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Pathology -- Cardiology > Valvular Disease > Flashcards

Valvular Disease Flashcards

(85 cards)

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1
Q

Only non-tricuspid valve

A

Mitral

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2
Q

Valves responsible for ventricular outflow

A

Semilunar valves

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3
Q

What are valves made of?

A

endocardium covering core of dense fibrous connective tissue. Lined with endothelial layers. AV have smooth muscle on atrial side.

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4
Q

Two reasons velocity is greater through the semilunar valves

A

Smaller openings

greater chamber pressure

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5
Q

What is insufficiency?

A

Failure to close completely, allowing regurg and backflow

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6
Q

What is stenosis?

A

a narrowing or constriction of an orifice

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7
Q

What is current formation?

A

Abnormal valve function that may cause jet streams.

This can damage vessels or current eddies that allow thrombosis and bacterial deposition on either side of valve

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8
Q

Four main types of left sided flow disruption

A

Mitral stenosis
Mitral regurg
Aortic Stenosis
Aortic Regurg

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9
Q

Important details about mitral stenosis

A

Usually from post-rheumatic fever scarring
Coexists with insufficiency
Takes decades to develop, well tolerated

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10
Q

Important details about mitral regurgitation

A

Caused by infection and papillary muscle abnormality

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11
Q

Important details from aortic stensois

A

Usually calcific degeneration of the bicuspid

Leads to pressure overload and LVH

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12
Q

Important details from aortic regurg.

A

Valvular disease or aortic root disease

Volume overload and LVH

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13
Q

Symptoms of insufficient cardiac output from valvular disease

A

Syncopal episodes
LVH
Increase water/salt retention + inc. in peripheral resisitance

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14
Q

Named type of mechanical damage associated with valvular damage

A

Jet stream damage to aortic and pulmonic outflow tracks.

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15
Q

Types of emboli associated with valvular damage

A

Infectious thrombi – vegetations in endocarditis

Thrombotic vegetations, small clots

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16
Q

When does Bicuspid Aortic Valve typically present

A

6th-7th decade

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17
Q

Pathogenesis of Bicuspid Aortic valve

A

Congenital bicuspid aortic valve –> Progressive calcification of cusps –> calcific aortic stenosis

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18
Q

Gross features of bicuspid aortic valve

A

Heaped up calcified masses w/in aortic cusps

Architectural distortion

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19
Q

Microscopic features of bicuspid aortic valve

A

Fibrosed + Thickened Cusps

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20
Q

In bicuspid aortic valve patients, _____ increases the likelihood of sudden death

A

Syncope

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21
Q

Pathogenesis of mitral valve prolapse

A

Floppy enlarged mitral leaflets balloon into left atrium during systole
Snapping or tending of everted cusps/chordae tendinae

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22
Q

Auscultation findings associated with mitral valve prolapse

A

Midsystolic click, late systolic click, holosystolic murmur

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23
Q

Gross features of mitral valve prolapse

A

Billowing of MV leaflets
Pathologic if more than 4mm above the base of the cusp
Stretched/elongated/ruptured chordae tendineae
Fibrosis/Calcification of valve/Ventricular surface

