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Cardio - Gupta > Valve Pathology > Flashcards

Valve Pathology Flashcards

(55 cards)

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1
Q

*Stenosis

A

**Narrowing of an orfice - will cause a large pressure differential between the two cavities linked by the stenotic orfice

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2
Q

*Insufficiency

A

***Caused by Floppy valves that regurgitate fluid Retrograde

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3
Q

*Calcific aortic Stenosis

A

***Common in old people and causes Aortic Stenosis

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4
Q

*Myxomatous Degeneration

A

**Causes Mitral Valve Prolapse - people with Marfans and Erlos Danlos are susceptible to this

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5
Q

*Rheumatic Heart Disease

A

***Causes by GAS - beta hemolytic streptococcus

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6
Q

*Aschoff Bodies

A

***Groups of Macrophages found in the myocardium in people with ACUTE RHD

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7
Q

*Anitschokow Cells

A

****Macrophages with Catepillar Nuclei that are found in myocardium of people with RHD

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8
Q

*Fishmouth/Buttonhole Stenoses

A

***Caused by CHRONIC RHD - leads to mitral valve stenosis

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9
Q

*Infective Endocarditis

A

***Caused when there are bugs in the blood along with a damaged heart valve

* Mitral most commmonly implicated with Strep Viridans
*Tricuspid implicated in IV drug users who get Staph A.

*Don’t for get about the others!

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10
Q

*Septic Emboli

A

**Cause by vegetations that shoot off and spread bacteria

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11
Q

*Noninfected Vegetations/Marantic

A

***Associated with Hypercoagulble states such as Pancreatic Adenocarcinoma (huessler’s)

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12
Q

*Libman-Sacks Endocarditis (LSE)

A
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13
Q

*Carcinoid Heart Disease / mucopolysaccharides

A
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14
Q

****What 3 layers are seen here are what are their predominant components?

A

F - Fibrosa - Luminal layer mainly composed of collagen

S - Spongiosa - middle layer consisting mostly of GAGs (glycosaminoglycans)

V - Ventricularis - Exterior layer commposed of Elastin

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15
Q

***What is this?

A

A normal Heart

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16
Q

****What is this?

A

(left) teenager Heart Valve, (right) Adult Heart Valve - can see pretty normal ECM distribution here

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17
Q

Differentiate between Valvular Stenosis and Insufficiency with respect to:

  • Pathologic Process
  • Root Cause (genetic, chronic, acute, etc.)
A

Stenosis
• Valve is constricted even when open
• Almost Always a CHRONIC process - e.g. Calcification or Scarring of Valve

Insufficiency
• Valve doesn’t Close completely causing Regurgitation
• Causes: Intrisic Disease of CUSPS - MARFANS, ERLOS DANLOS
ACUTE: chordal rupture
INSIDIOUSLY: Leaflet scarring and Retraction (RHF)

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18
Q

What are 4 causes of Degenerative Valve Disease?

A

• CALCIFICATIONS
• Fewer Matrix cells: Decreased Numbers of Valve Fibroblasts and Myofibroblasts
• Alterations in the ECM
• changes in production of MATRIX METALLOPROTEINASES or their Inhibitors from Inflammation

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19
Q

*****What processes has occurred here? KEY FEATURES

• Is this person more likely to experience Stenosis or Regurgitation? Why?

*H and E?

A

Calcific Aortic STENOSIS - Calcific Aortic Valve Disease

• Calcifications are one of the most common causes of Stenosis

KEY FEATURES: Cusp IS NOT affected, most Ca2+ is deposited in the Leaflet

H and E - shows Calcium inside of an Elastic Looking Membrane

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20
Q

****What pathologic processes might this person be predisposed to?

• What disease did this particular person probably experience?

A
  • Bicuspid Aortic Valve - more susceptible to wear and Tear
  • Ppl. with this are more susceptible to Aortic Regurgitation and other pathologies
  • THIS person is likely experiencing Calcific aortic valve disease (CAVD) from Calcification
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21
Q

What Sound would you expect to hear in Calcific Aortic Valve Disease?

A

• STENOSIS leads to a SYSTOLIC murmor that crescendos and decrescendos, this corresponds to pressure changes while valve is open

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22
Q

What are the steps leading to calcium deposition in CAVD?

A
  1. Endothelial Cells Activated and recruit Monocytes
  2. Macrophages invade and Accumulate
  3. TISSUE MACROPHAGES RELEASE PRO-OSTEOGENIC CYTOKINES
  4. Myofibroblasts differentiate into Osteoblast-Type Cells
  5. Calcified Matrix Vesicles are formed or Apoptotic bodies followed by Micro- and Macrocalcifications
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23
Q

¡Myxomatous Degeneration of Mitral Valve!
• What is a Myomatous Change?

