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Cardio - Gupta > Valve Pathology > Flashcards

Valve Pathology Flashcards

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?

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?

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
Q

Rheumatic Heart Disease

  • Causative Bug.
  • Pathophysiology
  • Parts of Heart affected
A

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
Q

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?
A

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
Q

In RHD what features are you looking for in the pericardium, myocardium, and valve?

A

Pericardium: FIBROSIS (generally resolves)

Myocardium: ASCHOFF BODIES, ANTISCHKOW CELLS

Valve: Fibrin/FIBRINOID NECROSIS - along the lines of CLOSURE

28
Q

****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?
A

***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
Q

*****What is this?

• What appearance would you expect to see on this person’s mitral valve?

A

Anitschkow Cells - enlarged macrophages with Catepillar-like Nucleus

• Fibrinoid Necrosis on the Mitral with the cusp edges involved

30
Q

*****What are these?

•what disease does this person have?

A
  • Aschoff Bodies
  • Person has RHD
31
Q

*****This is a RHD pt. with Fibrin on lines of closure in the mitral valve

A
32
Q

DIFFERENTIATE THE FEATURES OF ACUTE RHEUMATIC FEVER VS. THOSE OF CHRONIC RHEUMATIC FEVER.

A

ACUTE: Fibrosis of Pericardium, Aschkoff Bodies, Fibrin on Lines of Closure of Mitral

CHRONIC: FISHMOUTH APPEARANCE OF MITRAL VALVE, Thick Chordae Tendonae

33
Q

What is the most important consequence of CHRONIC RHEUMATIC HEART DISEASE?

A

STENOSIS - this is truely a problem of the chronic disease because it takes a while for the fibrin to build up

34
Q

*****What is the problem here?

A

Very Thick Chordae Tendinae - probably also have mitral valve STENOSIS or Regurgitation

35
Q

*******What is this rash called?

• Organsim that caused this disease?

A

Erythema Marginatum

• Cause by BETA HEMOLYTIC GROUP A STREP

36
Q

RHD

  • What is the most importnant Requirement?
  • Some other things to look for.
A

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
Q

Why are people with RHD way more likely to get infective endocarditis?

• Most likely organism Responsible?

A

STREP VIRIDANS is known to colonize scarred valves

**Staph is common with IV drugs uses but this typically affects tricuspid

38
Q

T or F: people with RHD are way more likely to get arrythmias and therefore are more likely to get mural thrombi.

A

True

39
Q

What disease is seen on this histological section of a valve?

• How do you know?

A

• 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
Q

Infective Myocarditis
• effect on the heart
• Valves involved

• Risk Factors

A

*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
Q

What are the CLINICAL features of Infective Endocarditis?
• Areas of the body affected?
• COMPLICATIONS

A

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

complications:

• Cardiac Failure
• Systemic Infarcts
• Systemic Abscesses
• Aneurysms
• Renal Failure

42
Q

*****What disease is associated with this Retina?

A

Infective Endocarditis causes these ROTH SPOTS

Janeway Lesions are also seen on the hand as shown here

43
Q

What are some complications or Infective Endocarditis and their causes?

A

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
Q

What 3 organisms typically cause Infective Endocarditis?

***KNOW THIS SHIT***

A

Streptococci - S. VIRIDANS
Staphylococci - STAPH. Aureus, and epidermidis
Enterococci - HACEK organisms - Haemophilus (parainfluenza, aphrophilus, actinobacillus), Actinomycetemcomitans, Cardiobacterium hominis, Ekenella Species, and Kingella Species

45
Q

Where are you most likely to pick up Staph Aureus that causes Infective endocarditis?

• Name the HACEK organisms

A

*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
Q

What two things do you need to get endocarditis?

A

Endothelial Damage + a bug

47
Q

****What is on this valve?

A

NONinfective vegetation - just a thrombi, we don’t see any necrosis or bacteria etc.

48
Q

Who is susceptible to Noninfective Vegetations of the Heart Valves?
• What disease in particular is this associated with?

A
  • People in Hypercoagulable states
  • MUCINOUS ADENOCARCINOMAS are a HUGE risk factor
49
Q

Compare Infective Endocarditis with Nonbacterial Thrombotic Endocarditis on the basis of:

  • Vegetation SIZE
  • Destruction
A

Infective Endocarditis:
• LARGE
• Destructive to leaflets and Adjacent Structures

Nonbacterial Thrombotic Endocarditis:
• SMALL
• NON-destructive

50
Q

Libman-sacks endocarditis (LSE)

  • patients who are susceptible
  • vegetation size
  • Unique Features
A

Patients with SLE or Antiphospholipid Antibody Syndrome are susceptible

• Small inflammatory vegetations line BOTH sides of valve leaflets

51
Q

****What prior existing condition did this patient probably have?

A

SLE or Antiphospholipid Syndrome leave patients susceptible to Libman-Sacks Endocarditis

52
Q

Carcinoid Heart Disease:

  • Cause?
  • Symptoms?
  • Gross and Microscopic Appearance?
A

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
Q

****What disease caused this gross appearance?
• what microscopic appearance do you expect?

A

Carcinoid Heart Disease
• Microscopic appearance: Green looking MUCOPOLYSACCHARIDES

54
Q

Advantages and Disadvantages for Mechanical and Bioprosthetic heart valves:
• Very susceptible to?

A

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
Q

What caused this? How do you know?

A

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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