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18 Cards in this Set

  • Front
  • Back
The mechanism of aortic valve regurgitation (3)
1) Valve cusp destruction endocarditis
2) Myxomatous degeneration
3) Dilation of the aortic root
Fever, heart murmur, fatigue, anemia, arthralgia, myalgia, and Roth spots (retinal hemorrhages)
Clinical manifestations of endocarditis
Complications of endocarditis
1- rupture of chordae tendinae
2- spread of infection into myocardium or aorta
3- thromboembolism w/ infarction
4- Septic thrombi w/ metastatic abscesses
5- Valvular dysfunction and CHF
Etiology: Unknown (?T-cell mediated)
Clinical:Fever, weight loss, headache, visual problems, claudication of jaw, pain and tenderness over temporal artery, polymyalgia rheumatica. Rare under the age of 50 years.
Pathology: Granulomatous inflammation with giant cells, fibrosis.
Giant Cell (Temporalis) Arteritis
- large vessel
Etiology: Unknown
Clinical: Thickening of the wall reduces blood flow in the major branches off the arch (“pulseless disease” due to weak pulses in the arms). Usually affects young women.
Pathology: Granulomatous inflammation with fibrosis involving the aortic arch and the arch branches.
Takayasu's Arteritis
- large vessel
Etiology: Mostly unknown; 30% Hep B surface antigen
Pathological: Segmental involvement of med and small muscular arteries; lots of macs and plasma cells
Clinical: Multiple organ involvement
Polyarteritis nodosa
- medium vessel
Etiology: It is suspected that a viral infection triggers a hypersensitivity reaction.
Clinical: Affects infants and young children. Skin rash, mucous membrane lesions, lymphadenopathy. Usually self-limited but 1-2% die with coronary artery vasculitis.
Kawasaki's Disease
- medium vessel
Etiology: Often due to antigen-antibody complexes.
Clinical: Fever, rash, joint swelling, pleural effusion, pulmonary infiltrates, myocarditis, GI bleeding, renal failure, presence of circulating anti-neutrophilic cytoplasmic antibodies (pANCA). May be manifestation of malignancy, autoimmune disease or other disorder.
Pathology: Involves arterioles, capillaries, venules. Fibrinoid necrosis, neutrophils (leukocytoclastic vasculitis).
Microscopic Polyarteritis
-small vessel
Etiology: Probably a form of T-cell mediated hypersensitivity.
Clinical: Involves sinuses, lungs and kidneys (glomerulonephritis). Associated with the presence of anti-neutrophilic cytoplasmic antibodies (cANCA).
Pathology: Necrotizing granulomas with vasculitis.
Wegener's granulomatosis
- small vessel
Etiology: Endothelial injury from a substance in cigarette smoke
Clinical: Usually begins before age 35. Pain and ischemia in extremities.
Pathology: Segmental acute and chronic vasculitis mainly in extremities with thrombosis.
Buerger's Disease (Thromboangiitis obliterans)
Dissecting aortic hematoma
Longitudinal tear of the aortic media which begins in the ascending aorta and extends variable distance proximal (toward the heart) and distal to the descending aorta.
Complications of dissecting aortic hematoma
severe hemorrhage from rupture, organ ischemia due to luminal compression by the expanding hematoma.
Predisposing factors of dissecting aortic hematoma
hypertension, inherited connective tissue disorders (i.e., Marfan’s syndrome) with medial degeneration
Pathogenesis of immune-mediated vasculitis
1) Immune complex formation
2) Antineutrophilic cytoplasmic antibodies (ANCA)
3) Anti-endothelial cell antibodies
4) Cell-mediated immunity
How does rheumatic fever correlate w/ mitral stenosis
The disease is thought to be due to the production of antibodies against the streptococcal bacteria which cross react with various antigens in the heart, joints and other sites
Mitral valve prolapse
Mitral valve prolapse is a condition in which the leaflets balloon into the left atrium during left ventricular contraction (systole)
In severe prolapse (also called floppy mitral valve) the valve cusps are large and microscopically show fragmentation, separation and
loss of collagen. This is what?
myxomatous degeneration
Floppy mitral valve is associated with what syndrome?
Marfan syndrome