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Flashcards in Valvular heart disease pathology Deck (24):

Essential vs Secondary Hypertension

Hypertension BP >140/90

Essential = Primary: 90%
1. Idiopathic
2. Medication or other causes

1. Renal disease
2. Endocrine
3. Cardiovascular


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)

1. Atherosclerosis/aneurysm
2. Cerebral vascular disease
a. Ischemic: arteriolosclerosis
b. Hemorrhage
3. Kidney: Key cause of "chronic renal disease"; often along with diabetic renal
a. Arteriolosclerosis
b. Glomerulosclerosis
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?

Hypoplastic valve


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
3. Infection


Most common cause of isolated mitral regurgitation

Myxomatous degeneration (mitral valve prolapse)

Note: names for valve changes:
1. Ballooning
2. Tenting
3. Myxomatous degeneration
4. Hooding


Complications of MV prolapse?

1. Asymptomatic
2. Regurgitation
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

Major criteria:
1. Heart: "pancarditis"
2. Joints: Migratory polyarthritis
3. Skin: erythema and subcutaneous nodules
4. CNS: Sydenham chorea

Minor criteria:
1. Fever
2. Arthralgias
3. Elevated APR

& Evidence of Ab against antistreptolysin O

Recall the pyogenies bakers picture


What does an Aschoff body indicate?

Rheumatic Fever



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

3. Complications:
-Valve function deficits
- can become infected


What is the most common bacteria for infectious endocarditis?

Strep viridans


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


Cor Pulmonale

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
- Problems:
○ Reduced outflow, leading to ventricular hypertrophy
○ Increased turbulence, leading to valve thickening and stenosis (biggest problem)


What happens to the chordae tendinea with respect to rheumatic HD?

. Chordae Tendinea: fibrosis, fusion, and shortening
- fish mouth stenosis