Valvular Disorders & Infective Endocarditis Flashcards Preview

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Flashcards in Valvular Disorders & Infective Endocarditis Deck (22):
1

Which valve is most commonly affected?

- the mitral valve

2

What is the most common cause of aortic stenosis?

- calcific aortic stenosis; calcified masses on the valvular cusps impede valve opening
- (there is NO fusion of the commissures here)

3

What is the most common congenital valvular lesion?

- bicuspid aortic valve

4

Mitral valve regurgitation is most commonly due to __________; mitral valve stenosis is most commonly due to ___________.

- regurgitation: myxomatous degeneration (floppy valve, ballooning of the leaflets)
- stenosis: rheumatic valvular disease ("fish mouth")

5

Rheumatic Heart Disease is cardiac inflammation via which organism? What is the pathology behind the disease?

- group A beta-hemolytic streptococci
- pathogenesis: the Ab produced against these bacteria also target the heart (bacterial M protein resembles human tissue: molecular mimicry)

6

A patient with Rheumatic Heart Disease will often have had what a few weeks back?

- pharyngitis (1 - 3 weeks before)
- (the bacteria often invade the pharynx first before leading to the systemic rheumatic fever)

7

Microbial invasion of the heart valves and endocardium (ie, the endocardium lining the valves) is known as:

- infective endocarditis

8

Pathogens of Infective Endocarditis

- Strep. viridans: most common; low virulence; infects previously damaged valves
- Staph. aureus: most common cause in IV drug users; high virulence; infects healthy valves
- Staph. epidermidis: most common cause of prosthetic valve infection

9

In Infective Endocarditis, what results in janeway lesions, splinter hemorrhages, and osler nodes?

- septic embolization

10

HACEK Organisms

- organisms that can cause infective endocarditis, but result in NEGATIVE blood cultures

11

Rheumatic Valvular Disease is a result of what? Which valves does it usually affect?

- it's a result of repeated exposure to the pathogen, resulting in scarring of the valves
- it can affect the mitral and aortic valves (mitral valve is more commonly affected)

12

What do we see in Rheumatic Fever/Rheumatic Heart Disease?

- JONES criteria:
- Joint issues (arthritis), "O" heart problems (pancarditis), Nodules in the skin, Erythematous rash, Sydenham's chorea (involuntary spasms)
- fusion of valvular commissures and shortening of chordae leads to "fish mouth"

13

On histology, what do we see in Rheumatic Heart Disease?

- Aschoff bodies with Anitskow ("caterpillar") cells
- a result of inflammation of the myocardium

14

Classic Triad of Symptoms for Aortic Stenosis

- chest pain, heart failure (dyspnea, PND), and syncope

15

What murmur is associated with Aortic Stenosis?

- a pan-systolic crescendo-decrescendo mumur

16

What is the key finding needed to diagnose Infective Endocarditis?

- bacteria in the blood-stream
- specifically, blood cultures persistently positive for one of these organisms, from cultures drawn more than 12 hours apart

17

Infective Endocarditis most commonly affects the:

- mitral valve (aortic valve is the 2nd most common)

18

Rheumatic Fever is most commonly seen in what demographic?

- children between the ages of 5 - 15

19

T or F: Aschoff bodies and Anitskow cells are specific for post-rheumatic carditis.

- false!
- Aschoff bodies ARE, but Anitskow cells are NOT

20

Aschoff Body

- an interstitial aggregate of macrophages and lymphocytes, with necrotic collagen, in an area of interstitial fibrosis

21

Anitskow Cell

- cells with linear condensation of nuclear chromatin
- resembles a caterpillar

22

Which organism is associated with Rheumatic Fever?

- Strep. pyogenes
- (remember, rheumatic fever follows pharyngitis)