LVH
with systemic hypertension (>140/90)***
CHF or arrhythmias
cor pulmonale
pulmonary disorder causes pulmonary HTN
leads to right side hypertensive heart disease
COPD, interstitial lung disease, recurrent PE, kyphoscoliosis, obesity
stenosis
valve can’t open completely
- cusp abnormality
- almost always chronic
insufficiency
regurg or incompetence
-reverse flow
functional regurg
valve fine
-dilated annulus
most common cause of valve problems
rheumatic heart disease - mitral valve
aortic stenosis
calcified aortic valve
aortic insufficiency
dilation of ascending aorta - HTN and aging
mitral stenosis
rheumatic heart disease
mitral insufficiency
myxomatous degeneration - prolapse
calcific aortic stenosis
senile - in elderly 60-80yo
calcium mass in sinuses of valsalva
lead to LVH (concentric)
bicuspid aortic stenosis
in 2% population
-congeintal
more susceptible to calcification
-develps earlier
40-50yo
mitral annular calcification
women over 60yo
- occasional associated with arrhythmias
- not often affect valvular function
myxomatous degeneration of mitral valve
mitral valve prolapse
- ballooning of leaflets
- midsystolic click - leaflets hit inside vnetricle wall
- regurg murmur
secondary dilation of annulus, fibrosis of leaflets, jet lesions, thrombi
- marfan syndrome
- young women
young women with midsystolic click, anxiety and depression
mitral valve prolapse
aka myxomatous dengeration of mitral valve
acute rheumatic fever
from strep pharyngitis - 10 days - 6 weeks after
-antibodies for group A strep attack heart
pancarditis - every layer affected
-myocardium, endocardium, pericardium
also get polyarthritis
immune problem, NOT infection
aschoff bodies
acute rheumatic fever
granuloma - macros, lymphos, other inflamm cells
mononuclear in aschoff bodies
anitschkow cells
multinucleated in aschoff bodies
achoff cells
linear chromatin in aschoff bodies
caterpillar cells
chronic rheumatic heart disease
rheumatic heart disease
- long term after acute rheumatic fever
- chronic valvular disease - mitral and aortic
often mitral stenosis**
jones criteria
for acute rheumatic fever
previous group A strep infection
AND 2 major finding, or 1 major and 2 minor findings
Major - polyarthritis, carditis, subQ nodules, erythema marginatum of skin, chorea
minor - fever, arthralgia, acute phase reactants
acute vs. chronic rheumatic?
acute - vegetations on valve (majority mitral)
chronic - diffuse fibrous thickening
VEGF - with revascularization
rheumatoid heart disease
NOT rheumatic
-no aschoff bodies
infective endocarditis organisms
strep viridans
staph aureus
HACEK - haemophilus, actinobacillus, cardiobacterioum, eikenella, kingella
artificial valves
often strep epidermidis causing infective endocarditis
infective endocarditis
bulky vegetations of fibrin/platelet clot and organisms
- erode away valves
- possible for systemic emboli
usually left heart valves
unless IV drug user - right side
acute bacterial endocarditis
worse
-very high fever, heart problems
staph aureus
IV drug users
subacute bacterial endocarditis
- intermittent fevers
- strep viridans
more common
diagnosis for infective endocarditis
3 cultures in 24 hours
use duke criteria
2 major, 1 major/3 minor, 5 minor
janeway lesions
new bumps on palms and soles of feet
from infective endocarditis
osler noes
nodes in pulp of digits
from infective endocarditis
roth spots
oval retinal hemorrhage with pale centers
from infective endocarditis
duke criteria
for diagnosis of infective endocarditis
2 major, 1 major/3 minor, 5 minor
MAJOR
- positive blood culture
- EKG findings diagnostic
- new murmur
MINOR
- IV drug use
- fever
- vascular lesions
- immune - osler, roth, janesaw
- EKG consistent
nonbacterial thrombotic endocarditis
NBTE
- along lines of closure of valve leaflets
- sterile - no microorganisms
- risk fx - hypercoag
aka - marantic endocarditis
thrombi can embolize
libman sacks disease
non-infected vegetations
- pt with SLE
- malar rash
- new murmur
any surface of mitral/tricuspid valves
vegetation both sides of valve
libman sacks - SLE
vegetations that extend to chordae tendinae
infective endocarditis
small bland vegetation at line of closure
NBTE
small, warty vegetations, on line of closure
rheumatic heart disease
carcinoid syndrome
metastatic tumor - releases substances
- serotonin, kallikrein, bradykinin, prostaglandins, histamine
- diarrhea, flushing, skin rash, bronchoconstriction
- and fibrous intimal thickening of endocardial surfaces
gut tumor - right heart
-tumor in lung - left heart
fen/phen
old drug for weight loss - can lead to thickening of endocardial surfaces
cardiomyopathy
heart disease from primary abnormality of myocardium
dilated cardiomyopathy
majority
large flabby heart
hypertrophic cardiomyopathy
thick left ventricle - banana shaped space
restrictive cardiomyopathy
uncommon
-increase in mass without increased volume of left ventricle
myocarditis
inflammation cause of myocardial injury
coxsackie A and B
major cause of myocarditis
major causes of myocarditis
coxsackie A and B viruses lyme disease - borrelia burgorferi hypersensitivity - eosions -trichinosis - helminths from undercooked meat -chagas disease - trypsanoma cruzi
trypsanoma cruzi
chagas disease
cause of myocarditis
round nucleus myocarditis
lymphocyte
-mononuclear
viral infection
bi-lobated nucleus myocarditis
eosinophils
hypersensitivity myocarditis
giant cells in myocarditis
giant cell myocarditis