporal)
_________________ and ____________ are both diseases that cause "medium vessel" vasculitis
name the 2 diseases that result in small vessel vasculitis
what are the 4 factors involved in the pathogenesis of vasculitis?
1) Immune complexes; circulating or may form in-situ
2) Antineutrophilic cytoplasmic antibodies (ANCA)
3) Anti-endothelial cell antibodies
4) Cell-mediated immune mechanisms
which Antineutrophilic cytoplasmic antibody (ANCA) is associated with microscopic polyarteritis?
- perinuclear localization
which Antineutrophilic cytoplasmic antibody (ANCA) is associated with Wegener granulomatosis?
- diffuse cytoplasmic distribution
anti-endothelial cell antibodies are important in the pathogenesis of what disease?
(a medium vessel vasculitis)
what are the clinical characteristics of Giant Cell (temporal) arteriosis?
rare before age 50
pain and tenderness over temporal artery
what are the pathological characteristics of Giant cell arteriosis?
Intimal proliferation / fibrosis
T/F: the etiology (cause) of both Giant cell, and Takayasu arteriosis have both been identified
the etiology of both is unknown
________________ is also called the "pulseless disease".... what causes this?
- patients have weak arm pulses
what is the pathology of Takayasu arteritis?
1) Involves aortic arch and branches
2) Intimal fibrosis
3) Granulomatous inflammation with fibrosis
(NOTE: numbers 2 & 3 are the same as giant cell vasculitis)
what are the clinical manifestations of Polyarteritis Nodosa?
1) acute-relapsing-chronic progression
3) weight loss
5) renal failure
7) abdominal pain
describe the pathology for Polyarteritis Nodosa
- Haphazard and segmental involvement of medium and small muscular arteries
- Kidney > liver > heart > GI
- Fibrinoid necrosis, PMN’s
- Thrombosis, aneurysms
- Heal by fibrosis
what sites in the body are usually involved with Polyarteritis Nodosa?
Usual sites of involvement are:
GI tract (50%).
________________ is also known as mucocutaneous lymph node syndrome
what is the etiology of Kawasaki disease?
anti-endothelial antibody triggered by viral infection
(It is suspected that a viral infection triggers a hypersensitivity reaction. AKA: mucocutaneous lymph node syndrome)
what age group is effected by Kawasaki disease?
Infants & young children
name the clinical features of Kawasaki disease:
mucous membrane erythema (eyes/mouth)
1-2% of patients with Kawasaki disease will die due to __________________
coronary artery vasculitis
what is the etiology/cause of Microscopic Polyangiitis?
what are the clinical signs for microscopic polyangiitis?
skin rash, other organs
microscopic polyangiitis may be caused by what "precipitating" conditions?
May be precipitated by:
foreign proteins or tumor proteins.
what is the pathology of microscopic polyangiitis?
Involves arterioles, capillaries, venules.
* small vessel vasculitis WITHOUT necrotizing granulomatous inflammation
what is the etiology, and the clinical signs, for Wegener's Granulomatosis?
Etiology: neutrophil-related endothelial damage mediated by PR3-ANCA
Clinical – sinusitis, pneumonitis, renal failure, glomerulonephritis
what is the pathology of Wegener's Granulomatosis?
- Affects kidneys, upper and lower respiratory tract
- Necrotizing granulomas
- Vasculitis with fibrinoid necrosis
give the etiology and clinical signs for Thromboangiitis Obliterans (Buerger Disease):
Etiology – endothelial injury from substance in cigarette smoke
Clinical – cigarette smoking, < 35 years, pain of extremities, ischemic ulcers, gangrene
what are the pathological characteristics of Thromboangiitis Obliterans (Buerger Disease)?
Vasculitis with thrombosis
what are the pathological characteristics for Dissecting Aortic Hematomas?
A) intimal tear - split between mid & outer third of the
B) media may be normal or have degeneration
what are the complications AND predisposing factors for Dissecting aortic hematomas?
1) rupture – hemorrhage
2) branch obstruction
2) connective tissue disorders (Marfan’s)