Flashcards in Hemodynamic Disorders II Deck (34):
second most common valvular disease causing hemodynamic disorder
Calcific aortic stenosis
Three main causes of Calcific aortic stenosis
congenitally anomalous bicusid valve
Chronic rheumatic disease
The cause of CAS in most patients under 65 is:
The cause of CAS in most patients over 65 is:
Symptoms of CAS
Angina pectoris (chest pain due to myocardial ischemia), syncope, dyspnea
Symptoms usually occur with exertion.
Surgical valve replacement improves survival
Early pathology of CAS
Thickening with lipid deposition and inflammation (macrophages and lymphocytes) followed by some fibrosis.
Late pathology of CAS
Nodular heaped up calcifications
What is mitral valve regurgitation.
Well, the mitral valve is between the left atrium and left ventricle so Mitral regurgitation is when , during systolic contraction, some of the blood from the left ventricle goes back into the left atrium when the valve doesn't work properly.
Most common cause of mitral regurgitation
Mitral valve prlapse....followed by ischemic heart disease.
Pathophys consequences of mitral regurgitation are?
Decreased forward stroke volume
Increased left atrium volume and pressure
Volume related stress on the left ventricle because the added left atrial volume is returned to it along with the normal left atrial volume during diastole
Flash pulmonary edema
When rupture of a papillary muscle due to an MI or IE causes sudden mitral regurgitation, increasing left atrial pressure which is then transmitted backwards to the pulmonary circulation, may cause rapid pulmonary edema which is called flash pulmonary edema. MEDICAL EMERGENCY
Acute mitral regurg symptom
Chronic mitral regurg symptom
Forward stroke volume from normal of 100ml down to 75 is what
Mitral valve prolapse maybe associated with connective tissue disorders like Marfans
Most common valvular disease?
Rheumatic Heart DIsease
A "pancarditic" (endo, myo, and epi cardium) disease of inflammation following pharyngitis caused by group A Beta hemolytic strep.
Gross pathology of ARF
Tiny vegetations lined up where the valves close
Fibrin and platelett thrombi on valves, and aschoff bodies
Whats an Aschoff Body
foci of fibrinoid necrosis with histocytes anitschkow cells.
Chronic Rheumatic Heart Disease is more common with:
Recurrent carditis, carditis at an early age, or severe carditis
Surgical valve replacement leads to the requirement of lifelong anti-coagulants
Associated with Lupus. 50% of pts. Usually occurs simultaneously with pericarditis. Can feature vegetations (flat or berrylike) on all valves though mitral and tricuspid are most common.
Nonbacterial thrombotic endocarditis. Its common and occurs in 75% of patients with malignant tumors. Its basically the deposition of blood clot on heart valves and can be a PRECURSOR TO IE.
Marantic endocarditis is also prevalent in pts with what?
DIC, sepsis, and swan-ganz heart catheterization
Pathology of Marantic Endocarditis
small fibrin and platelet thrombi most commonly on the atrial side of the mitral valve.
Pathogeneisis of Infective endocaditis
valvular injury, platelet and fibrin deposition, microbial seeding, microbial multiplication
Three classifications of IE
Acute bacterial vs. subacute bacterial (Acute = Aureus, subacute= viridians streptococci),
Prosthetic valve endocarditis is commonly due to what organism
Pathology of IE
Large friable vegetations that are some combination or tan, red, gray, brown.
Common physical signs of IE
fever, heart murmur,petechiae, splenomegaly
Fever, weakness dyspnea