Crr Week 5: Valvular Heart Disease (Kern)

Front 1

What kind of complications arise from an aortic valve which has only 2 leaflets?

Back 1

Usually no complications arise early in life, but later it may result in stenosis of the arortic valve.

Front 2

Valvular stenosis results in ________ overload of the chamber.

Back 2

Pressure overload

Front 3

Valvular insufficiency results in ________ overload of the chamber

Back 3

Volume overload

Front 4

Valvular stenosis causes what sort of physical change?

Back 4

Muscle hypertrophy

Front 5

Valvular insufficiency causes what sort of physical change?

Back 5

Chamber dilation

Front 6

List 3 complications of valve disease.

Back 6

1. Congestive heart failure
2. Arrhythmias and sudden death
3. Predisposition to infective endocarditis

Front 7

What causes functional mitral regurgitation?

Back 7

Dilation of left ventricle
(common in ischemic heart disease)

*Valve itself is normal

Front 8

What is acute rheumatic fever?

How long does it occur after infection?

Back 8

Immune-mediated multisystem inflammatory disease, following pharyngitis with Group A Streptococcus

*Results from immune response against streptococcal antigens which cross-react with host tissues

*10 days to 6 weeks after pharyngiti

Front 9

What is the main, long-lasting complication of acute rheumatic fever?

Back 9

Chronic valvular disease
(mitral valve most common)

Front 10

Which antibodies will be present during serological testing of a patient with rheumatic fever?

Back 10

(Ab against streptococcal antigens)

1. Streptolysin O Antibody (ASO)
2. Streptococcal DNase B Antibody

Front 11

Why are patients who have had acute rheumatic fever put on antibiotic prophylaxis?

Back 11

To prevent recurrent Strep infections
(people who have had one episode of rheumatic fever are predisposed to have recurrent episodes if they become reinfected with Strep species which cause rheumatic fever)

Front 12

What are the most common clinical manifestations of acute rheumatic fever?

Back 12

1. Migratory polyarthritis of large joints
2. Pancarditis

Others:
3. Subcutaneous skin nodules
4. Erythema marginatum
5. Sydenham chorea

Front 13

What is the Jones criteria?

Back 13

Set of diagnostic criteria used to diagnose rheumatic fever.

1. Serological evidence of previous streptococcal infection
2. Presence of sufficient number of clinical manifestations of disease

Front 14

Describe the pathognomonic histological findings for acute rheumatic heart disease

Back 14

1. Aschoff bodies
2. Anitschow cells

Collections of T-cells, plasma cells, and distinctive macrophages called Anitschow cells

Front 15

What are "caterpillar cells"?

Back 15

Anitschow cells
(distinctive macrophages found in aschoff bodies --> acute rheumatic fever)

Front 16

List 5 complications of acute rheumatic heart disease that can be heard upon auscultation.

Back 16

1. Pericardial friction rub
2. Weak heart sounds
3. Tachycardias
4. Arrhythmias
5. May progress to acute heart failure

Front 17

Which valves are usually involved in chronic rheumatic fever?

Back 17

Mitral valve > Aortic valve > Tricuspid > pulmonic

*Mitral valve = 65 - 70% of cases
*Pulmonic valve = almost never

Front 18

Mitral valve stenosis can lead to what complications?

Back 18

1. Left atrial dilation
2. Mural thrombi
3. Atrial fibrillation
4. Congestive failure

Front 19

What is the most common acquired valve abnormality?

Back 19

Aortic stenosis

Front 20

What is the most common cause of aortic stenosis?

Back 20

Nodular Ca2+ deposits in valve cusps which protrude into sinuses of Valsalva

Front 21

Congenital bicuspid aortic valves usually present with calcification and stenosis at what age?

Back 21

50 - 70 yo

Front 22

Calcification of normal aortic valves generally causes stenosis at what age?

Back 22

70 - 90 yo

Front 23

What are some consequences of aortic stenosis?

Back 23

1. Left ventricular hypertrophy
2. May progress to left ventricular failure and CHF
3. Arrhythmias may occur
4. Sudden death may occur

Front 24

What is the most common cause of mitral stenosis?

Back 24

Rheumatic heart disease

Front 25

List 4 manifestations of mitral stenosis.

Back 25

1. Left ventricular and left atrial dilation
2. Congestive heart failure
3. Atrial fibrillation and other arrhythmias
4. Mural thrombi with emobilization

Front 26

What is mitral valve prolapse?

Back 26

Weakening of mitral valve leaflets resulting in prolapse of leaflets back into left atrium during systole

Front 27

How is a mitral valve prolapse (MVP) detected?

