CV lecture 3- Cardiac Valvular Disease and Vasculitis Flashcards Preview

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Flashcards in CV lecture 3- Cardiac Valvular Disease and Vasculitis Deck (62):
1

Acquired mitral valve stenosis is usually caused by what?

usually due to chronic (recurrent) rheumatic valvular disease

2

what is mitral valve stenosis?

failure of a valve to open completely, obstructing forward flow

3

what strain of bacteria is usually responsible for acquired stenosis?

Group A β-hemolytic Streptoccocal pharyngitis

4

mitral valve stenosis usually effects what group of people?

children

(only 20% of cases are in adults)

5

what are the clinical features of Acute rheumatic fever (ARF)?

arthritis (often polyarthritis)
carditis
erythema marginatum (skin rash)
subcutaneous nodules

6

The myocarditis caused by ARF is characterized microscopically by _______ bodies

Aschoff

7

what are the 3 types of Rheumatic Carditis?

Pericarditis – fibrinous

Endocarditis – sterile vegetations

Myocarditis – Aschoff bodies

8

what are the microscopic characteristics of Aschoff bodies?

- mononuclear cells and fibroblasts

- form of granulomatous inflammation

9

Recurrent bouts of acute rheumatic fever lead to __________ and ____________

fibrosis

and

mitral valve stenosis

10

______________ refers to a valve that fails to close completely, allowing backflow of blood

Regurgitation (insufficiency)

11

what is Mitral valve prolapse?

a condition in which the leaflets balloon into the left atrium during left ventricular contraction (systole)

12

what are the THREE causes of mitral valve regurgitation?

1) Ischemic heart disease
2) Infective endocarditis
3) Floppy mitral valve (severe MV prolapse)

13

floppy mitral valve (sever MV prolapse) can be isolated or part of ___________ syndrome

Marfan syndrome

14

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

15

_____________ degeneration is the name given when mitral valves separate and lose collagen

myxomatous degeneration

16

what are the possible complications of floppy mitral valve syndrome?

- MV regurgitation
- endocarditis
- thromboemboli
- sudden death (rare)

17

_____________ Stenosis is caused by fibrosis and calcification

Aortic Valve Stenosis

18

what is the effect on the heart from fibrosis and calcification during aortic valve stenosis?

reduce the valve cusp mobility

19

what are the 3 types/causes of Aortic valve stenosis?

- Chronic rheumatic valvular disease

- Degenerative (senile)

- Congenital bicuspid valve

20

which form of Aortic valve stenosis is more common in younger people?

Congenital bicuspid valve

- much younger initial onset (40-50 years)

21

what are the 3 causes of Aortic Valve Regurgitation?

- Valve cusp destruction

- Weakened valve cusps

- Dilation of the aortic root

22

what 2 conditions can cause valve cusp destruction (and lead to Aortic valve regurgitation)?

infectious endocarditis

rheumatic heart disease

23

myxomatous degeneration (from Marfan syndrome) will lead to the weakening of what structure?

(causes aortic valve regurgitation)

Weakened valve cusps

24

A Dilation of the ________ can occur as a result of degeneration of the media of the aorta

dilation of the aortic root

25

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

26

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)

27

list the clinical signs of infective endocarditis:

Fever

Fatigue

Anemia

Myalgia/arthralgia

Splinter hemorrhages; Roth spots (retinal hemorrhages)

Heart murmur

28

where are "splinter hemorrhages" found in patients with infective endocarditis?

in the nail beds

29

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

30

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

31

what are the causes of vasculitis?

***Infection***
Immunologic mechanisms
Radiation
Trauma
Caustic substances
Unknown

32

what are the 2 diseases that lead to "large vessel" vasculitis?

Giant cell (temporal)
Takayasu arteritis

33

_________________ and ____________ are both diseases that cause "medium vessel" vasculitis

Polyarteritis nodosa

and

Kawasaki disease

34

name the 2 diseases that result in small vessel vasculitis

Microscopic polyarteritis

Wegener granulomatosis

35

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

36

which Antineutrophilic cytoplasmic antibody (ANCA) is associated with microscopic polyarteritis?

Anti-myeloperoxidase (anti-MPO)

- perinuclear localization

37

which Antineutrophilic cytoplasmic antibody (ANCA) is associated with Wegener granulomatosis?

Anti-proteinase-3 (anti-PR3)

- diffuse cytoplasmic distribution

38

anti-endothelial cell antibodies are important in the pathogenesis of what disease?

Kawasaki disease

(a medium vessel vasculitis)

39

what are the clinical characteristics of Giant Cell (temporal) arteriosis?

rare before age 50
fever
weight loss
headache
visual disturbances

pain and tenderness over temporal artery

polymyalgia rheumatica

40

what are the pathological characteristics of Giant cell arteriosis?

Granulomatous inflammation

Intimal proliferation / fibrosis

41

T/F: the etiology (cause) of both Giant cell, and Takayasu arteriosis have both been identified

FALSE

the etiology of both is unknown

42

________________ is also called the "pulseless disease".... what causes this?

Takayasu Arteritis

- patients have weak arm pulses

43

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)

44

what are the clinical manifestations of Polyarteritis Nodosa?

1) acute-relapsing-chronic progression
2) fever
3) weight loss
4) hematuria
5) renal failure
6) hypertension
7) abdominal pain
8) melena

45

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

46

what sites in the body are usually involved with Polyarteritis Nodosa?

Usual sites of involvement are:

kidneys (85%),
heart (75%),
liver (65%),
GI tract (50%).

47

________________ is also known as mucocutaneous lymph node syndrome

Kawasaki disease

48

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)

49

what age group is effected by Kawasaki disease?

Infants & young children

50

name the clinical features of Kawasaki disease:

fever
mucous membrane erythema (eyes/mouth)
skin rash
cervical lymphadenopathy

usually self-limited

51

1-2% of patients with Kawasaki disease will die due to __________________

coronary artery vasculitis

52

what is the etiology/cause of Microscopic Polyangiitis?

antigen-antibody complexes

Ag-Ab complexes/MPO-ANCA

53

what are the clinical signs for microscopic polyangiitis?

skin rash, other organs

54

microscopic polyangiitis may be caused by what "precipitating" conditions?

May be precipitated by:
drugs
microorganisms
foreign proteins or tumor proteins.

55

what is the pathology of microscopic polyangiitis?

Involves arterioles, capillaries, venules.

Fibrinoid necrosis

* small vessel vasculitis WITHOUT necrotizing granulomatous inflammation

56

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

57

what is the pathology of Wegener's Granulomatosis?

- Affects kidneys, upper and lower respiratory tract

- Necrotizing granulomas

- Vasculitis with fibrinoid necrosis

58

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

59

what are the pathological characteristics of Thromboangiitis Obliterans (Buerger Disease)?

Vasculitis with thrombosis

60

what are the pathological characteristics for Dissecting Aortic Hematomas?

A) intimal tear - split between mid & outer third of the
media

B) media may be normal or have degeneration

61

what are the complications AND predisposing factors for Dissecting aortic hematomas?

Complications:
1) rupture – hemorrhage
2) branch obstruction

Predisposing factors:
1) hypertension
2) connective tissue disorders (Marfan’s)

62

which form of vasculitits is MUCH more common in women than in men?

Takayasu arteriosis

- most common in women under 40 yrs old