Flashcards in Valvular heart disease pathology Deck (24):
Essential vs Secondary Hypertension
Hypertension BP >140/90
Essential = Primary: 90%
2. Medication or other causes
1. Renal disease
Pathogenesis of hypertension
Sustained pressure overload on the LV leads to concentric hypertrophy of myofibers
Additional sarcomeres/myofibrils added to existing cardiomyocytes
Microscopic evaluation of hypertrophy
1. Nuclei actually get bigger "boxcar"
2. Hypertrophied one has additional sarcomeres making it thicker
Clinical manifestations of systemic hypertension
1. Often silent "Silent Killer"
2. Can manifest w/ headache or dizziness
Complications of systemic hypertension (LV)
2. Cerebral vascular disease
a. Ischemic: arteriolosclerosis
3. Kidney: Key cause of "chronic renal disease"; often along with diabetic renal
4. Congestive heart failure (pulmonary edema
and eventual right heart failure)
Pulmonary hypertension (RV) cause
1. Left HF (any cause)
2. Congenital heart disease
3. Cor Pulmonale (RHF) - emhysema, ILD, or bronchiectasis
4. Pulmonary vessel disease like emboli
5. Chest movement alterations
What complications happen downstream in Rheumatic HD ?
- what type of infection?
- results of that infexn?
- how does the infxn present?
- Valves can’t open (stenosis) or close (regurgitation) normally … can progress to heart failure
Susceptibility to infective endocarditis --> inflammation following infxn
"Passive" Congestion of liver = nutmeg liver, ascites and lower leg edema
Runt valve that doesn't work very well called what?
3 types of developmental/congenital valves? Cause what problems?
1. Hypoplastic valve.
2. Unicuspid aortic valve
3. Bicuspid aortic valve
1. Reduced outflow, leading to ventricular hypertrophy
2. Increased turbulence, leading to valve thickening and stenosis
Abnormal valves at increased risk for what?
1. Nodular calcification and fibrosis
2. Vegetation formation
Most common cause of isolated mitral regurgitation
Myxomatous degeneration (mitral valve prolapse)
Note: names for valve changes:
3. Myxomatous degeneration
Complications of MV prolapse?
3. Infective endocarditis
Clinical correlations for Calcific Aortic Stenosis
1. Increased demand for myocardial oxygen in the hypertrophied ventricle
How do you get rheumatic fever?
Strep pyogenes infection... Get antibodies against M protein of Group A strep cross-react with body's own glycoproteins
Criteria for Rheumatic fever diagnosis
1. Heart: "pancarditis"
2. Joints: Migratory polyarthritis
3. Skin: erythema and subcutaneous nodules
4. CNS: Sydenham chorea
3. Elevated APR
& Evidence of Ab against antistreptolysin O
Recall the pyogenies bakers picture
What does an Aschoff body indicate?
inflammation of endocardium / valves and eventual fibrosis due to rheumatic heart disease
Valve cant open or close normally => heart failure
Susceptibility to infective endocarditis
What are vegetations? Etiology? Complications?
1. Sterile/non-bacterial thrombotic endocarditis (clot formation on valve) or infective endocarditis
2. Etiology: Damaged valve from Lupus or RHD
-Valve function deficits
- can become infected
What is the most common bacteria for infectious endocarditis?
What are some risk factors for endocarditis?
Introduce bugs via:
1. Dental procedures
2. Surgical procedures
3. Venous access for catheterization
4. Inravenous drug abuse
Pulmonary heart disease :
the enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance or high blood pressure in the lungs (pulmonary hypertension).
note - Right ventricle will commonly be thick in Pulmonary HTN
Causes of Cor pulmonale (other than the major Lt sided HF)
• Pulmonary Parenchyma Disease
• Pulmonary Vessel Disease
• Chest Movement Alterations
incidence and long term implications of a bicuspid aortic value.
- Pretty common
- Asymptomatic until you get accelerated wear and tear
○ Reduced outflow, leading to ventricular hypertrophy
○ Increased turbulence, leading to valve thickening and stenosis (biggest problem)