L66 – Valvular Heart Diseases Flashcards Preview

MBBS I CPRS > L66 – Valvular Heart Diseases > Flashcards

Flashcards in L66 – Valvular Heart Diseases Deck (48):
1

What is the valvular response to mechanical injury- e.g. wear and tear, excessive blood flow?

Damages endothelial layer

>> superficial fibrous
thickening (= scar) over preserved architecture

2

What is the valvular response to Inflammation?

1. Vascularisation of structure

2. Fibrosis

>> Decrease in size / surface area

3

What is the valvular response to Degenerative changes?

Distortion and increase in size

Due to deposition of calcium salts, cholesterol... etc

4

What are the 3 effects of valvular disease?

Stenosis
Incompetence
Mixed

5

Describe valve stenosis?

Tightening of the valvular opening

Resulting in decreased forward flow of blood through the opening

6

Describe Incompetence of valves?

Incomplete closure of the valvular opening, allowing backflow of blood through valvular opening

7

How does Mitral valve stenosis lead to atrial dilatation?

Mitral stenosis > Decreased outflow from Left atrium to Left Ventricle

> Increase atrial volume and pressure > Atrial dilatation

8

How does Left Atrial dilatation lead to right heart hypertrophy?

LA dilatation > Increased blood volume and pressure in pulmonary vessels

> Congestion of lungs > pulmonary hypertension

> Right heart hypertrophy

9

How does Mitral stenosis lead to systemic embolisation?

Mitral stenosis >>> Atrial dilatation

Turbulent blood flow > Atrial thrombus > Systemic thrombus

10

What is the treatment for valve stenosis?

balloon valvuloplasties

*not cure*

11

How does aortic stenosis lead to MI?

Aortic stenosis obstructs left ventricular outflow

LV systolic pressure increases > LV Hypertrophy

> Increase myocardial O2 consumption cannot be met > Myocardial infarction

12

What is the treatment for valve incompetence?

valvular annuloplasty

13

Name the three common valvular diseases?

DRI

Degenerative

Rheumatic fever/ heart disease

Infective endocarditis

14

What are the 3 subtypes of degenerative, common valvular diseases?

CMM

Calcific aortic stenosis

Mitral annular calcification

Myxomatous degeneration of mitral valves (Mitral valve prolapse)

15

Which valvular abnormality is the most frequent?

Calcific aortic stenosis

16

What causes the differences in age of onset of calcific aortic stenosis?

Onset in elderly:
 Congenital bicuspid
individuals: 50’s and 60’s

 Previous normal valves: 70’s, 80’s

17

Why is the age of onset of calcific aortic stenosis earlier in congenital bicuspid valve patients>?

stress on 2 instead of 3 valves >> more easily worn out

18

What causes calcific aortic stenosis?

Wear and tear induces
calcification >> formation of hard, heaped up calcified mass on valve surface

>> valves become difficult to open

19

Asymptomatic period for calcific aortic stenosis?

10-20 years

20

What are some general symptoms of calcific aortic stenosis?

Fatigue
Increasing dyspnea
Decreasing physical activity
Syncope during exertion

21

What are some specific symptoms of calcific aortic stenosis?

Palpitations
Angina
Congestive HF

22

What are the signs of calcific aortic stenosis?

Small amplitude/ weak pulse

Displaced apex beat

Systolic thrill + ejection murmur

23

What is the normal architecture of aortic valve?

3 valvular cusps and 3 distinct commissures

24

Describe Mitral annular calcification?

Degenerative calcific deposits in the RING** (atrio-ventricular junction) of mitral valve

25

What are the risk factors of Mitral annular calcification?

Source of thrombi and emboli

Prone to Infective endocarditis

Prone to mitral regurgitation

26

What group in the population is most affected by Mitral annular calcification?

Women over 60

27

What are the clinical features of Mitral annular calcification?

Systolic murmur (in half of patients)

Develop into HF alongside existing cardiac diseases

Associated with hypertension

28

What is another name for mitral valve prolapse?

Myxomatous degeneration of valve

29

Describe the characteristics of mitral valve prolapse?

"Tenting"/ ballooning of valvular cusps (insertion / deposit of mucopolysaccharides)

>> affected leaflets become thickened, rubbery, fail to fit into AV junction

30

What causes mitral valve prolapse?

Developmental anomaly of connective tissue

Associated with Marfan's syndrome

31

What are the general clinical features of mitral valve prolapse?

Fatigue
Anxiety
Migrane headache
Chest pain

*Could be asymptomatic altogether*

32

What are the specific clinical features of mitral valve prolapse?

Palpitations
Stroke (rare in young patients)

33

Describe Rheumatic fever?

acute, immunologically-mediated, multi-system inflammatory disease

34

What causes rheumatic fever?

Group A (ß-hemolytic) streptococcal pharyngitis

>> immune response: B lymphocytes in lymph node develops antistreptolysin O (ASO) antibodies

>> cross-react to attacks own body tissue

35

Duration of onset of rheumatic fever?

Occurs a few weeks after an episode of Group A streptococcal pharyngitis

36

What is the histology of acute phase rheumatic heart disease?

Foci of fibrinoid degeneration surrounded by lymphocytes

>> ASCHOFF BODIES distinctively in heart, but can disseminate

37

What is the most important consequence of rhuematic fever>?

Chronic Rheumatic Valvular Heart Disease

38

What occurs in Chronic Rheumatic Valvular Heart Disease ?

Inflammatory deformit of valves

Mostly mitral or aortic valves affected

39

What are the characteristics of Rheumatic Valvular Heart Disease?

 Leaflets thicken (replaced by fibrous tissue)
 Commissures fuse
 Chordae tendinae shorten, thicken, fuse (tighten)
 Vascularization

40

What causes pancarditis and what are its effects?

Acute rheumatic heart disease:

Pancarditis >> pathology in all three layers of the heart (endocardium, Myocardium, Pericardium)

41

Explain how each heart layer changes in Pancarditis?

1. Endocarditis: verrucae vegetations

2. Myocarditis: myocardial
Aschoff body >> diagnostic
of acute rheumatic carditis

3. Pericarditis: fibrinous
pericarditis

42

What is the most common site of Infective endocarditis?

Most common sites = left heart valves

43

Tricuspid valve endocarditis occurs in which patient groups?

Intravenous drug abusers

44

What are some complications of bacterial endocarditis?

SSeptic shock

Septic emboli

Abscess formation

45

What cardiac vegetation affects debilitated patients?

Nonbacterial thrombotic endocarditis

seen in patients with terminal illness (e.g. cancer)

46

Explain the effects of Libman Sacks Endocarditis?

Mitral, tricuspid valvulitis in
patients with Systemic Lupus Erythematosis (SLE)

change valve shape, damage chordae tendinae

Vegetation on both surfaces of valves

47

What are the 3 risks of prosthetic valves?

Risk of:
-Structural failure (time dependent

-Thrombosis

-Bacterial endocarditis (coagulase negative Staphylococcus)

48

What continuous therapy is given to many patients with valvular heart disease? What are possible side effects?

Anticoagulant therapy

Higher risk of fatal haemorrhage esp. in head (blood cannot clot easily)

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