Heart Valve Disease

Question 1

Coaptation

Answer 1

When the heart valves come together.

Question 2

Aortic valves ———– as you get older.

Answer 2

thicken. AKA fibrosis.

Question 3

3 types of valvular heart disease.

Answer 3

1) Rheumatic Heart Disease
2) Infective Endocarditis
3) Non-infective Endocarditis

Question 4

Saying about Rheumatic Fever

Answer 4

“RF licks the joints but bites the heart.”

Question 5

How do you get RF (organism)?

Answer 5

You get infected with a beta-hemolytic (GAS) strep bacteria.

Question 6

What are on the surface of the GAS strep bacteria?

Answer 6

An M protein and streptolysin (an exotoxin).

Question 7

Why is the heart attacked in Rheumatic Fever?

Answer 7

Because the myosin and tropomyosin of the heart share the same M proteins as those found on the strep bacterial surface.

So the body’s antibodies attack the strep bacteria and also the heart muscle.

Question 8

How does acute Rheumatic fever first present?

Answer 8

Pharyngitis then inflammation of the joints.

Question 9

Clinical diagnosis of Rheumatic Heart Disease.

Answer 9

Jones criteria:

1) Rheumatic component.
2) Heart disease.
3) Recent GAS infection.
4) Polyarthritis
5) Skin lesions

Question 10

Antibodies to the M protein on the strep bacteria ———— with M proteins on myosin and tropomyosin.

Answer 10

cross-react

Question 11

Skin lesion associated with Rheumatic Fever/Heart Disease.

Answer 11

Erythema Marginatum

Question 12

3 changes in the heart from Rheumatic heart disease.

Answer 12

(1) Vegetations
(2) Myocardial Aschoff bodies
(3) Fibrinous pericarditis

Question 13

The look of the pericardium in rheumatic pericarditis.

Answer 13

Bread and butter appearance.

Question 14

Aschoff Body

Answer 14

1) In acute Rheumatoid Fever.
2) Only in the heart.
3) Granuloma-like lesion.
4) Macrophages are present - called Anitschkow myocytes.

Question 15

Caterpillar cell

Answer 15

AKA Anitschkow myocyte seen in Aschoff bodies.

Question 16

Most important aspect of Acute Rheumatic Fever

Answer 16

Valvulitis.

Question 17

Order of valves most to least affected

Answer 17

Mitral valve -> Aorta -> Tricuspid -> Pulmonary valves

Question 18

Valvulitis of ARF

Answer 18

Verrucae (wart-like vegetations) seen on the valves.

Question 19

Chronic rheumatic Valve Disease

Answer 19

Occurs years after having acute Rheumatic Fever. You get a deformed, thickened, fibrotic valve.

Question 20

Signature lesion of Rheumatic Fever

Answer 20

Mitral stenosis

Question 21

Difference between acute and subacute bacterial endocarditis.

Answer 21

In Acute, the valve was normal to begin with and gets damaged. In Subacute, the valve was already damaged, but can get damaged more.

Question 22

Two types of bacterial endocarditis.

Answer 22

Acute and Subacute.

Question 23

Who gets fungal endocarditis?

Answer 23

Drug users or immunocompromised hosts.

Question 24

The organism that causes acute endocarditis.

Answer 24

Staph aureus.

Question 25

The organism that causes subacute endocarditis.

Answer 25

Staph viridans.

Question 26

What causes endocarditis?

Answer 26

Blood that is contaminated with bacteria gets to the heart and infects the valves, then the infected valves shed the bacteria to the body.

Question 27

Sources of infection for endocarditis.

Answer 27

IV lines Injection drug use Dental procedures

Question 28

Pathogenesis of endocarditis.

Answer 28

1) The endothelium is damaged. 2) Matrix and collagen is exposed. 3) Causes platelet aggregation and fibrin deposits on the valve.

Question 29

Types of non-rheumatoid endocarditis

Answer 29

1) Infective | 2) Non-Infective

Question 30

Types of Infective endocarditis.

Answer 30

1) Acute | 2) Sub-acute

Question 31

Type of Non-infective endocarditis

Answer 31

1) Non-bacterial thrombotic endocarditis (marantic) | 2) Atypical Verrucous endocarditis

Question 32

Non-Bacterial Thrombotic Endocarditis (NBTE)

Answer 32

1) Often occurs in a hypercoagulable state. 2) Associated with malignant disease. 3) Often affects a normal valve. 4) Often spares (doesn't damage) the valve. 5) Gives rise to emboli.

Question 33

Marantic endocarditis AKA

Answer 33

NBTE

Question 34

What doesn't NBTE have?

Answer 34

NO INFLAMMATION OR BACTERIA. They're STERILE deposits.

Question 35

Vegetations are ------ in NBTE.

Answer 35

Friable.

Question 36

Most common need for valve replacement.

Answer 36

Aortic Stenosis.

Question 37

Causes of aortic stenosis.

Answer 37

1) Rheumatic Fever | 2) Aging

Question 38

Aortic stenosis causes ----- -------- hypertrophy.

Answer 38

left ventricular

Question 39

_____ ______ is normal in aortic stenosis.

Answer 39

Serum calcium

Question 40

Risk factor for arterial stenosis.

Answer 40

High LDL, males, smoking.

Question 41

______ is related to stasis or endocardial injury.

Answer 41

Thrombosis.

Question 42

Most common heart tumor in adults.

Answer 42

Cardiac myxoma.

Question 43

Most common location of the cardiac myxoma.

Answer 43

Left atrium.

Question 44

Cardiac myxomas can ________.

Answer 44

embolize

Question 45

You're not going to see these organisms in NBTE.

Answer 45

Neutrophils - because there's no inflammation.

Question 46

Blood culture in NBTE.

Answer 46

NEGATIVE BC THERE ARE NO BACTERIA!!!!!

Question 47

Clinical features of infective endocarditis.

Answer 47

``` Fever Heart murmur + blood culture Known source of infection Evidence of emboli ```

Question 48

Staph aureus causes.

Answer 48

Acute infective endocarditis. Affects normal valves.

Question 49

Staph viridens causes.

Answer 49

Subacute infective endocarditis. Affects already-damaged valves.

Question 50

Presentations of bacterial endocarditis.

Answer 50

Osler nodes Janeway lesions Splinter hemorrhages conjunctival petechiae

Question 51

Patients who are septic and have severe burns can become _________, thus making them predisposed to ________.

Answer 51

Hypercoagulable; NBTE