L66 – Valvular Heart Diseases Flashcards by Max Kam

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

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What is the valvular response to Inflammation?

Vascularisation of structure
Fibrosis

> > Decrease in size / surface area

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What is the valvular response to Degenerative changes?

Distortion and increase in size

Due to deposition of calcium salts, cholesterol… etc

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What are the 3 effects of valvular disease?

Stenosis
Incompetence
Mixed

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Describe valve stenosis?

Tightening of the valvular opening

Resulting in decreased forward flow of blood through the opening

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Describe Incompetence of valves?

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

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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

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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

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How does Mitral stenosis lead to systemic embolisation?

Mitral stenosis&raquo_space;> Atrial dilatation

Turbulent blood flow > Atrial thrombus > Systemic thrombus

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What is the treatment for valve stenosis?

balloon valvuloplasties

not cure

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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

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What is the treatment for valve incompetence?

valvular annuloplasty

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Name the three common valvular diseases?

DRI

Degenerative

Rheumatic fever/ heart disease

Infective endocarditis

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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)

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Which valvular abnormality is the most frequent?

Calcific aortic stenosis

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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

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

stress on 2 instead of 3 valves&raquo_space; more easily worn out

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What causes calcific aortic stenosis?

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

> > valves become difficult to open

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Asymptomatic period for calcific aortic stenosis?

10-20 years

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What are some general symptoms of calcific aortic stenosis?

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Fatigue
Increasing dyspnea
Decreasing physical activity
Syncope during exertion

What are some specific symptoms of calcific aortic stenosis?

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Palpitations
Angina
Congestive HF

What are the signs of calcific aortic stenosis?

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Small amplitude/ weak pulse

Displaced apex beat

Systolic thrill + ejection murmur

What is the normal architecture of aortic valve?

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3 valvular cusps and 3 distinct commissures

Describe Mitral annular calcification?

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

What are the risk factors of Mitral annular calcification?

Source of thrombi and emboli Prone to Infective endocarditis Prone to mitral regurgitation

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

Women over 60

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

What is another name for mitral valve prolapse?

Myxomatous degeneration of valve

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

What causes mitral valve prolapse?

Developmental anomaly of connective tissue Associated with Marfan's syndrome

What are the general clinical features of mitral valve prolapse?

Fatigue Anxiety Migrane headache Chest pain *Could be asymptomatic altogether*

What are the specific clinical features of mitral valve prolapse?

Palpitations | Stroke (rare in young patients)

Describe Rheumatic fever?

acute, immunologically-mediated, multi-system inflammatory disease

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

Duration of onset of rheumatic fever?

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

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

What is the most important consequence of rhuematic fever>?

Chronic Rheumatic Valvular Heart Disease

What occurs in Chronic Rheumatic Valvular Heart Disease ?

Inflammatory deformit of valves Mostly mitral or aortic valves affected

What are the characteristics of Rheumatic Valvular Heart Disease?

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

What causes pancarditis and what are its effects?

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

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

What is the most common site of Infective endocarditis?

Most common sites = left heart valves

Tricuspid valve endocarditis occurs in which patient groups?

Intravenous drug abusers

What are some complications of bacterial endocarditis?

SSeptic shock Septic emboli Abscess formation

What cardiac vegetation affects debilitated patients?

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

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

What are the 3 risks of prosthetic valves?

Risk of: -Structural failure (time dependent - Thrombosis - Bacterial endocarditis (coagulase negative Staphylococcus)

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)

L66 – Valvular Heart Diseases Flashcards

(48 cards)