• Primary and Secondary causes***

• Clinical Manifestation?

Study These Flashcards
A

What is it:
• Expansion of middle Spongiosa (increased GAGs) and Thinning of the Fibrosa

Primary: Marfans (due to fibrillin I muts.) or Erlos Danlos

Secondary: Injury to Myofibroblasts

Clinical: Causes Floppy valves that tend to PROLAPSE

24
Q

****What Gross Changes would you expect to see in a person whose MITRAL valve histology had these changes?

Study These Flashcards
A
  • This person has myxomatous changes due to marfans, erlos danlos, or myofibroblast destruction
  • Gross Appreance: DILATED ATRIUM and HOODED VALVE seen below

**This appeance is caused by increased fluid in the atrium during systole because it starts taking on blood from both the pulmonary circuit and left ventricle

25
**Rheumatic Heart Disease** * Causative Bug. * Pathophysiology * Parts of Heart affected
RHD Cause: **BETA HEMOLYTIC GROUP A STREPTOCOCCUS** Pathophysiology: Cross reactive autoantibodies generated against M-protein bind to valves, **CD4+** T cells bind and mediate inflammatory response **MITRAL STENOSIS** - most prominent feature but **ALL** parts of the heart are **Inflammed**
26
How long does is take RHD to manifest? * How can you know it's RHD if all cultures come back negative? * Valves most likely to be effected? in what way?
Time: RHD take 2-3 weeks to Manifest itself How do you know: **look for serum titers, STREPTOLYSIN O or DNAase** Valves: Mitral STENOSIS (fishmouth) or Aortic STENOSIS
27
In RHD what features are you looking for in the **pericardium, myocardium, and valve?**
Pericardium: **FIBROSIS** (generally resolves) Myocardium: **ASCHOFF BODIES, ANTISCHKOW CELLS** Valve: **Fibrin/FIBRINOID NECROSIS - along the lines of CLOSURE**
28
\*\*\*\*This person has MITRAL valve stenosis. What is seen here? • What would you expect to see on inspection of the myocardium? * What seromarkers would you use to Dx? * what would you see on H and E?
\*\*\*Firbrinopurlent Exudate is see with PINK fibrin strands \*\*\*Bubblegum pink pericardium is seen on H and E Myocardium: Anitschkow Cells and Aschoff Bodies Seromarker: Streptolysin O and DNAase
29
\*\*\*\*\*What is this? • What appearance would you expect to see on this person's mitral valve?
**Anitschkow Cells** - enlarged macrophages with Catepillar-like Nucleus • Fibrinoid Necrosis on the Mitral with the cusp edges involved
30
\*\*\*\*\*What are these? •what disease does this person have?
* Aschoff Bodies * Person has RHD
31
\*\*\*\*\*This is a RHD pt. with Fibrin on lines of closure in the mitral valve
32
**DIFFERENTIATE THE FEATURES OF ACUTE RHEUMATIC FEVER VS. THOSE OF CHRONIC RHEUMATIC FEVER.**
ACUTE: Fibrosis of Pericardium, Aschkoff Bodies, Fibrin on Lines of Closure of Mitral CHRONIC: FISHMOUTH APPEARANCE OF MITRAL VALVE, Thick Chordae Tendonae
33
What is the most important consequence of **CHRONIC RHEUMATIC HEART DISEASE?**
**STENOSIS** - this is truely a problem of the chronic disease because it takes a while for the fibrin to build up
34
\*\*\*\*\*What is the problem here?
Very Thick Chordae Tendinae - probably also have mitral valve STENOSIS or Regurgitation
35
\*\*\*\*\*\*\*What is this rash called? • Organsim that caused this disease?
Erythema Marginatum • Cause by BETA HEMOLYTIC GROUP A STREP
36
RHD * What is the most importnant Requirement? * Some other things to look for.
Dx Requires SEROLOGIC evidence of GAS infection Need Two or More of the JONES criteria too: Carditis, Poly-Arthritis, Subcutaneous Nodules, **ERYTHEMA MARGINATUM,** Sydenham's Chorea (Uncoordinated muscle movement)
37
Why are people with RHD way more likely to get infective endocarditis? • Most likely organism Responsible?
STREP VIRIDANS is known to colonize scarred valves \*\*Staph is common with IV drugs uses but this typically affects tricuspid
38
T or F: people with RHD are way more likely to get **arrythmias** and therefore are more likely to get **mural thrombi.**
True
39
What disease is seen on this histological section of a valve? • How do you know?
**• Infective Endocarditis** you can see destruction of the valve via **necrosis and neutrophils** and **bacteria as a dark purple mass in the center** \*\*\*\*Note: other Heart Diseases do not directly Destroy Valves
40
