L8 Valvular and Congenital Heart Disease

Question 1

___________: failure of a valve to open completely (impedes forward flow)

Answer 1

Stenosis: failure of a valve to open completely (impedes forward flow)

Question 2

_______________: failure of a valve to close completely (allows reverse flow)

Frequency of Involvement?

Answer 2

Incompetence (Insufficiency): failure of a valve to close completely (allows reverse flow)

Left Heart more prevalent

Mitral > Aortic

Right Heart less frequent

Tricuspid > Pulmonary

Can be Acquired or Congenital:

Acquired more common, typically post-inflammation

Typically in left heart due to higher pressure/ strain

Question 3

Infective Endocarditis Findings?

Answer 3

Findings:

Sepsis

Murmur

Fever of Unknown Origin

Vegetations (1mm –4cm)

Necrosis/Perforation of Valve Tissue

Question 4

__________________:

Difficult to diagnose

Fevers spike/ diminish

Subacute bacterial endocarditis

Answer 4

Insidious Onset (SBE) Endocarditis

Difficult to diagnose

Fevers spike/ diminish

Subacute bacterial endocarditis

Question 5

___________

Rapidly fatal - early diagnosis essential

Acute bacterial endocarditis

Answer 5

Fulminant Onset (ABE) Endocardits

Rapidly fatal - early diagnosis essential

Acute bacterial endocarditis

Question 6

Which valves are typically affected by endocarditis?

Answer 6

Left sided Valves >>> Right

Mitral Valve (bicuspid) > Aortic (often both)

Tricuspid Valve Endocarditis –“always” IV Drug Abuse

Question 7

Risk Factors for Endocarditis?

Answer 7

Risk factors

Immunosuppression (except in AIDS)

Intravenous Drug Abuse (IVDA)

Any Low-Grade Chronic Bacteraemia

Preexisting Valvular Disease

• Congenital
• Rheumatic
• Mitral Valve Prolapse
• Prosthesis

Question 8

Organisms involved in Infectious Endocarditis?

Different Valve types?

Answer 8

Organisms InvolvedTypically effects Valvular Endocardium

Normal Valve- Likely Staph Aureus

Diseased Valve - Less virulent organism (Streptococci)

Prosthetic Valve (Likely Staph Aureus)

HACEK Group

Fungi

10% culture negative

Question 9

Complications of Endocarditis?

Answer 9

Complications

Valvular Insufficiency

Myocardial Abscess

Suppurative Pericarditis

Valve Dehiscence (rupture)

Embolic Disease –Brain, Kidney etc.

Infection elsewhere

Question 10

Causes of Non-Infective Endocarditis

Answer 10

Rheumatic Fever/Valvular Heart Disease

SLE (Libman-Sacks) Endocarditis

Non-Bacterial Thrombotic Endocarditis

Question 11

Rhematic Fever vs. Rhematic Heart Disease?

Answer 11

Acute (Rhematic Fever): multisystem

Chronic (Rhematic Heart Disease): valvular abnormalities, mainly mitral

Question 12

Acute vs. Chronic Rheumatic Valvular Heart Disease

Answer 12

Acute:

Aschoff Bodies

Verrucous Vegetations: lines of valve closure –chordae tendineae

Chronic:

Fibrosis Scarring of Cusps/Chordae

=> Stenosis / Incompetence

Question 13

Valves affected by Rhematic Valvular Heart Disease

Answer 13

Mitral >> Aortic >> Tricuspid >>> Pulmonary

Question 14

Complications of Rheumatic Valvular Heart Disease

Answer 14

Complications:

Endocarditis

Cardiac Failure

Thrombosis/Embolisation

Pulmonary Hypertension

Question 15

______________________:

• Small, sterile, verrucous (warty looking) vegetations occurring on the surface of the MITRAL (more common) and TRICUSPID Valves
• _________ Reduce Incidence
• Regurgitation manifestation

Answer 15

SLE (Libman-Sacks) Endocarditis

• Small, sterile, verrucous (warty looking) vegetations occurring on the surface of the MITRAL (more common) and TRICUSPID Valves
• Steroids Reduce Incidence
• Regurgitation manifestation

