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Flashcards in Path: diseases of endocardium and valves Deck (17):
1

Rheumatic fever

-A sequelae to strep throat, inflammation due to M protein (on capsule) that causes multi-systemic inflammatory disease
-Causes: acute rheumatism, rheumatic heart disease, polyartheritis rheumatica
-Can lead to chronic rheumatic heart disease (mostly affecting mitral valve, but also can affect Ao valve)
-Incidence is 5-15 yrs, and increases w/ poor nutrition, high density population, large families, developing countries

2

Clinical features of rheumatic fever

-Sore throat followed by 2-4 wk latent period followed by signs/Sx of rheumatic fever
-Blood cultures during rheumatic fever will usually be negative
-Sx: polyartheritis, chorea, carditis, subcutaneous nodules, erythema marginatum

3

Heart pathology of rheumatic fever

-Most serious effect, usually a pancarditis
-Endocarditis: vegetations (platelet, RBC, fibrin) on valves or chordae
-Myocarditis (interstitial): lymphocytes and Aschoff bodies (cigar shaped)
-Aschoff bodies are small granulomas with anitschkow myocytes (owl eyes), can cause arrhythmias
-Pericarditis (fibrinous): fibrosis can be a problem if it affects the valves

4

Sequelae of rheumatic fever

-ASO (anti-streptolysin O) titer used to Dx
-Sequellae: majority recover in 6 wks, but recurrence does increase risk for chronic valvular disease
-Chronic valvular disease can lead to cardiac failure
-Sub-acute endocarditis also a complication of valvular disease
-Rx: bed rest and high doses of salicylates (also antibios during strep laryngitis will decrease chance of rheumatic fever)

5

Rheumatic valvulitis

-Following recurrent rheumatic fever, leads to progressive scarring, stenosis, incompetence, or both
-Especially affects mitral (and Ao) valve
-May take years of Sx to arise (usually adults)

6

SLE valvulitis

-Multiple small vegetations on both surfaces on valves
-Sx may mimic rheumatic fever (pericarditis and myocarditis may be present)

7

Carcinoid syndrome

-Affects R side of heart (pulm and tricuspid valves)
-Due to biogenic amines (5HT, histamine) released by carcinoid tumors

8

Noninfective vs infective endocarditis (EC)

-Noninfective: seen in advanced cancer, wasting disease
-Infective: predisposition of valves that are damaged (Rh fever)

9

Infective EC

-Usually due to S aureus (more acute) or strep viridans (sub-acute/chronic)
-Acute: usually highly virulent and affecting normal valves (staph, IVDU)
-Sub-acute: low virulence on damaged valves (strep viridans)
-Damaged valves: RF, congenital heart disease, degenerative heart disease, prosthetics
-Infective thrombi develop and can embolize (L: brain, kidney, gut; R: lungs)
-M > A > T > P

10

Consequences of EC

-Bacteremia: splenomegaly, splinter hemorrhages, roth spots (eye hemorrhages)
-Immune complexes: osler nodes, janeway lesions, glomerulonephritis
-Valve dysfxn: changing murmur, perforation
-Embolism
-Local infected (mycotic) aneurysm

11

Mitral stenosis

-Due to rheumatic heart disease, usually female
-Causes diastolic rumble murmur, LAE, L sided HF and pulmonary edema
-Leads to interstitial fibrosis, pulmonary artery HTN, RVH

12

Mitral regurg

-Due to degenerative valve disease (myxomatous degeneration- floppy valve, CT d/os, fibroelastic deficiency), rheumatic fever, chronic LV failure (dilation of annulus), ischemia/infarction
-Pathophysiology: holosystolic murmur w/ dilation of LV and LA and L sided HF (may lead to RVH)

13

Ao stenosis

-Etiology: usually degenerative valve disease (includes congenital bicuspid), from fibrosis/calcification of valve from aging (and congenital bicuspid), can be rheumatic
-There is a crescendo-decrescendo systolic murmur, hypotention and syncopal attacks, angina (decreased coronary perfusion)
-LVH and L sided heart failure common

14

Ao regurg

-Usually due to degenerative and/or congenital bicuspid, possibly rheumatic (rheumatic often involves multiple valves)
-Leads to decrescendo early diastolic murmur, wide pulse pressure, bounding (water-hammer) pulse, LV is dilated and hypertrophic

15

Multiple valve disease

->50% rheumatic
-40% due to degenerative
-Often just Ao and Mitral, but can be Ao, mitral, and tricuspid (pulm often spared)

16

Complications of valvular disease

-HF, arrhythmias, thromboembolism, infective endocarditis (IE)
-Fibrosis/calcification (afib, other arrhythmias)
-Dilated ventricles: mural thrombus
-Damaged valves: IE
-Valve dysfxn Rx: medical Rx of HF and surgical Rx of valve

17

Neoplasms of the heart

-Atrial myxoma: arises from endocardium, mostly in LA and may obstruct the AV valve
-Most common primary tumor of adults
-Rhabdomyoma: most frequent primary tumor in children
-Metastatic: most commonly involves the pericardium, multiple metastases