• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/26

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

26 Cards in this Set

  • Front
  • Back
Aortic Valve Stenosis - calficic
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
where does calcification usually start in aortic calcific stenosis
at the base of cusps (area of stress)
calcific vs rheumatic aortic valve stenosis
rheumatic heart disease aortic stenosis causes fusion of the commisures
aortic stenosis profnosis
BAD

need to replace valves quick
calcification of mitral annulus
fibrious ring is calcified - does not affect valve function

see in women > 60

will see on radiograph as a ring structure
mitral valve prolapse
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
rheumatic heart disease
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
group A strep
pharyngitis

+ASO titer

more severe infection - greater risk of rheumatic fever

delay before rheumatic fever onset - indicates immune response
what is the most distinctive anatomic feature in acute rheumatic fever?
aschoff bodies during cellular phase

aschoff bodies are nodules with fibrinoid change, lymphocytic infiltrates, and characteristic abnormal macrophages (anitschkow macrophages) - granulomatous
3 phases of acute rheumatic heart disease
exudative - nondistinct

cellular - pathognomonic - see fibrinoid necrosis, anitschkow, aschoff, and cardiac histocytes - multinucleated giant cells

fibrotic - important clinically
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
pericardial rheumatic fever
pericarditis - pericardial, myocardial, endocardial

pericardial - diffuse fibrinous inflammation - "bread and butter" pericarditis w/ friction rub and violin sring adhesions
myocardial rheumatic fever
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
endocardial rheumatic fever
ominious aspect -> chronic disability due to valve scarring

see small wart like vegetations on closure of leaflets
maccallum plaques
mural endocardial involvement in rheumatic fever by subendocardial aggregations of aschoff bodies
chronic rheumatic heart disease
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
extra cardiac involvement in rheumatic disease
large joints - knees

arteries

lungs

CNS

subcutaneous nodules - giant aschoff bodies of extensor tendons

erythemia marginatum - bathing suit distribution macropapular riash
what rash is associated rheumatic heart disease
erythema marginatum
jones criteria
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
infective endocarditis
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
subacute infectious endocarditis vs acute infectious endocarditis
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
morphology of endocarditis - acute vs chronic
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
nonbacterial thrombotic endocarditis
small vegetation due to fibrin and platelets on valve leaflets - along line closure

sterile like rheumatic fever and libman sacks disease
nonbacterial verrucous endocarditis (libman - sacks disease)
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
carcinoid heart disease
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
artificial valves
theomboembolic complications