Question 16

________________:

Calcified masses in cusps with fibrosis and degeneration

Congenital as a child

Calcification of Bicuspid Valve age 50-60

Answer 16

Aortic Stenosis (Sclerosis):

Calcified masses in cusps with fibrosis and degeneration

Congenital as a child

Calcification of Bicuspid Valve age 50-60

Question 17

_______________:

Connective Tissue abnormality

Variable severity

Idiopathic (unknown cause)

Some overlap w/ Marfans Syndrome

Answer 17

Mitral Valve Prolapse

Connective Tissue abnormality

Variable severity

Idiopathic (unkown cause)

Some overlap w/ Marfans Syndrome

Question 18

Ischemic (Papillary Muscle Infarction) => _____________

Answer 18

Ischemic (Papillary Muscle Infarction) => Mitral Regurgitation

Question 19

Dilated Mitral Valve Ring => ____________

Answer 19

Dilated Mitral Valve Ring => Mitral Regurgitation

Question 20

Examples of Degenerative Valvular Disease

Answer 20

Aortic Stenosis (Sclerosis)

Mitral Valve Prolapse

Ischemic (Papillary Muscle Infarction)

Dilated Mitral Valve Ring

Question 21

Two examples of congenital heart disease which present for the first time in adults?

Answer 21

–Mitral Valve Prolapse

–Bicuspid Aortic Valve

Question 22

Answer 22

Question 23

Types of Shunts?

Answer 23

Shunts

Left to Right Acyanotic

Right to Left Cyanotic (Eisenmenger’s Syndrome)

Question 24

_________________: due to an increase in pulmonary pressure, RV Hypertrophy exceeds LV pressure=> right to left shunt circulation leading to ___________

Answer 24

Eisenmenger’s Syndrome: due to an increase in pulmonary pressure, RV Hypertrophy exceeds LV pressure=> reversal right to left shunt circulation= Cyanosis: Dexoxygenated blood enters systemic ciruclation

Question 25

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_: Most common congenital abnormality "Hole in Heart" Small =\> \_\_\_\_\_\_\_\_\_\_\_ Large =\> \_\_\_\_\_\_\_\_\_\_\_

Answer 25

**Ventricular Septal Defect** Most common congenital abnormality "Hole in Heart" Small =\> spontaneous closure Large =\> Cardiac failure / Eisenmenger's Syndrome

Question 26

What defect leads to Paradoxical Emboli?

Answer 26

Paradoxical Emboli (venous thrombus in systemic circulation) are caused by: **Atrial Septal Defect** 4 Types (Based on Location) Ostium Secundum (90%) Ostium Primum (Downs Syndrome) Sinus Venosus Coronary Sinus

Question 27

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_:** Physiologic Shunt in Utero Contracts post partum after breathing start and fibroses (closes) Can be kept open w/ ___________ for treatment of \_\_\_\_\_\_\_

Answer 27

**Patent Ductus Arteriosus:** Physiologic Shunt in Utero Contracts postpartum after breathing starts and fibroses (closes) Can be kept open w/ **_Prostaglandins_** (**Treatment of Cyanotic Congenital Heart Disease)** Allows oxygenated blood to mix with deoxygenated

Question 28

**_Congenital Aortic Stenosis_** Supravalvular - \_\_\_\_\_\_\_\_\_\_\_ Valvular– \_\_\_\_\_\_\_\_\_\_\_\_ Subvalvular – \_\_\_\_\_\_\_\_

Answer 28

**_Congenital Aortic Stenosis_** Supravalvular - **hypercalcemia → Narrowing** Valvular– **bicuspid valve stenosis** Subvalvular – **fibrous band**

Question 29

Coarctation of the Aorta characteristics?

Answer 29

Preductal (Ductus Arteriosus): Presents early in childhood Postductal: Presents as adult, secondary hypertension

Question 30

Manifestations of Tetrology of Fallot

Answer 30

Question 31

Cyanotic Congenital Heart Diseases? Treatment?

Answer 31

**Tetrology of Fallot** **Transposition of the Great Vessels** **Treatment:** Patent Ductus Arteriosus can be kept open w/ **_Prostaglandins_** allowing oxygenated blood to mix with deoxygenated

Question 32

Manifestations of Transposition of the Great Vessels?

Answer 32