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59 Cards in this Set
- Front
- Back
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Stenosis is
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failure to open completely
impede forward flow |
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Insufficiency is
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failure to close completely
allows reverse flow |
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functional regurgitation due to dilatation of ventricle
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TV & MV papillary m are pulled down & out during systole
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functional regurgitation due to dilatation of aortic or pulmoanary artery
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preventing full closure of AV or PV
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Stenosis characteristics
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aquired - most frequent
AV/MV 2/3 of all valve disease primary cusp chronic |
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Insufficiency characterisitics
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intrinsic disease of cusp OR distortion of support structures
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Calcific disease
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dystrophic calcification - wear & tear
high repetitive mechanical stress |
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Calcific aortic stenosis
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inc pres needed in LV - LVH
ischemic myocardium - angina CHF may ensue poor prognosis |
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Bicuspid aortic valve
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predisposed to calcification
midline raphe may become incompetent |
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reasons for a bicuspid aortic valve to become incompetent
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aortic dilatation
cusp prolapse infective endocarditis |
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Mitral valve calcification
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fibrous ring - annulus
doesnt affect valve fxn |
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what does mitral valve calcification lead to?
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stenosis
regurgitation arrhythmia/sudden death infective endocarditis |
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Mitrial valve myomatous degeneration (prolapse)is?
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balloning of leaflets into atria - midsystolic click
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who gest mitral valve prolapse?
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anxiety
women |
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What do you see in mitrial valve prolapse?
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annular dilatation!!!
thickened rubbery leaflets dec collagen in chordae, elongated, thin |
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What do you hear with mitral valve prolapse?
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mid-systolic click
holosystolic blowing |
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What is the pathogenesis of mitrial valve prolapse?
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defects in structural P
Marfans |
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What are some complications of MV prolapse?
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infective endocarditis
stroke or infarct requires surgery arrhythmia |
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slow onset MV prolapse that is incompetent can be seen as
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leaflet deformity
dilated annulus chordal lengthening |
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you can see what in rapid onset MV prolapse incompetency
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cordal rupture
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Rheumatic fever is caused by
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strep A (pyogens) pharyngitis
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Why do you get Rheumatic fever?
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Ab against strep cross rxts with the heart tissue
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What is the Jones Criteria?
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required for rheumatic fever
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Major criteria for Jones
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migratory polyarthritis
carditis subcutaneous nodules erythema marginatum sydenham chorea |
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What are minor Jones criteria
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fever
aches inc WBC elevated acute phase rxn Ps |
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what is syndenham chorea
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major jones criteria for rheumatic heart
neurologic disorder w/ involunatary purposeless rapid movements |
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Acute carditis clinical features
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pericardial friction rubs
weak heart sounds tachycardia arrythmias |
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myocarditis clinical features
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dilatation
functional MV insufficiency heart failure |
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what can you see histologically with acute rheumatic fever?
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aschoff bodies in peri, myo & endocardium
from inflammmation |
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what is the most common cause of mitral stenosis?
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rheumatic heart disease
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what are some secondary changes in mitral stenosis?
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LA dilatation
pulmonary vascular congestion RVH |
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MV involvement in chronic rheumatic carditis causes
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LA dilation
heart failure |
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AV involvement in chronic rheumatic carditis causes
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LVH
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other things caused by chronic rheumatic carditis
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thromboembolism
infective endocarditis |
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Chronic Rheumatic heart disease has these changes
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aschoff bodies replaced by fibrosis
fibrotic leaflet thickening commisural fusion shortening/thickening/fusion of chordae |
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Infective endocarditis is
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colonization/invasion of heart valves or endocardium by a microbe
bulky/friable vegetations |
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what type of infective endocarditis vegetations are larger?
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fungal larger than bacterial
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What valves are most common?
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AV & MV
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What is unique about ppl who get right heart infective endocarditis?
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IV drug users
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Acute infective endocarditis
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rapid progression
valve previously normal highly virulent high death rate |
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Subacute infective endocarditis
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protracted course
valve abnormal low virulence pts recover |
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Microscopic findings with infective endocarditis
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fibrin, inflam debris, organisms
subacute vegetation has granulation tisse at base |
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vegetations can be
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ulcerative/ necrotizing
acute> subacute erode into underlying myocardium - ring abscess |
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Possible valvular abnormalities that predispose to infective endocarditis
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myxomatous MV
degenerative calcific stenosis bicuspid AV prosthetic valves rheumatic heart disease |
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possible host factors taht predispose to infective endocarditis
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neutropenia, immunodeficient, malignancy, dibetes, alcohol & IV drugs
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What are some organisms that cause infective endocarditis?
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strep viridans
staph aureus staph epidermis HACEK oral bacteria enterococcus, gr - rods, fungi |
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staph viridans infective endocarditis
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most common sub acute
low virulence previously damaged valves |
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Staph aureus infective endocarditis
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great virulence
from skin IV drug users |
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staph epidermis infective endocarditis
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prosthetic valves
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HACEK infective endocarditis
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hemapholis
actionbacillus cardobacterium Eikenella Kingelle |
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Clinical features of acute infective endocarditis
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stormy onset w rapidly developing fever, chills, weakness
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Clinical featuers of subacute infective endocartitis
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fever may be slight, non-specific symptoms
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Embolic complications of left-sided vegitations
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brain, heart, spleen, kidney
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embolic complications of right-sided vegitations
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lungs
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What do you see in non-bacterial thrombotic endocarditis
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leaflets w fibrin, platelets & other blood products
non-infectious may embolize |
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Libman-Sacks disease
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SLE
vegetation on underside of MV/TV, endocardium & cords necrosis may occur |
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Which type of artificial valve is flexible?
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bioprosthesis
mechanica is rigid |
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Mechanical valve complications
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local thromobtic obstruction
distant embolism long term anticoagulation |
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Prostetic valve complications
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infective endocarditis
hemolysis structural deterioration inadequate or too much healing |
