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Cardiovascular System > Valvular and congenital patho > Flashcards

Valvular and congenital patho Flashcards

1
Q

What is valvular stenosis?

A

Failure of valve to open completely → prevents forward flow

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2
Q

What is valvular insufficiency/ regurgitation/ incompetence?

A

Failure of valve to close complete → allow reverse flow

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3
Q

True or false:
Valvular stenosis and insufficiency can co-exist.

A

True

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4
Q

What are the risk factors to developing valvular heart disease?

A

Structurally abnormal valves:
1) Bicuspid aortic valve
2) Valves damaged by rheumatic heart disease
3) Prosthetic valves

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5
Q

What are 2 causes of valvular stenosis?

A

1) Post inflammatory scarring
- rheumatic heart disease

2) Calcification
- senile calcific aortic stenosis

3) Congenital

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6
Q

What are 3 causes of valvular insufficiency?

A

1) Post inflammatory scarring
- rheumatic heart disease

2) Genetic/developmental
- Marfan’s

3) Degenerative
- Mitral valve prolapse with Myxomatous (gelatinous) degeneration of the mitral
valve

4) Infectious
- eg. syphillis, IE

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7
Q

What is the most common cardiac valvular abnormality?

A

Aortic valve calcification

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8
Q

What does aortic valve calcification lead to?

A

Aortic stenosis

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9
Q

Aortic valve calcification is a/w___________ and accelerated in ________________.

A

Aortic valve calcification:
- a/w: age-associated degeneration
- accelerated in congenitally bicuspid aortic valves

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10
Q

What does mitral valve prolapse lead to?

A

Mitral regurgitation

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11
Q

What is the gross appearance of mitral valve prolapse?

A

Ballooning of the valvular cusps with Myxoid degeneration of affected leaflets thickened and rubbery

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12
Q

Mitral valve prolapse most commonly affects ______________ and the most commonly caused by ____________.

A

Young women
Unknown cause but a/w Marfan syndrome

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13
Q

What is the pathogenesis of Rheumatic fever?

A

M protein in Group A Strep (molecular mimicry) → Type 2 HS → Cross reactive Abs → heart cells

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14
Q

In acute rheumatic heart disease, inflammation occurs in ________________ and form __________________.

A

Any or all 3 layers of heart (pancarditis)

Form vegetations (verrucae)

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15
Q

What is the characteristic histological feature of acute rheumatic heart disease?

A

Aschoff bodies
- T lymphocytes
– Plasma cells
– Aschoff giant cells
– Activated macrophage (Anitschkow cell /
caterpillar cell)

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16
Q

Which valve is most commonly affected in chronic rheumatic heart disease?

A

Mitral > Aortic > Tricuspid and pulmonary (L>R)

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17
Q

Chronic rheumatic heart disease often leads to ________________ and predisposes a px to: (2).

A

Leads to stenosis and regurgitation (#1 mitral)

Predispose to IE, Thromboemboli, Arrythmias

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18
Q

How is rheumatic fever diagnosed?

A

Revised Jones Criteria:
carditis, arthritis, chorea, erythema marginatum, and subcutaneous nodules

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19
Q

What is infective endocarditis?

A

disease caused by microbial infection of the cardiac valves or endocardium → formation of vegetations leading to tissue destruction

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20
Q

Which valves are most commonly affected in IE?

A

Mitral and Aortic (L>R)

21
Q

How is Infective Endocarditis diagnosed?

A

Modified Duke Criteria

22
Q

What are 2 risk factors for ACUTE infective endocarditis?

A

1) IV drug use
2) Open heart surgery
3) Septicaemia

(normal valves, highly virulent pathogens)

23
Q

What is the most common causative pathogen of acute endocarditis?

A

Staph aureus

24
Q

What is the most common causative pathogen of subacute endocarditis?

A

Strep viridans

25
Q

What is the most common causative pathogen of prosthetic valve endocarditis?

A

Staph epidermidis

26
Q

Other than Staph aureus and epidermidis and strep viridans, what are 2 other organisms that can cause infective endocarditis?

A

1) HACEK group
2) Enterococci
3) Fungi

27
Q

What are 2 risk factors in general that predispose a px to infective endocarditis?

A

1) Abnormal valves
2) Microbial seeding into blood (eg. dental/surgical procedures, IV drug use, break in epithelial barriers)

28
Q

What are 5 complications of infective endocarditis?

