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26 Cards in this Set
- Front
- Back
Aortic Valve Stenosis - calficic
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calcific aortic valve stenosis - most common cause of aortic stenosis in adult patients
advancing age leads to calcification, fibrosis, stenosis obstruction of LV outflow - creates gradient between the LV and aorta see very high LV pressure -> hypertrophy -> dilation -> decreased output LV will compensate initially - asymptomatic - eventually leads to dyspnea, angina, syncope calcification usually starts at base of cusp |
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where does calcification usually start in aortic calcific stenosis
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at the base of cusps (area of stress)
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calcific vs rheumatic aortic valve stenosis
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rheumatic heart disease aortic stenosis causes fusion of the commisures
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aortic stenosis profnosis
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BAD
need to replace valves quick |
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calcification of mitral annulus
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fibrious ring is calcified - does not affect valve function
see in women > 60 will see on radiograph as a ring structure |
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mitral valve prolapse
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enlarged floppy valves -> proplase into LA during systole
more in females 20-40 years mid systolic click myxomatous degeneration marfan's often posterior leaf > anterior leaf w/ or w/o enlarged annulus ballooning of leaflet, long chordae (possible rupture), initially delicate then fibrotic mitral regurgitation, arrhythmia |
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rheumatic heart disease
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inflammatory disease that is caused by a cross reactive antibodies to group A strep M protein - often seen from 5-17yo
effect on heart valves - biggest concern antibodies against sarcolemma of myofibrils, smooth muscle, interstitial connective tissue also see migratory polyarthritis, fever, carditis (pancarditis), erythem marginatum, chorea, subcutaneous nodules diffuse fibrinous inflam pericarditis "bread and butter" look -> friction rub violin-string adhesions to pericardium don't see as much due to antibiotics and public health control |
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group A strep
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pharyngitis
+ASO titer more severe infection - greater risk of rheumatic fever delay before rheumatic fever onset - indicates immune response |
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what is the most distinctive anatomic feature in acute rheumatic fever?
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aschoff bodies during cellular phase
aschoff bodies are nodules with fibrinoid change, lymphocytic infiltrates, and characteristic abnormal macrophages (anitschkow macrophages) - granulomatous |
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3 phases of acute rheumatic heart disease
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exudative - nondistinct
cellular - pathognomonic - see fibrinoid necrosis, anitschkow, aschoff, and cardiac histocytes - multinucleated giant cells fibrotic - important clinically |
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What structures are retroperitoneal?
What does retroperitoneal mean? What does secondarily retroperitoneal mean? |
Suprarenal glands (adrenal glands)
Aorta/IVC Duodenum--2nd, 3rd, 4th parts Pancreas--except tail Ureters Colon--ascending, descending Kidneys Esophagus Rectum Retroperitoneal = not enclosed by mesentary, fixed position, immobile Secondarily Retroperitoneal = lost its mesentary during development |
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pericardial rheumatic fever
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pericarditis - pericardial, myocardial, endocardial
pericardial - diffuse fibrinous inflammation - "bread and butter" pericarditis w/ friction rub and violin sring adhesions |
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myocardial rheumatic fever
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pericarditis - pericardial, myocardial, endocardial
major cause of death from arrhythmias or cardiac failure mitral or aortic insufficiency (rheumatic fever effects high presure valves) see aschoff bodies |
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endocardial rheumatic fever
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ominious aspect -> chronic disability due to valve scarring
see small wart like vegetations on closure of leaflets |
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maccallum plaques
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mural endocardial involvement in rheumatic fever by subendocardial aggregations of aschoff bodies
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chronic rheumatic heart disease
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due to permanent valvular deformity
organization of acute vegetations -> leaflet thickening, fibrosis, blundting characteristic "fishmouth" or "button-hoe" stenotic deformity thickened chordae tendinae LA dilation -> Afib + thrombus formation NO ASCHOFF BODIES |
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extra cardiac involvement in rheumatic disease
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large joints - knees
arteries lungs CNS subcutaneous nodules - giant aschoff bodies of extensor tendons erythemia marginatum - bathing suit distribution macropapular riash |
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what rash is associated rheumatic heart disease
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erythema marginatum
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jones criteria
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need 2 major
or 1 major+2minor major criteria: carditis polyarthritis chorea erythema marginatum subcutaneous nodules minor criteria previous RF arthralgia fever increased ESR prolonged P-R |
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infective endocarditis
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many microbes can cause -> vegetations
see with hearts with some other valvular disease see with IV drug use, surgery, artificial valves, chronic alch, catheters, pacemakers most often strept. viridans in subacute most often straph aureus in acute |
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subacute infectious endocarditis vs acute infectious endocarditis
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subacute:
1. underlying abnormality 2. low virulence organism - usually strep viridans 3. well defined extracardiac infection is uncommon acute: 1. normal heart or prior cardiac surgery - no disease 2. drugs/alcoholism 3. highly virulent organism - staph aureus 4. well defined extracardiac focus |
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morphology of endocarditis - acute vs chronic
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friable, bulky, septic vegitations on heart valves
does not encircle entire free margins like in acute rheumatic fever acute infective endocarditis tends to be bulkier, cause perforation and erosion of valve subacute less likely to erode, smaller, and extend into mural endocardium |
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nonbacterial thrombotic endocarditis
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small vegetation due to fibrin and platelets on valve leaflets - along line closure
sterile like rheumatic fever and libman sacks disease |
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nonbacterial verrucous endocarditis (libman - sacks disease)
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due to disseminated lupus erythematosus
mitral and tricuspid valves small berry like vegetations like rheumatic fever and NBTE random distribution on back of cusp - not usually clinically significant but may cause mitral regurg |
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carcinoid heart disease
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neoplasm of neuroendocrine cells
serotonin, hydroxytryptophan, and kallikirein --> flushing, nausea, vomiting, diarrhea plaque like thickening of endocardium in RIGHT heart arterial outflow tract of pulmonic valve is common place -> thickened and fused -> stenosus lung metabolism prevents left heart from being effected |
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artificial valves
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theomboembolic complications
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