Valve Heart Disease

Question 1

Atrioventricular Valves

Answer 1

Tricuspid (r)

Mitral (l)

Question 2

Semilunar outflow valves

Answer 2

pulmonary (r)

aortic (l)

Question 3

Valve Function

Answer 3

Maintain unidirectional blood flow

Question 4

Stenosis

Regurgitation

Answer 4

impaired forward flow

=incompetence
Allowing reversed flow

Can be pure or mixed

Question 5

Common heart valve pathologies

Answer 5

mitral stenosis/regurg
Aortic stenosis/regurg
Ventricular abnormalities

Pathologies involving artificial valves

Question 6

What can detect signs of valve pathologies

Answer 6

auscltation

Question 7

Draw murmurs

Answer 7

…

Question 8

Common pathogenic mechanisms in valvular heart disease

Answer 8

1) Developmental defects in CT (eg; marfans syndrome)
2) Calcification
3) Infection
4) Post-infection
5) Hypercoagulable states
6) Carcinoid tumours

Question 9

Developmental Defects in the CT

Answer 9

Stenosis of pulmonary or aortic valve

Leaflet abnormalities (eg) bicuspid aortic valve)

Myxomatous degeneration of mitral valve

-may affect upto 4% adults (idiopathic)
-Occurs in Marfans and other CT disorders.
-Often symptomatic
-May increase risk of infective edocarditis &mitral insufficiency
Often leads to secondary damage

Question 10

Developmental defects in CT: myxomatous mitral valve degeneration

Answer 10

“floppy” mitral valves

Mitral valve prolapse

Question 11

Dystrophic calcification

Answer 11

• Can occur in local areas after extensive cell injury
• cumulative damage
• Initiates when dead/dying cells accumulate calcium (in mitochondria/ membrane-bound vesicles)
• propagates

Most common

1) annular calcification of mitral valve (‘ring’)
2) stenosis of aortic valve

sometimes secondary to developmental defects

Question 12

Infection: “infective endocarditis”

Answer 12

Colonisation or invasion of heart valves by a microbe

-often after seeding blood with
microbes (surgery or IVDA)

Lesion = vegetations build up

Pathogens: bacteria, fungi, chlamydiae (a range)

Question 13

“infective endocarditis” is divided into two types

Answer 13

• Acute: high virulence organisms, often previously normal valve, destructive, high mortality
• Sub-acute: Low-virulence organism, often previously abnormal valve. insidious

Question 14

Post-infective: Rhuematic fever

Answer 14

• multi-system inflammation occurring week after nasopharyngeal infection by strp. pyogenes (grp A strep)
• Type II hypersensitivity reaction
• Immune response against strep may cross-react with heart antigens.

Question 15

Symptoms and what it leads to: post -Infective rhuematic fever

Answer 15

-Can cause scaring and fibrosis of heart: valve veges, aschoff bodies and pericarditis

leads to ‘chronic valve deformities’ especially mitral stenosis

Predisposes infective endocarditis

Question 16

Aschoff bodies

Answer 16

foci of oedematous CT surrounded by lymphocytes, plasma cells and macrophages.

In the myocardium, pale areas

Question 17

Valve damage from rhuematic fever predisposes

Answer 17

Infective endocarditis

Question 18

Hypercoagulable states

Answer 18

Thrombosis on a heart vavle, eg; NBTE, prosthetic valves

Question 19

NBTE

Answer 19

Non-bacterial thrombotic endocarditis

• deposition of fibrin/platelets on heart valves
• No pathogens (so sterile) involved
• May occur if patient in hypercoagulable state due to an underlying cause (cancer/sepsis)

Can predispose to I.E

Question 20

Carcinoid tumours

Answer 20

Range of neoplasms arising from neuroendocrine cells hormone producing) or their precursors

• secrete variety of bioactive substances > plaque-like thickenings (made of SM) on R heart
• Affect tricuspid and pulmonary