How is it confirmed?

Back 27

Mid-systolic "click" on auscultation

*Confirmed by electrocardiogram

Front 28

What kind of symptoms occur with mitral valve prolapse?

Back 28

Majority of patients are ASYMPTOMATIC

*Minority have symptoms:
1. Chest pain
2. Palpitations
3. Dyspnea
4. Fatigue

Front 29

List 4 serious complications that can arise from a mitral valve prolapse.

Back 29

1. Infective endocarditis
2. Mitral insufficiency
3. Stroke/ systemic infarct
4. Arrhythmias

Front 30

What causes mitral annular calcification?

Back 30

Degenerative Ca2+ deposits in fibrous ring (annulus) of valve

Front 31

What usually causes infectious endocarditis?

Back 31

Usually results from bacteremia, with seeding of valve

(rarely can be caused by fungal infection)

Front 32

What is the difference between acute and subacute endocarditis?

Back 32

Acute endocarditis --> infection of previously NORMAL valve by virulent organism

Subacute endocarditis --> Infection of previously DISEASED valve by less virulent organism

Front 33

Which organisms are normally responsible for acute and subacute endocarditis?

Back 33

Acute --> Staphylococcus aureas

Subacute --> Streptococcus viridans

Front 34

Which is a more fulminant process-- acute or subacute endocarditis?

Back 34

Acute endocarditis

Front 35

What is the treatment for acute endocarditis?

Back 35

Surgical intervention
(antibiotics alone are not sufficient)

Front 36

What is the treatment for subacute endocarditis?

Back 36

Antibiotics

Front 37

What is the most consistent clinical feature of infective endocarditis?

Back 37

Fever

Front 38

What symptoms occur with acute endocarditis?

Back 38

Rapidly developing fever, chills, and weakness

Front 39

Which disease may result in embolic or immune complex phenomena?

Give an example of immune complex phenomena

Back 39

Infective endocarditis

Immune complex phenomena--> Glomerulonephritis

Front 40

List the 4 criteria for diagnosis of Infective endocarditis.

Back 40

1. Fever
2. Systolic murmur
3. Multiple blood cultures
4. Echocardiogram

Front 41

Which valves are most commonly involved in infective endocarditis?

Back 41

Aortic and mitral valves

Front 42

The right heart is commonly involved in infective endocarditis in which individuals?

Back 42

IV drug users

Front 43

What usually causes Nonbacterial thrombotic endocarditis (NBTE)?

Back 43

1. Underlying cancer, especially mucinous adenocarcinomas
2. Hypercoagulable states
3. Indwelling catheters

Front 44

Does Nonbacterial thrombotic endocarditis (NBTE) result in an inflammatory response?

Back 44

NO

Front 45

Endocarditis of SLE is also known as?

Back 45

Libman-Sacks Disease

Front 46

Libman-Sacks disease typically involves which valves?

Back 46

Mitral or tricuspid valves

Front 47

What are carcinoid tumors?

Back 47

Neuroendocrine tumors associated with the production of bioactive products (serotonin, histamine, bradykinin, kallikrein)

*Most often found in GI tract

Front 48

Which side of the heart is carcinoid heart disease limited to?

Back 48

RIGHT side

Front 49

Carcinoid heart disease usually manifests as a deficiency of which valves?

Back 49

Tricuspid +/- pulmonary valve

Front 50

Carcinoid heart disease typically occurs in which patients?

Back 50

Those with extensive carcinoid tumor mestasasis to the liver.

Front 51

What are the 2 types of prosthetic heart valves?

Back 51

1. Mechanical
2. Bioprosthetic (heart valves from animals-- usually pigs)

Front 52

What is the major complication of mechanical heart valves?

Back 52

Thrombosis of valve

*Patients must be maintained on prophylactic anticoagulation

Front 53

What is the major complicaton of bioprosthetic heart valves?

Back 53

Degeneration of valve

Front 54

Are prophylactic anticoagulants required for patients with bioprosthetic heart valves?

Back 54

No.

Front 55

What kind of degeneration takes place in mitral valve prolapse?

Back 55

Myxomatous degeneration

Front 56

List 3 physical signs of endocarditis that can be viewed in the clinic just be looking at the patient.

Back 56

1. Janeway lesions (small erythematous/hemorrhagic lesions on palms/soles; consequence of embolic events)
2. Osler nodes (tender, subcutaneous nodules on fingertips)
3. Roth spots (oval retinal hemorrhages with pale centers)