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24
Q

What would you see in a symptomatic MVP patietient

A

Angina, dyspnea, fatigue, depression, personality disorders, anxiety rxn

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25
Four main concerns with MVP
1. Infective Endocarditis 2. MV Insufficiency 3. Arrythmia 4. Sudden Death
26
What is Rheumatic Heart Disease
An acute, recurrent inflammatory disease following pharyngeal infection with S. pyogenes Mainly in children (leading cause of heart disease death from ages 5-25)
27
Pathogenesis of Rheumatic Heart disease
Immunological cross rxn | Lesions are sterile, not from direct bac. invasion
28
Gross features of Rheumatic Heart disease
Mitral and Aortic Valves Mitral valvulitis --> Stenosis Vegetations Pericarditis
29
name for the vegetations associated with Rheumatic Heart disease
Verrucae
30
What are Aschoff bodies?
Foci of fibrinous necrosis surronded by lymphocytes and macrophages PATHOGNOMIC for rheumatic myocarditis (Anitschkow are not)
31
Describe valvular lesions associated with Rheumatic Heart disease
Verrucae vegs along lines of closure Focal collagen degeneration surrounded by inflamm. Ulceration of valve with fibrin deposits
32
Jones Criteria for Rheumatic fever?
``` Migratory Polyarthritis Carditis Subcutaneous Nodules Erythema marginatum Sydenham's chorea ```
33
Main cause of death in rheumatic fever
Congestive Heart Failure from Myocarditis
34
Where in the heart is acute rheumatic heart disease?
Any layer of the heart
35
Important associations with Chronic Rheumatic Heart Disease
Recurrent Attacks with different strep Permanent valve deformity (esp. MV) Conspicuous, irregular thickening/fusion of leaflets MacCallum's patches on posterior atrium
36
Incidence of LSE?
in about half of SLE patients
37
What are LSE vegetations made of?
Necrotic Debris, Fibrinoid Material, Disintegrating Fibroblasts, and Inflammatory Cells
38
LSE effects on Cusps/Other
Fibrinoid Necrosis w/ neutrophils and mononuclear infiltrate | Myocardial arterioles/small arteries undergo necrosis
39
Infective Endocarditis, Rheumatic Endocarditis, LSE. | Which Valves?
IE - Any RE - Mitral LSE -- Mitral, tri, pulmonic
40
Infective Endocarditis, Rheumatic Endocarditis, LSE. | Size of vegetations
IE -- Large (5-20) RE -- Small LSE -- Small
41
Infective Endocarditis, Rheumatic Endocarditis, LSE. | Distribution.
IE - Single Foci RE -- Lines of cusp closure, beading verrucae LSE -- Multiple, Random. Both sides of valve
42
What is endocarditis?
Colonization or invasion of valves/mural endocardium by a microbial agent leading to friable vegetations
43
Who should you suspect in Endocarditis patients?
Strep. viridans | Staph, enterococci, pneumococci, G- Rods
44
What predisposes you to endocarditis?
Anything causing abnormal flow, shunting, exposure of collagen, or valve damage
45
IV drug exposure predisposes you to.....
Right sided infections (S. aureus, Candida, Aspergillus)
46
Pathogenesis of infective endocarditis w/ damaged valved/fucked up blood flow
Desposition of Fibrin and Agglutinated Organisms
47
Pathogensiss of infective endocarditis in R to L shunt?
Bypass filtering of blood by lungs
48
Gross features of infectiveendocarditis?
Friable, Bulky, bacteria laden vegetations on heart valves Usually Mitral+Aortic Not usually around whole free edge Evetually becomes fibrotic/Calcified
49
Microscopic Features of infective endocarditis
Vegetations -- Irregular masses of fibrin,platelets, blood cell debris, organisms, and inflam. cells Leaflets -- Vascularization + Nonspecific Inflammation
50
Intrinsic consequences of endocarditis?
Erosion, destruction of valve leaflets Deformation of valve leaflets -- stenosis, insufficiency CHF Suppurative pericarditis (penetration of heart wall, myocardial metastatic abscesses)
51
Extrinsic consequences of endocarditis?
Seeding of Aorta, Kidney, Spleen, Brain w/ infective emboli | Arterial thrombotic emboli
52
Acute Bacterial Endocarditis clinical circumstances
Destructive, tumultuous infection Necrotizing, ulcerative, invasive valvular infections Can occur in normal heart
53
Acute Bacterial Endocarditis is associated with...
IV catheter, Prosthetic Valve
54
Organisms typically responsible for Acute Bacterial Endocarditis
STAPH AUREUS
55
Morphology of Acute Bacterial Endocarditis
