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Cardio Week 5 > Pathology: Valvular Diseases > Flashcards

Pathology: Valvular Diseases Flashcards

1
Q

Morphology of Rheumatic Valvular Disease

  • What is are the main characteristics of this disease on a histological scale?
A
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2
Q

In Rheumatic Valvular Disease, what is the inflammation due to? What condition do most patients have before getting it?

A
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3
Q

Clinical features of rheumatic heart disease

  • Describe the differences in the outcomes of cultures and serum tests done on patients who have rheumatic heart disease due to rheumatic fever
A
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4
Q

What do matrix metalloproteinases do?

A

Destroy/Remodel ECM

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5
Q

The top figure is a normal heart valve and the bottom myxomatous mitral
valve (E).

A
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6
Q

A patient had a history of chronic strep throat. They died and the picture shown is of their mitral valve. What would indicate that they had Rheumatic heart disease?

A
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7
Q

Clinical Features of Calcific Aortic Stenosis

  • In severe disease, how much are the valve orifices compromised?
  • How is Cardiac Output maintained, and how does this affect blood pressure?
    • Relating to the answer to the above question, what kind of pathology can develop?
  • If not treated with surgery, what percentage of patients die 2 to 3 years after Dx?
A
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8
Q
  • This image shows an aortic valve.
    • What kind of pathology is present?
    • What do you see at the arrow?
      • How is the feature at the arrow different in rheumatic aortic valve stenosis
A
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9
Q
  • Degenerative valve disease is a term used to describe changes that affect the integrity of valvular ECM.
    • List these changes (4)
A
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10
Q

Clinical features of rheumatic heart disease

  • What PT population is Acute rheumatic fever common in?
  • When do symptoms start, and what symptoms are usually seen at first?
A
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11
Q

Clinical features of rheumatic heart disease

  • What type of criteria is used to Dx acute rheumatic fever?
A
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12
Q

What is the likely basis for Primary myxomatous degeneration of the mitral valve?

A
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13
Q

What is the morphologic hallmark of Calcific Aortic degeneration (Aortic Stenosis)?

Describe how this impedes valve opening

A
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14
Q

What devastating type of cardiac inflammation can Rheumatic fever cause?

A
  • Pancarditis: inflammation of the entire heart: the epicardium, the myocardium, and the endocardium.
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15
Q

The incidence of rheumatic fever (and rheumatic HD)

  • What are the differences between the developed world and the developing world?
A
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16
Q

Morphology of Rheumatic Valvular Disease

  • What makes up the Aschoff bodies seen in Rheumatic Valvular Disease?
  • What are Anitschkow cells?
    • Describe how these cells look
A
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17
Q

What produces the most important clinical features in Rheumatic heart disease?

A
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18
Q

In Rheumatic Heart Disease

  • What can happen to the pericardium that generally resolves without
    sequelae?
  • What happens in the myocardium?
A
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19
Q

Describe how turbulent flow through diseased valves manifests

A

Murmurs

The sound foes in the direction of blood flow

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20
Q

Clinical Features of Myxomatous Mitral Valve

  • What conditions can PTs develop?
  • What increased risks to PTs face?
A
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21
Q

In Rheumatic Heart Disease

  • What kind of changes and pathology can happen to the heart valves?
    • Use specific names for any growths
A
  • Fibrinoid necrosis and fibrin deposition along the lines of closure
    • Form 1- to 2-mm vegetations, verrucae, that cause little disturbance in cardiac function.
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22
Q
  • In those with the primary mitral disease, concomitant tricuspid valve involvement is _________; _________ commonly, aortic and pulmonic valves also may be affected.
A
  • In those with primary mitral disease, concomitant tricuspid valve involvement is frequent (20% to 40% of cases); less commonly, aortic and pulmonic valves also may be affected.
23
Q

Define Stenosis

A
24
Q
  • Bicuspid aortic valves are generally neither stenotic nor incompetent through early life.
    • If the above statement is true, how do bicuspid aortic valves actually cause harm to people?
A
25
Q

Consequences of rheumatic heart disease

  • What are the most important functional consequences of this disease?
    • Which consequence tends to be more dominant?
    • What valve is implicated by itself in almost 70% of cases?
      • The above valve is combined with which other valve in about 25% of cases?
      • What valve is almost never associated with this disease?
  • What happens to the left atrium, and why?
    • What conditions can this cause?
  • What can occur due to the long-standing passive venous congestion?
    • What changes in the heart because of this?
A
26
Q

Clinical features of rheumatic heart disease

  • Acute rheumatic fever can cause carditis, amongst other things
    • What are the general clinical signs of carditis?
    • If Myocarditis from rheumatic fever is severe enough, what can occur in the heart?
  • How many people die from acute rheumatic fever?
A
27
Q

How much does acquired stenosis of the aortic and mitral valves account for all valvular diseases?

