Nichols- Hemodynamics 2

Question 1

Libman Sacks endocarditis is associated with what autoimmune disease?

Answer 1

Lupus.. think LSE is assc w/ SLE

Question 2

Where are the vegetations in LSE?

Answer 2

Mitral & tricuspid valves (only on one side of the valve!

Question 3

will the vegetations likely embolize in LSE?

Answer 3

Hell no!

Question 4

Whats so special about marantic endocarditis?

Answer 4

It is not bacterial, but THROMBIC!!

Question 5

Nichols made a red slide: What is marantic endocarditis a precursor for?

Answer 5

Infective endocarditis

Question 6

Marantic endocarditis is assc with?

Answer 6

Malignant tumors, especially adenocarcinomas

Question 7

On which side of the valve does marantic endocarditis form?

Answer 7

Atrial side

Question 8

An infection on a blood clot on a heart valve is known as?

Answer 8

Infective endocarditis

Question 9

what is the 4 step pathogenesis of IE?

Answer 9

1. Valvular injury
2. Platelet/fibrin deposition
3. microbial seeding
4. microbial multiplication

Question 10

What bug is ACUTE IE usually caused by?

Answer 10

Acute= S. Aureus

Question 11

What bug is Subacute IE usually caused by?

Answer 11

Subacute= viridans Strep

Question 12

What bug usually gets on prosthetic heart valves?

Answer 12

Staph epi

Question 13

What valve do drug users typically get IE on?

Answer 13

tricuspid

Question 14

You have a patient with IE. You culture it. You tell the lab you are culturing an IE cuz some of the organisms are slow growing. You get results of Strep bovis. Whats your concern?

Answer 14

Colon cancer

Question 15

What are the slow growing oral flora that can cause IE?

Answer 15

HACEK

Question 16

What do 70% of IE pts have in common?

Answer 16

They had a pre-existing heart condition

Question 17

How often will IE kill you if you dont treat it?

Answer 17

All the ducking time.. quack!

Question 18

2 big criteria for diagnosis of IE?

Answer 18

1. Fever

2. Positive blood culture

Question 19

What is aortic stenosis?

Answer 19

Narrowing of aortic valve making it hard to pump blood out of LV

Question 20

3 main causes of aortic stenosis?

Answer 20

1. Congenital bicuspid valve
2. Senile degradation
3. Chronic rheumatic disease

Question 21

describe the pathology of aortic stenosis

Answer 21

Thickened valve –> lipid deposition –>inflammation –> calcifications

Question 22

symptoms of aortic stenosis?

Answer 22

SAD: syncope, angina, dyspnea

Question 23

What is aortic stenosis gonna do to the left ventricle?

Answer 23

LVH

Question 24

What is mitral valve regurg?

Answer 24

regurg from LV to LA; usually due to MVP

Question 25

Contrast acute vs. chronic mitral regurg

Answer 25

1. Acute you're gonna get flash pulmonary edema due to increased LA pressure; this will lead to DYSPNEA 2. Chronic you're gonna get LA dilation to compensate for the increased volume. Eventually the compensation will not be able to keep up and you'll get decompensation and HF

Question 26

What is MVP?

Answer 26

billowing of MV into LA; it is very common and can progress to mitral regurg

Question 27

Congenital causes of MVP?

Answer 27

Marfan, ehlers-danlos

Question 28

describe the micro path of MVP

Answer 28

1. Degredation of outer zona fibrous | 2. Expansion of inner zone spongiosa

Question 29

Specific sign for MVP.. u better know this!

Answer 29

Midsystolic click: S1... click!... S2 (lub.. click.. dub)

Question 30

Rheumatic heart disease is inflammation following infection by?

Answer 30

Group A beta hemolytic strep

Question 31

Your body's immune system thinks antigens from your heart are the bacterial M-proteins from the group A strep.. this phenomenon is known as?

Answer 31

Molecular mimicry

Question 32

Diagnosis for Rheumatic heart disease is proof of infection by group A beta hemolytic strep (via ASO titer or anti-DNAse B titer) and...

Answer 32

2 major or 2 major/1minor Jones criteria. The major jones criteria are: 1. J- joints- migratory polyarthritis 2. O- heart- pancarditis 3. N- nodules - subQ nodules 4. E- erythema marginatum 5. S- Sydenham's chorea

Question 33

Gross path of Rheumatic heart disease?

Answer 33

Small vegetations on valve closure

Question 34

Micro path of Rheumatic heart disease?

Answer 34

Aschoff bodies and Anitschkow cells

Question 35

Complications of Rheumatic heart disease?

Answer 35

65% go onto mitral stenosis | 25% go onto aortic regurg/stenosis

Question 36

What is aortic regurg?

Answer 36

Regurg of blood from aorta -> LV

Question 37

Causes of aortic regurg?

Answer 37

1. Congenital bicuspid aortic valve 2. Endocarditis 3. Chronic rheumatic valve deformation

Question 38

Describe acute aortic regurg

Answer 38

1. Decreased forward SV 2. Increased EDV 3. Backup into LA and pulmonary edema

Question 39

Describe chronic aortic regurg

Answer 39

1. Compensation by dilation of LV 2. Normal forward SV; increased overall SV 3. Decreased diastolic BP 4. Eventually decomensation with decreased SV, increased EDV, increased EDP leading to HF

Question 40

Bigtime!: Patient presents with bounding pulse so hard that their head is bobbing. Very wide pulse pressure. What do they have?

Answer 40

Aortic regurg