Valvular Heart Disease

Question 1

Functional regurgitation

Answer 1

Valve incompetence due to pathology in support structures

Question 2

Mitral stenosis

Answer 2

Rheumatic heart disease

Question 3

Mitral insufficiency

Answer 3

Mitral valve prolapse

Question 4

Aortic stenosis

Answer 4

Calcification

Question 5

Aortic insufficiency

Answer 5

Dilation of ascending aorta

Question 6

Calcification aortic stenosis

Answer 6

Most common valvular abnormality

Age related degenerative calcification

If aortic valve is congenitally bicuspid, comes to attention in 50 to 70

If previously normal, comes to attention in 60s to 80s

Question 7

Calcification aortic stenosis morphology

Answer 7

Rheumatic stenosis has commissar always fusion (degenerative usually does not)

Mitral valve involvement in rheumatic heart disease

Question 8

Calcification aortic stenosis clinical

Answer 8

Obstruction causes concentric LV hypertrophy

May cause systolic and diastolic (CHF) dysfunction

Question 9

Senile aortic stenosis

Answer 9

Tricuspid aortic valve undergone calcification

Question 10

Congenital bicuspid aortic valve

Answer 10

Cusps usually unequal

Mitral valve normal

Question 11

Acquired bicuspid aortic valve

Answer 11

Post inflammatory commissural fusion in rheumatic heart disease

Mitral valve is also abnormal

Question 12

Myxomatous degeneration of the mitral valve

Answer 12

Most often young women

Most common valvular disease in industrialized nations

One or both mitral leaflets are enlarged,hooded, redundant, or floppy

Rarely lead to serious complications

Question 13

Myxomatous degenerative of mitral valve morphology

Answer 13

Hooding of mitral leaflets
Leaflets are thick and rubbery
Cords often elongated, thinned, and occasionally ruptured

Commissural fusion is absent unlike in rheumatic heart disease

Question 14

Myxomatous degen of the mitral valve histology

Answer 14

Attenuation of collagenous fibrosa layer

Thickening of spongiosa layer

Deposition of mucous material in the leaflets

Question 15

Myxomatous degen of the mitral valve PE

Answer 15

Midsystolic click

May have late systolic or holosystolic murmur

Question 16

Rheumatic fever

Answer 16

Occurs a few weeks after an episode of group A streptococcal pharyngitis

Often involves heart acutely but may progress to chronic valvular disease

Question 17

Acute rheumatic fever morphology

Answer 17

Aschoff bodies

Anitschkow cells

Pancarditis

Question 18

Aschoff bodies

Answer 18

T lymphocytes

Occasional plasma cells

Plump macrophages

Found in all layers

Question 19

Anitschkow cells

Answer 19

Plump macrophages

Abundant cytoplasm

Nuclear chromatin is central, slender, wavy ribbon

Larger ones form giant cells

Question 20

Pericarditis

Answer 20

Fibrinous or serofibrinous exudate

Question 21

Myocarditis

Answer 21

Aschoff bodies often perivascular

Question 22

Endocarditis

Answer 22

See fibrinoid necrosis within the cusps or along the tendinous cords

Verrucae along line of closure of valves

Question 23

MacCallum plaques

Answer 23

Rheumatic heart disease

Irregular subendocardial thickening usually in left atrium

Question 24

Acute rheumatic fever pathogenesis

Answer 24

Damage to heart caused by:

Immune response to group A strep which cross reacts with host tissue

CD4+ cells specific for strep peptides also react with self proteins

Question 25

Acute rheumatic fever clinical

Answer 25

Evidence of preceding group A strep pharyngitis (10 days to 6 weeks) and Jones criteria: 2 major or 1 major and 2 minor Most often in children ages 5 to 15 Lab antibodies to streptolysin O and DNAse B

Question 26

Jones criteria Major manifestations

Answer 26

Migratory polyarthritis Carditis Subcutaneous nodules Erythema marginatum of the skin Sydenham chorea

Question 27

Jones criteria Minor manifestations

Answer 27

Fever Arthralgias Elevated acute phase reactant (C reactive protein)

Question 28

Carditis

Answer 28

Pericardial friction rubs Weak heart sounds Tachycardia Arrythmias

Question 29

Consequence of rheumatic fever

Answer 29

Chronic rheumatic heart disease

Question 30

Chronic rheumatic heart disease

Answer 30

Deforming fibrotic heart disease Particularly mitral stenosis Leaflet thickening Commissural fusion Shortening, thickening, and fusion of the tendinous cords

Question 31

Chronic rheumatic heart disease morphology

Answer 31

LA dilation with possible mural thrombus May cause RV hypertrophy 2* pulmonary congestion leading to vascular and parenchymal changes

Question 32

Infective endocarditis

Answer 32

Serious infection of heart valves or mural endocardium Invasion by a microbe-> formation of vegetation’s with destruction of underlying tissue Usually do to bacteria Can be in aorta, aneurysmal sacs, other blood vessels, prosthetic devices

Question 33

Acute endocarditis

Answer 33

Highly virulent organisms Frequently affect normal valves, as well as abnormal Destructive, tumultuous infection 50% die even with antibiotics and surgery

Question 34

Subacute endocarditis

Answer 34

Organisms with low virulence Previously abnormal valve Most recover after appropriate therapy

Question 35

Agents causing Infective endocarditis

Answer 35

Strep viridans - oral flora - damaged abnormal valves Staph aureus - found on skin - #1 in drug abusers Enterococci and HÁČEK Staph epidermidis -prosthetic valves

Question 36

Infective endocarditis morphology

Answer 36

Friable vegetation’s composed of fibrin, inflammatory cells, bacteria aortic and mitral valves are usual sites Right-sided valves may be involved esp IV drug users May produce abscess in myocardium-ring abscess

Question 37

Infective endocarditis clinical

Answer 37

Fever Fatigue, wt loss, flu like syndrome Murmur (90%) Less frequently Janeway lesions, Oiler nodes, Roth spots Positive blood culture Echocardiography- mass or abscess

Question 38

Janeway lesions

Answer 38

Erythematous lesions on palms or soles in infective endocarditis

Question 39

Older nodes

Answer 39

Subcutaneous nodules in pulp of digits in infective endocarditis

Question 40

Roth spots

Answer 40

Retinal hemorrhages in infective endocarditis

Question 41

Complications of artificial valves

Answer 41

Thromboembolic complications - long term anticoagulation - may cause hemorrhage complications

Question 42

Structural deterioration of artificial valves

Answer 42

Major failure mode of bioprostheses

Question 43

Other complications of artificial valves

Answer 43

Intravascular hemolysis from shear forces Paravalvular leak from inadequate healing Obstruction from overgrowth by fibrous tissue during healing