A

Local
1) Valve rupture
2) Myocardial ring abscess
3) Suppurative pericarditis

Distant
1) Septic emboli
2) Immune complex mediated glomerulonephritis
3) Anemia (due to chronic disease)
4) Splenomegaly

29
Q

What are 2 causes of heart valve vegetations?

A

1) Infection (IE)
2) Non-bacterial thrombotic endocarditis
3) Lupus (Libman-Sacks endocarditis)
4) RHD

30
Q

Nonbacterial thrombotic endocarditis common occurs in ________________px with __________ blood due to acute phase response. This causes _________________ vegetations on heart valves

A

NBTE:
- occurs in severely debilitated cancer/sepsis px
- hypercoagulable blood
- small, non-infective, platelet-rich vegetations

31
Q

What are 4 complications of heart valvular disease?

A

Heart
1) LVH
2) Myocardial ischaemia
3) HF
4) Arrythmias
5) IE

Lung
1) Congestion
2) Pulmonary hypertension

32
Q

What are 2 causes of cardiac tamponade?

A

1) Ruptured MI
2) Aortic dissection
3) Trauma (fish bone)

33
Q

What is the term for pus in the pericardium?

A

Purulent/suppurative pericarditis

34
Q

True or false:
When fluid accumulates in the pericardium, whether acutely or chronically, it is not well tolerated and will cause cardiac tamponade.

A

False.
Chronic increases in fluid can be well tolerated; Acute increases can be fatal (eg. Cardiac tamponade)

35
Q

What are 3 causes of pericarditis?

A

1) Infection
2) Trauma
3) Autoimmune (eg. RHD, lupus)
4) Metabolic (eg. uremic)
5) Iatrogenic (eg. post-op, radiation)
6) Neoplasms

36
Q

What are 4 pathological subtypes of pericarditis?

A

1) Serous pericarditis
– Non-infectious inflammatory diseases

2) Fibrinous pericarditis (can overlap with serous)
– Eg. Post MI, RHD, etc

3) Suppurative (purulent) pericarditis
– Infections

4) Hemorrhagic pericarditis
– Direct spread or metastatic malignant neoplasm

5) Caseous pericarditis
– Tuberculosis

37
Q

What are 2 results of chronic healed pericarditis?

A

1) Adhesive pericarditis (mild)
2) Adhesive mediastinopericarditis (severe)
3) Constrictive pericarditis (severe)

38
Q

Which type of shunt is cyanotic, left to right or right to left?

A

Right to left

39
Q

What is the most common cyanotic congenital heart disease?

A

Tetralogy of fallot

40
Q

What are 3 acyanotic congenital heart diseases?

A

Obstructions
1) Pulmonary stenosis
2) Coarctation of aorta
3) Aortic stenosis

L→R shunts
4) VSD
5) ASD
6) PDA

41
Q

What is the most common congenital heart disease?

A

VSD

42
Q

Why are ASD, VSD and PDA all acyanotic when they provide a passage for mixing of oxygenated and deoxygenation blood?

A

Left heart is at much higher pressure → limited effect of tissue perfusion (only flow from L→R not R→L)

43
Q

What is the #1 concern of left to right shunts?

A

Eisenmenger syndrome:
L→R shunt
→ ↑P in pulmonary circulation
→ pulmonary arterioles hypertrophy and vasoconstrict to maintain P → ↑R
→ RVH → ↑R heart P
→ R→L shunt
→ De-O2 blood enters systemic circulation → ↓tissue perfusion → cyanosis

44
Q

What are 3 examples of cyanotic congenital heart diseases?

A

1) Tetralogy of fallot (#1)
2) Truncus arteriosus
3) Transposition of great arteries
4) Tricuspid atresia
5) Total anomalous pulmonary venous return

45
Q

What is the tetralogy of fallot?

A

1) Pulmonary stenosis
2) RVH
3) VSD
4) Overriding aorta (both R and LV open to aorta)

46
Q

What is a paradoxical embolism?

A

Thrombo-embolism can travel to systemic circulation via septal defect

47
Q

What is transposition of great vessels?

A

RV → Aorta
LV → Pulmonary trunk

48
Q

What is coarctation of aorta?

A

narrowing of the aorta, most commonly occurring just beyond the left subclavian artery

Cardiovascular System (12 decks)

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