**Infective Myocarditis** • effect on the heart • Valves involved • Risk Factors
\*Causes **Friable vegetations** composed of necrotis debris, thrombus, and organms (these can embolize can cause major complications) \*Mitral Valve usually with **Strep Viridans** or **Tricuspid in IV drug use with Staph. A.** **RISK FACTORS:** **Pre Existing Structural Heart Disease (of any kind) Degenerative Valve Disease Cardiac Interventions (prothetic valve, pacemaker, defibrillator) Congenital Heart Disease**
41
What are the CLINICAL features of Infective Endocarditis? • Areas of the body affected? • **COMPLICATIONS**
Patients presents with **fevers, rigors, and night sweats.** They may be **confused** or have other neurologic dysfunction. **Skin Lesions may involve OSLER'S NODES**, **JANEWAY LESIONS** ## Footnote **complications:** **• Cardiac Failure • Systemic Infarcts • Systemic Abscesses • Aneurysms • Renal Failure**
42
\*\*\*\*\*What disease is associated with this Retina?
**Infective Endocarditis** causes these **ROTH SPOTS** Janeway Lesions are also seen on the hand as shown here
43
What are some complications or Infective Endocarditis and their causes?
Complications: * Cardiac Failure - volume overload due to lesions and infarcts * Systemic Infarcts - emboli * Systemic Abscesses - infected emboli * Aneurysms - infected emboli * Renal Failure - emboli, **immune mediated glomerulonephritis**
44
What 3 organisms typically cause Infective Endocarditis? \*\*\*KNOW THIS SHIT\*\*\*
**Streptococci** **- S. VIRIDANS Staphylococci - STAPH. Aureus, and epidermidis Enterococci - HACEK organisms - Haemophilus (parainfluenza, aphrophilus, actinobacillus), Actinomycetemcomitans, Cardiobacterium hominis, Ekenella Species, and Kingella Species**
45
Where are you most likely to pick up Staph Aureus that causes Infective endocarditis? • Name the HACEK organisms
\*Most likely from indwelling central venous catheters, diabetes, chronic hemodialysis, and prosthetic valve - BASICALLY ANYTIME ANY type of medical equipment goes in you HACEK: * Haemophilus * Actinomycetemcomitans * Cardiobacterium Hominis * Eikenella Species * Kingella species
46
What two things do you need to get endocarditis?
Endothelial Damage + a bug
47
\*\*\*\*What is on this valve?
NONinfective vegetation - just a thrombi, we don't see any necrosis or bacteria etc.
48
Who is susceptible to Noninfective Vegetations of the Heart Valves? • **What disease in particular is this associated with?**
* People in Hypercoagulable states * **MUCINOUS ADENOCARCINOMAS are a HUGE risk factor**
49
**Compare Infective Endocarditis with Nonbacterial Thrombotic Endocarditis** on the basis of: * Vegetation SIZE * Destruction
Infective Endocarditis: • LARGE • Destructive to leaflets and Adjacent Structures Nonbacterial Thrombotic Endocarditis: • SMALL • NON-destructive
50
**Libman-sacks endocarditis (LSE)** * patients who are susceptible * vegetation size * Unique Features
**Patients with SLE or Antiphospholipid Antibody Syndrome are susceptible** **• Small inflammatory vegetations line BOTH sides of valve leaflets**
51
\*\*\*\*What prior existing condition did this patient probably have?
SLE or Antiphospholipid Syndrome leave patients susceptible to Libman-Sacks Endocarditis
52
**Carcinoid Heart Disease:** * Cause? * Symptoms? * Gross and Microscopic Appearance?
Cause: • Bioactive compounds like Serotonin Released From Carcinoid Tumors Clinical: • Flushing, Diarrhea, Dermatitis, and Bronchoconstriction Gross: • GLISTENING WHITE INTIMAL PLAQUE-LIKE thickenings on ENDOcardial surfaces Histo: • Abundant **MUCOPOLYSACCHARIDES**
53
\*\*\*\*What disease caused this gross appearance? • what microscopic appearance do you expect?
Carcinoid Heart Disease • Microscopic appearance: **Green looking MUCOPOLYSACCHARIDES**
54
Advantages and Disadvantages for Mechanical and Bioprosthetic heart valves: • Very susceptible to?
Mechanical: • ADV: Long Lasting • DISadv: Cause Hemolysis and Require Chronic Anticoagulation Bioprothetic: • ADV: No Anticoagulation need and no Hemolysis • DISadv: Less Durable BOTH: **can host ENDOCARDITIS and the SUTURE LINE!** **\*\*\*susceptible to all types of infection\*\*\***
55
What caused this? How do you know?
This is INFECTVE ENDOCARDITIS because you see NECROSIS and Infective endocarditis is the only one of these that causes necrosis

Cardio - Gupta (12 decks)

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