3-1: 8/24: Pathology Of Valvular Disease

Front 1

Valvular Disease:
Causes
Valves Commonly Affected

Back 1

Causes of Valvular Dz:
Malformations, deformations, stenosis, insufficiency (abnormal cusp/leaflet)

2/3 of all lesions are ACQUIRED lesions of MV or AV

Front 2

Where does calcification occur in the heart? Generally and specifically.

Is calcium all that's seen in calcifications?

Back 2

Calcium deposited in areas of wear and tear

Most frequently affects aortic valve and/or mitral annulus

Bicuspid aortic valve especially prone

Don't just see Ca2+, but also see lipid deposition and atherosclerosis

Front 3

Rheumatic Heart Disease is a common cause of ___________.

Back 3

Calcific Aortic Stenosis

Front 4

What is the most common cause of calcific aortic stenosis?

Back 4

Aging

(Stenosis = stiffening)

Front 5

What is the mitral annulus?

Effect of calcification?

Back 5

Fibrous ring that surrounds the mitral

Calcification often does not impair valve function but can contribute to mitral insufficiency or mitral stenosis

(Often continuous with calcium deposits in AV cusps)

(Can extend into skeleton or conduction system)

Front 6

What causes mitral valve prolapse?
Effects?
Complications?

Back 6

Myxomatous (weakening of CT) degeneration of mitral valve; manifestation of MARFAN SYNDROME (mutation in fibrillin gene)

Leaflets become large, hooded, floppy

Can cause emboli, arrhythmia

Front 7

What valvular complication exhibits decreased expression of hyaluronan?

Back 7

Mitral Valve Prolapse

Front 8

Rheumatic Heart Disease:
Causes

Back 8

Hypersens Rxn induced by Group A Strep; Abs against M proteins of streptococci cross-react w/glycoprots in heart/other organs

Front 9

What is an Aschoff body?

Back 9

Area of fibrinoid necrosis/degeneration surrounded by macs, giant cells, lymphocytes.

Indicative of Rheumatic Heart Dz

Front 10

What is an Anitschkow cell?

Back 10

Large mac with abundant amphophilic cytoplasm and nuclear chromatin which forms central irregular ribbon resembling a CATERPILLAR

Indicated of Rheumatic Heart Dz (NOT 100% OF THE TIME)

Front 11

Effects of Rheumatic Heart Disease on endocardium.

Back 11

Endocarditis - necrosis in cusps/leaflets (usually AV or MV), may extend to chordae tendinae

Results in fibrosis with thick, stiff cusps and/or leaflets; chordae retract, thicken and fuse

Front 12

What is infective endocarditis?

Complications?

Back 12

Colonization with our without invasion of endocardium (not always on a valve)

Often destroys underlying tissue

Can colonize prosthetic valves

Complications:
Valvular stenosis/insufficiency
Abscess in annulus, paravalvular leak (prosthesis)

Front 13

Cause of Acute Bacterial Endocarditis?

Back 13

Acute: due to highly virulent organisms such as staph aureus; can affect previously normal valves, risk of septic emboli

Front 14

Cause Subacute Bacterial Endocarditis?

Back 14

Organisms of lesser virulence at sides of enthelial injury (previously deformed valves or impact of high velocity flow)

Less destruction of underlying tissue than in acute bacterial endocarditis

Front 15

Causes of nonbacterial thrombotic endocarditis?

Histologic difference from bacterial endocarditis?

Back 15

Debilitated patients (OLD)

Small noninfected, loosely attached masses of fibrin, platelets, othe rblood components on valves are deposited

THROMBI WITH NO INFLAMMATION

Front 16

What form of endocarditis is associated with Lupus?

Back 16

Libman-Sacks Endocarditis

Front 17

What is carcinoid syndrome?

Back 17

Fibrous plaque-like endocardial thickening on walls of chambers/valves

Secrete SEROTONIN

If have high levels of serotonin, likely to have Carcinoid Syndrome

Likely to be on Right Side of Heart

Front 18

Mechanical vs Tissue Prosthetic Heart Valves

Back 18

Mechanical: non-physiological biomaterials

Tissue (bioprosthetic): chemically-treated animal tissue mounted on frame

Front 19

Complications of Prosthetic Valves

Back 19

Embolism
Structural Deterioration

Front 20

Complications of Cardiac Transplant

Back 20

Lymphocytic myocarditis (signs of rejection)
Long-term progressive intimal thickening of coronary arteries (graft arteriosclerosis)
Lymphomas related to EBV in immunosuppressed pt

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