Flashcards in Valvular Heart Disease Deck (26)
What do semilunar valves function depend on?
cusps and attachements
What do atrioventricular valves function depend on?
-leaflets + annulus, chordae tendinae, papillary muscles, ventricle wall
Bicuspid aortic valve
1. leads to earlier aortic stenosis(50-60's)
2. underlying aortopathy
What is the most common valvular abnormality?
valvular degeneration due to calcification
-wear and tear
-chronic injury-hyperlipidemia, HTM, inflammation
What does calcific aortic stenosis lead to?
1. calcified masses within aortic cusp prevent cusp opening and obstruct outflow
2. increased gradient pressure across valve
3. concentric LVH
What are symptoms of aortic stenosis?
congestive heart failure
What is mitral valve prolapse?
enlarged, redundant, floppy leaflets
balloon into the atrium during systole
-thinning of fibrosa
-expansion of spongiosa via deposition of myxomatous (mucoid) material
-3% of population
-majority asymptomatic-midsystolic click
-minority with nonspecific symptoms: chest pain, dyspnea, fatigue, depression, anxiety
Rare, serious complications of mitral valve prolapse
-stroke/systemic infact-embolism of leaflet or atrial thrombia
What is infective endocarditis?
Destructive inflammation of cardiac valves and endocardium
-bacterial most common
-thrombotic debris, fibrin, inflammatory cells, microorganisms
What is acute infective endocarditis vs. subacute infective endocarditis?
-highly virulent micro-organisms
-usually previous normal valve
-rapide, severe destruction of vavle
-low virulence organism
-affect previously deformed valve
-recovery with appropriate treatment
What type of patients are at risk for endocarditis and what are the portals of entry?
At risk: valvular disease, prosthetic valves, immunodeficient, diabetic, IV drug users, alcoholics
Portals of entry: infection elsewhere, dental or surgical procedures with bacteremia, injection of contaminated material into blood stream, occult source-gut, oral caviity, trivial injury
How do you diagnose infective endocarditis? What are the treatments
prophylaxis with antibiotics for those at high risk
What are the complications that can occur with endocarditis?
-valve insufficiency or stenosis
-valve dehiscence or paravalvular leak in prosthetic valves
What are some visible symptoms with endocarditis?
-splinter hemorrhage in nailes
What are three things that can cause non infected vegetations?
1. nonbacterial thrombotic endocarditis
2. endocarditis of system lupes erythematous
3. acute rheumatic fever
What do the vegetations look like in nonbacterial thrombotic endocarditis (marantic endocarditis) ? Who gets marantic endocarditis?
sterile thrombi (vegetations)
-local-little effect on valve itself
-systemic-emboli and infarcts
Patients prone to hypercoagulable states
b. Cancer (Mucinous adenocarcinomas)
d. Indwelling catheters (endocardial trauma)
What do the vegetations look like in endocarditis of systemic lupus erythematosus (libman-sacks endocarditis)
1. sterile vegetations
-mitral and tricuspid valves, chords
2. consequence of immune complex deposition and associated inflammation
-leads to subsequent fibrosis, valve deformity
What is the pathogenesis of acute rheumatic fever?
immune response to strep A streptococci which cross-react with host tissue
-antibodies directed against M proteins of strep cross-react with self antigens in the heart
-CD4 T cells specific for strep peptides react with cardiac self proteins
-prodcued cytokines activate macrophages
What are the manifestations of acute rheumatic fever?
What is Jones Criteria?
Major: migratory polyarthritis- large joints, carditis (pancarditis), subcutaneous nodules, erythema marginatum of skin, sydenham chorea
Minor: fever, arthralgia, elevated acute-phase reactants
Preceding strep A infection+
2 major or 1
major and 2 minor
What are aschoff bodies seen in acute rhuematic fever?
-Macrophage=anitschkow cells (caterpillar cells)
What type of vegetations do you see in rheumatic fever endocarditis?
1-2 mm vegitations
left sided heart valves
What happens to in rheumatic fever endocarditis?
organization of inflammation
obliteration of normal leaflet structure
terbulence induced by ongoing valve deformities-->addtional fibrosis
What happens in chronic rheumatic valvular disease?
valve leaflet fibrosis fusion
-fish mouth or buttonhole stenosis
-cords short, thick, fused
Which valve is most commonly involved in chronic rheumatic valvular heart disease?
mitral vavle alone 65-70%
aortic and mitral 25%
tricuspid and pulmonary valves-rare
What is carcinoid tumor? How does it relate to heart disease?
-GI tract, tracheobronchial tree
secretes bioactive products
-serotonin (5 hydroxytryptamine)
1. Right sided heart failure
2. Plaque like thickening of endocardium and valves
3. Correlation of serotonin levels with right sided heart disease