Friable, Bulky, Bacteria laden vegetitations
56
Clinical course of Acute Bacterial Endocarditis?
Diagnosis and Treatment Improve Prognosis Fever most common sign Stormy onset, rapid fever, chills Murmurs
57
How to confirm Acute Bacterial Endocarditis?
Blood Culture
58
Clinical circumstances Subacute bacterial Endocarditis?
Previous Heart Disease (Congenital, RHD, Surgery, Endo) | Seeding to damaged valves
59
Organisms typically responsible for Subacute bacterial Endocarditis?
STREP VIRIDANS
60
Which bacteria is associated with previous SBE? Previous RHD?
SBE -- Strep Viridans | RHD -- Group A Hemolytic Strep
61
Clinical course of Subacute bacterial Endocarditis?
Flu-like illness going on for months Heart Murmur + Signs of Systemic Infection Requires Antibiotics
62
Complication for watch out for in Subacute bacterial Endocarditis?
Heart failure from valve scarring/damage | Also increased MI risk from embolization
63
ABE, SBE, Non-bacterial thrombotic endocarditis. | Identify the most common organism.
ABE -- S. Aureus SBE -- Strep Viridans NBTE -- None (SLE, Tumors)
64
ABE, SBE, Non-bacterial thrombotic endocarditis. | Clinical Setting?
ABE -- IV contamination SBE -- Dental Work NBTE -- SLE, Tumors
65
ABE, SBE, Non-bacterial thrombotic endocarditis. | Clinical Presentation?
ABE -- Fever, Stormy Course, Murmurs SBE -- Flu-like, Fever of unknown Origin NBTE -- Distant embolization
66
ABE, SBE, Non-bacterial thrombotic endocarditis. | Clinical Association?
ABE -- Healthy or damaged valves SBE -- Previously damaged valves NBTE -- From other diseases
67
ABE, SBE, Non-bacterial thrombotic endocarditis. | Consequences?
ABE -- Acute Heart Failure, Septic Embolization SBE -- Chronic Heart Failure, Septic Embolization NBTE -- Embolization; secondary infection
68
Pathogenesis of Non-bacterial thrombotic endocarditis?
Endothelial Damage --> Platelet+Fibrin Deposition on Valve Leaflets --> Formation of Nodular Vegetations
69
Non-bacterial thrombotic endocarditis is associated with..
SLE, Cachexia, Mucin-producing tumors, endothelium damage
70
Non-bacterial thrombotic endocarditis vegetations embolize and cause infarcts in...
Spleen, Kidney, Brain, Gut, Extremities
71
Clinical features of Carcinoid Heart Disease?
Distinctive Episodic flushing of skin, cramps, Nausea, Vomiting, Diarrhea 1/2 get cardiac lesions
72
Pathogenesis of Carcinoid Heart Disease?
Deposits of Pearly gray, uniform fibrosis on tri/pulm valves | Insufficiency+Stenosis
73
Why do carcinoids only affect the right heart?
Metabolized in the lungs, don't reach the L heart
74
What causes the fibrous tissue rxn in Carcinoid Heart Disease?
Elaboration of Bioactive products by argentaffinomas (including seratonin, kallikrein, bradykinin, His, prostaglandins)
75
Gross features of Carcinoid Heart Disease?
Plaque-like thickenings made of unusual fibrous tissue superimposed on the endocardium of the cardiac chambers and valvular cusps
76
Microscopic features of Carcinoid Heart Disease?
Fibrous thickening resembling cellular atheromas
77
Pathogenesis of Mitral valve annulus calcification?
Trauma --> Fibrotic Changes --> Calcification --> Hemodynamic Obstruction, murmur
78
Gross features of Mitral valve annulus calcification
Calcium deposition transforms mitral ring into a rigid curved bar up to 2 cm in diameter Posterior leaflet may be distorted/Upwardly displaced
79
Microscopic Features of Mitral valve annulus calcification?
Amorphous masses of calcified material in connective tissue of valve ring. Calcificaion can extend into base leaflets and the ventricular septum.
80
Major source of morbidity and mortality in artifical heart valves? less common, but serious complication?
Thromboembolism | Infective Endocarditis
81
With prosthetic valves, early infection is associated with ____ and late with ____
Early - Staph | Late -- Strep
82
Four things that cause immediate cyanosis
Tetralogy Tricuspid Atresia Truncus Arteroisis Transposition of Great Arteries
83
Causes of aortic stenosis...who usually presents in patient 60/70s? 70s? 80s/90s?
60/70s- Bicuspid Aortic Valve 70s - RHD 80s-90s - Senile Calcification
84
What are Aschoff bodies?
Collections of reactive histiocytes
85
Unique feature of Anitschkow myocytes?
Caterpillar chromatin pattern

Pathology -- Cardiology (13 decks)

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