diseases of the heart valves, pericardium and congenital heart disease

Question 1

What is stenosis of valves?

Answer 1

Failure of valves to open completely -> prevent forward flow

Question 2

What is insufficiency of valves?

Answer 2

Failure of valves to close completely -> allow reverse flow

Question 3

Some causes of valve stenosis?

Answer 3

• post inflammatory scarring eg rheumatic heart disease
• calcification
• congenital

Question 4

Some causes of valve insufficiency?

Answer 4

• post inflammatory scarring eg rheumatic heart disease
• developmental eg Marfan’s
• degenerative eg Myxomatous degeneration
• infectious eg. syphilis, IE

Question 5

Rules of valvular heart disease

Answer 5

• stenosis and insufficiency can occur at the same time
• more than 1 valve can be affected
• usually left sided valve affected
• structurally abnormal valve is at a higher risk

Question 6

What are the 4 important valvular heart disease?

Answer 6

1. Aortic valve calcification
2. Mitral valve prolapse
3. Rheumatic heart disease
4. Infective endocarditis

Question 7

What is aortic valve calcification?

Answer 7

Aortic stenosis caused by calcification due to age associated degeneration

Question 8

What is mitral valve prolapse?

Answer 8

Myxoid degeneration of valvular cusps -> becomes thickened and rubbery
Ballooning of valvular cusps into left atrium -> loss of collagen and elastic tissue

results in Mitral Regurgitation

Question 9

What are some examples of structurally abnormal valves?

Answer 9

• congenital bicuspid aortic valve
• valves damaged by RHD
• prosthetic valves

Question 10

What is Rheumatic Fever?

Answer 10

• abnormal immune response to group A streptococcal antigens that cross react with host proteins following pharyngitis
• diagnosed by Jones criteria
• can cause rheumatic heart disease

Question 11

What is acute rheumatic heart disease?

Answer 11

inflammation affecting all 3 layers of the heart aka pancarditis (includes pericarditis & myocarditis)

Question 12

What are some macroscopic findings seen in acute rheumatic heart disease?

Answer 12

Aschoff’s bodies with caterpillar cells
T lymphocytes
plasma cells

Question 13

What is the gross finding seen in acute rheumatic heart disease?

Answer 13

Small vegetations (masses) called verrucae formed by antibody complexes

Question 14

What is seen in chronic rheumatic heart disease?

Answer 14

Fish mouth stenosis

Question 15

Which valve is commonly affected in chronic rheumatic heart disease?

Answer 15

Mitral valve

Question 16

What are the common valves involved in IE?

Answer 16

Mitral Valve
Aortic Valve

-> vegetations form in IE

Question 17

How to diagnose IE?

Answer 17

modified Duke criteria

Question 18

What conditions predispose to IE?

Answer 18

Abnormal valve
Microorganism seeding into blood
- procedure
- contaminated needle
- breaks in epithelial barriers

Question 19

What bacteria is involved in Acute IE?

Answer 19

Staphylococcus Aureus for IV drug abusers

Question 20

Acute IE

Answer 20

virulent microorganisms attacking normal valves

Question 21

Subacute IE

Answer 21

weaker microorganisms attacking abnormal valves

Question 22

What bacteria is involved in Subacute IE?

Answer 22

Streptococcus viridians (normal floral cavity)
Staphylococcus epidermis (prosthetic valve endocarditis)

Question 23

Local complications of IE

Answer 23

• valve rupture
• myocardial ring abscess
• suppurative pericarditis

Question 24

Distant complications of IE

Answer 24

• septic emboli (vegetation can dislodge): organ infarction and abscess formation
• glomerulonephritis

Question 25

Complications of valvular heart disease

Answer 25

heart: - LVH - MI - HF - Arrhythmia - Predisposition to IE lung: - congestion - pulmonary hypertension

Question 26

What are the types of pericarditis?

Answer 26

- Serous - Fibrinous - Suppurative - Haemorrhagic - Caseous

Question 27

Entire pericardium covered by fibrin has a...

Answer 27

bread and butter appearance

Question 28

What are the causes of pericarditis?

Answer 28

Infection Trauma Autoimmune Metabolic Iatrogenic Neoplastic

Question 29

Types of chronically healed pericarditis

Answer 29

adhesive pericarditis [no effect on cardiac function] adhesive mediastinopericarditis [affects cardiac function] constrictive pericarditis [affects cardiac function]

Question 30

Left to Right shunt = Acyanotic What are some examples of left to right shunts?

Answer 30

- VSD - ASD - Patent Ductus Arterioles (blood travels from higher pressure aorta to lower pressure pulmonary trunk)

Question 31

Describe the Eisenmenger Syndrome (shunt reversal).

Answer 31

1) Left to right shunt will increase the pressure and volume of low pressure pulmonary circulation 2) Pulmonary arterioles will undergo medial hypertrophy and vasoconstriction 3) Right ventricular hypertrophy 4) Pulmonary vascular resistance increases and approaches systemic levels 5) Right to left shunt is created - deoxygenated blood enters the systemic circulation

Question 32

What are some examples of obstruction in congenital heart disease?

Answer 32

- pulmonary and aortic stenosis - coarctation of aorta

Question 33

In coarctation of aorta with PDA:

Answer 33

deoxygenated blood from PT will top up loss of blood volume due to coarctation => lower limb will be cyanotic

Question 34

In coarctation of aorta withOUT PDA:

Answer 34

lower limb will have a drop in BP

Question 35

Right to left shunt = Cyanotic What are some examples of right to left shunts?

Answer 35

5 Terrible Ts: 1. Tetralogy of Fallot 2. Transposition of great arteries 3. Truncus arteriosus 4. Tricuspid atresia 5. Total anomalous pulmonary venous return

Question 36

What is happening during Tetralogy of Fallot?

Answer 36

1. Pulmonary stenosis 2. RVH 3. VSD 4. Overriding aorta (aorta shifts to the right such that both RV and LV open into the aorta) => cyanosis

Question 37

What is happening during Transposition of great arteries?

Answer 37

Aorta and PT switch places such that: RV opens up into Aorta LV opens up into Pulmonary Trunk => deoxygenated blood enters the systemic circulation without passing through the lungs => cyanosis

Question 38

Complications of untreated congenital heart disease

Answer 38

LVH/RVH HF Pulmonary hypertension Shunt reversal IE Paradoxical emboli (emboli from right side of heart enters systemic circulation through septal defects)

Question 39

What is a common cause of mitral valve stenosis

Answer 39

RHD

Question 40

In nonbacterial thrombotic endocarditis, what is observed?

Answer 40

small, non-infective, platelet-rich vegetations on heart valves

Question 41

Define congenital heart disease

Answer 41

abnormalities of the heart and/or great vessels that are present at birth