Valvular Heart Disease Pathology Flashcards Preview

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Flashcards in Valvular Heart Disease Pathology Deck (35):
1

commissures

the points of lateral attachment between adjacent cusps

2

layers of the valve leaflets

fibrosa, spongiosa, and ventricularis

3

fibrosa

constitutes the major structural component of the cusp

consists of dense fibrous tissue

4

spongiosa

beneath the fibrosa and occupies a central position

consists of proteolgycan, loosely arranged collagen fibrils, and scattered fibroblasts

5

ventricularis

subadjacent to the spongiosa

in direct contact with the endothelium of the inflow surface of the cusp

contains a large amount of elastic fibrils

6

major causes of acquired valvular stenosis

postinflammatory (rheumatic) mitral or aortic stenosis

calcific aortic stenosis

7

causes of valvular incompetence/regurgiation

leaflet abnormality

papillary muscle damage

valve ring abnormalities

8

types of noninfective endocarditis

nonbacterial thrombotic endocarditis

rheumatic endocarditis

Libman-Sacks endocarditis

9

nonbacterial thrombotic endocarditis

the deposition of small masses of fibrin, platelets,and other blood components on leaflets of cardiac valves

lesions do not contain microorganisms

valvular damage is not a prerequisite

valves are usually previously noromal

aka NBTE or marantic endocarditis

10

pathogenesis of NBTE

subtle endothelial abnormalities

hypercoagulable states from malignancies (especially adenocarcinomas) in 50% of cases

11

morphologic features of NBTE

small nodules on lines of valve closure

nodules may be bulky and friable

valve leaflets otherwise normal

aortic valve most common, mitral valve next most frequently involved

12

infective endocarditis

infection of the cardiac valves or mural surface of the endocardium, with formation of adherent mass of thrombotic debris and organisms, termed a "vegetation"

any microorganism may be present, but most cases are bacterial

broken down into acute bacterial endocarditis (ABE) and subacute bacterial endocarditis (SBE)

13

ABE

acute and rapidly progressive valvular dysfunction

can be fatal in up to 50% of patients

due to highly vurilent organisms such as staphylococcus aureus

organisms affect normal valves

14

SBE

usually presents as a more insiduous process that can progress slowly over time (weeks)

prognosis is markedly better than ABE

usually due to low virulence organisms such as alpha-hemolytic streptococci

affects previously abnomral valves

infection due to abnormal hydrodynamics and surface irregularieis of the abnormal valve, leading to microscopic surface thrombosis

15

acute infective endocarditis morphology

small to large vegetations

rapid destruction of valve leaflets - rupture of leaflets, chordae tendinae, or papillary muscles

organisms, fibrin, blood cells

virtually no inflammatory response

systemic embolization infarcts of brain, kidneys, myocardium, etc.

abscesses at site of infarcts

16

subacute infective endocarditis morphology

firmer than in acute

cause less valve damage

granulation tissue at base of lesions

eventual fibrosis and calcification may occur

systemic emboli - infarcts (less likely to supprate)

17

complications of infective endocarditis

septicemia

emboli and septic emboli - infarcts to heart, brain, kidney, and spleen

immun complex mediated injury - focal glomerulonephritis (flea bitten), vasculitis in skin

valve perforation - congestive heart failure

18

clinical mainfestations of infective endocarditis

infection - prolonged fever

vegetations - changing heart murmur

emboli - symptoms of cardiac, renal, plenic, or cerebral infarction

immune complex disease:

-> kidney - hematuria, renal failure

-> subcutaneous - splinter hemorrhages, Osler's nodes

-> retina - Roth's spots

valve rupture - congestive heart failure

19

symptoms of rheumatic fever

Syndehams chorea

polyarticular arthritis

skin changes

carditis (pancarditis)

20

Aschoff nodule

a collection of lymphocytes and histiocytes most easily found in the fibrous interstital septa of the myocardium

lesions indicative of rheumatic carditis

21

fibrinous pericarditis

results from rheumatic heart disease

gives rise to a friction ribe

"bread-and-butter" pericarditis

22

supporting evidence of Streptococcal infection

increased titer of anti-strep antibodies

positive throat culture (group A strep)

recent scarlet fever

23

major Jones criteria

carditis

polyarthritis

chorea

erythema marginatum

subcutaneous nodules

24

minor Jones criteria

previous RF or RHD

arthalgia

fever

actue phase reactants

prolonged P-R interval

25

Antichow cell

round or oval nucleus with chromatin condensed at the nuclear periphery and along the center

results in an appearance like an owl eye or caterpillar

seen around the area of fibrinoid necrosis

26

verrucous endocarditis

mall excrescences along lines of valve closure

lesions may resolve or undergo fibrosis

27

causes of mitral valve regurgitation

abnormalities of leaflets and commissures

abnormalities of tensor apparatus

abnormalities of the mitral valve annulus or left ventricle

28

abnormalities of leaflets and commissures leading to MR

postinflammatory scarring

infective endocarditis

floppy mitral valve

29

abnormalities of tensor apparatus leading to MR

rupture of papillary muscle

papillary muscle dysfunction (fibrosis)

rupture of chordae tendinae

30

abnormalities of the mitral valve annulus or left ventricle leading to MR

LV enlargement (myocarditis, dilated cardiomyopathy)

calcification of mitral annulsus

31

morphology of mitral valve prolapse

mitral valve cusps are soft, enlarged, and ballooned into the left atrium during systole

cordae may rupture

loose, edematous, basophilic ground substance in valve leaflets and chordae

32

causes of aortic stenosis

postinflammatory scarring

senile calcific aortic stenosis (>60 yrs)

calcification of congenitally deformed valve (30-50 yrs)

33

causes of aortic regurgitation

intrinsic valvular disease:

postinflammatory scarring

infective endocarditis

aortic disease:

syphilitic aortitis

anylosing spondylitis

rheumatoid arthritis

Marfan's disease

34

ankylosing spondylitis

systemic disease affecting joints, lungs, heart, and eyes

inflammation can involve the aorta and heart

can cause aortic regurgitation due to dilatation of the aorta and scarring of the valve cusps

35

etiology of aortic root disease