A
28
Q

Morphology of chronic rheumatic heart disease

  • What destroys the normal leaflet architecture?
  • The image shows cardiac valves with chronic rheumatic involvement.
    • What does panel A show specifically, and where?
    • What does panel B show?
A
29
Q

What are the 4 main determinates of the outcome of valvular disease?

A
30
Q

Clinical Features of Myxomatous Mitral Valve

  • How do most patients present?
  • What occurs in a minority of cases?
  • What do you hear upon Auscultation?
    • What is this due to?
A
31
Q

What is the principal type of valvular pathology associated with Rheumatic fever?

A
32
Q

Primary mitral valve prolapse is a form of myxomatous mitral degeneration.

  • What is the population that this disease affects?
    • What is the incidence amongst adults?
    • How is this different than secondary mitral valve prolapse?
A
33
Q

What is Commissural fusion a sign of, and how does it manifest in degenerative aortic stenosis?

A
34
Q
  • This show an aortic valve.
    • How do you know right away that there is pathology?
    • What kind of pathology do you see?
    • What does the arrow show?
A
  • Aortic valve should be tricuspid. This shows a congenitally bicuspid valve
  • It shows Calcific aortic stenosis of a congenitally bicuspid valve
  • One cusp has a partial fusion at its center, called a raphe (arrow).
35
Q

Clinical features of rheumatic heart disease

  • If a valve was involved with a previous case of rheumatic carditis, what can happen to it later on in life?
  • What are the major secondary types of pathology associated with chronic rheumatic heart disease?
    • Think changes in heart function, size, and rhythm.
A
36
Q

Define Insufficiency

A
37
Q

What kind of pathology does this image of the myocardium show?

A
38
Q

Morphology of chronic rheumatic heart disease

  • What “type” of stenosis is seen in this mitral valve?
    • What is it caused by?
    • What are the arrows pointing to?
A
39
Q

What is the most common congenital valvular lesion?

How often does this occur?

What may be the genetic pathway that causes this?

A
40
Q

In myxomatous degeneration of the mitral valve, describe what happens to the

  • Mitral leaflets
  • Tendinous cords
A
41
Q

Clinical features of rheumatic heart disease

  • After an initial attack and the generation of immunologic memory,
    • What happens to patients in terms of recurrence of disease?
    • When does this become evident?
A
42
Q

In myxomatous degeneration of the mitral valve

  • What happens to the mitral leaflets?
    • Is the main problem of this disease related to the systole or diastole?
A
43
Q

Pathogenesis of Rheumatic Valvular Disease

  • Why is there a delay in symptom onset?
  • Why do we suspect that there is a genetic component to this disease?
  • What is the deforming fibrotic lesion associated with Rheumatic Valvular Disease a product of?
A
44
Q

Are stenosis and regurgitation/insufficiency mutually exclusive?

A

No

45
Q

Describe the shape of the two cusps in bicuspid aortic valves

A
46
Q
  • This shows an image of a mitral valve. This heart belonged to a patient who had chronic Rheumatic heart disease.
    • What are the indications in the image that are associated with chronic Rheumatic heart disease?
A
  • (A) Acute rheumatic mitral valvulitis superimposed on chronic rheumatic heart disease.
    • Small vegetations (verrucae) are visible along the line of closure of the mitral valve leaflet (arrows).
    • Previous episodes of rheumatic valvulitis have caused fibrous thickening and fusion of the chordae tendineae.
47
Q

Pathogenesis of Rheumatic Valvular Disease

  • What causes Acute rheumatic fever?
  • What Antibodies are involved?
  • What role does the activation of complement, Fc receptor–bearing cells, and CD4+ T cells play, if any?
A
48
Q

Describe the long-term prognosis of rheumatic heart disease

A
49
Q

Morphology of chronic rheumatic heart disease

  • What are the main characteristics?
  • What happens to the Aschoff bodies, Valve cusps, leaflets, and mitral valve?
A
50
Q

What causes the incidence of Calcific Aortic degeneration (Aortic Stenosis) to increase?

A
51
Q

How is the most common cause of Aortic Stenosis usually discovered?

A
52
Q

Microscopically, what is the main change in primary myxomatous degeneration of the mitral valve?

  • What happens to the fibrosa layer?
  • What happens to the spongiosa layer?
  • What is Secondary myxomatous change usually due to?
A
53
Q

During acute RF, where can Aschoff bodies be found?

A

Cardio Week 5 (10 decks)

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