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27 Cards in this Set
- Front
- Back
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Explain pathophysiology and epidemiology of Acute Rheumatic fever |
Systemic complication of pharyngitis due to group A beta-hemolytic strep. Affects kids ages 5-15 2-3 weeks after strep throat. Caused by molecular mimicry; bacterial M protein resembles human tissues (myosin, collagen) so Anti-M antibodies also attach to endocardium and myocardium, causing inflammation, increased pilability and give, leading tovalvular and muscular damage and mitral insufficiency. |
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How would you diagnose ARF? |
Using JONES criteria -evidence of a prior group A beta-hemolitic strep infection (ASO (antistreptolysin) or anti-DNase B titer) -minor criteria (fever and elevated ESR) -major criteria -J-joint- migratory polyarthritis -O-heart problems (pancarditis) -N-subcutaneous nodules -E-erythema marginatum -S-sydenham's chorea All of these will resolve over time except the heart problems |
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WHich layer is attacked first in AR carditis? |
endocardium. |
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What is evidence of AR carditis within the myocardium? |
Aschoff bodies: focus of chronic inflammation with giant cells and fibrinoid material (degenerated collagen) and anitchkow cells - with catarpillar nucleus. This is important because the myocarditis in ARF is the #1 cause of death in the acute phase. |
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If a patient comes in with recent history of strep throat and sudden onset of chest pain, which layers of the heart do we suspect are affected? |
All 3! Endo happens first, then myo, then peri (which would cause a friction rub-->chest pain) |
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_______ _______ _______ _______ is caused by repeat exposure to group A strep. Explain. |
Chronic Rheumatic heart disease. Each time you get it increases the risk for chronic rheumatic valvular disease (each time you relapse the acute phase) |
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Chronic rheumatic valvular disease is basically ___________ of the mitral (or aortic) valve. This produces _______. Explain ... |
scarring; stenosis
scarring of valves with fusion of the commissures. this reduces the oriface of the valve --> fish mouth appearance of the valve. |
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What is a complication of a damaged valve? |
endocarditis |
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What is the main cause of aortic stenosis (without mitral stenosis)? How big is the aortic valve usually/when it's stenosed? |
Wear and tear. Appears in late adulthood (>60 years).
THe aortic valve is 4cm in diameter when healthy. 1 cm when it is stenosed. |
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Which condition hastens onset of aortic stenosis and increases risk? |
bicuspid aortic valve |
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How can you tell the difference btwn aortic valves in aortic stenosis and chronic rheumatic valvular disease? |
Wear and tear is just fibrosis around valve. CRHD will also have mitral valve stenosis and fusion of the commisures of the aortic valve. |
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With aortic stenosis, compensation leads to _______ ___________ _______. |
Prolonged asymptomatic stage |
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What is the heart murmur heard in aortic stenosis? |
Systolic ejection click followed by a crescendo-decrescendo murmur. (LV compensates, pushes harder, and eventually the valve will open (with a click) and the smaller opening will cause the crescendo-decrescendo because of the high pressure being let out.. as pressure decreases within the ventricle, the pitch gradually decreases too). |
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What are the complications of Aortic Stenosis? |
concentric left ventricular hypertrophy; angina and syncope with exercise; microangiopathic hemolytic anemia (when blood flows across the degenerative calcified valve, blood cells rupture) |
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Treatment of Aortic stenosis (when)? |
Replacement of the aortic valve after the onset of complications. |
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During which phase of the cardiac cycle does aortic regurgitation occur? |
diastole |
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Most common causes of aortic regurgitation? |
Isolated aortic root dilation (syphilitic aneurysm). Also valve damage (Infectious endocarditis) |
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Clinical features of aortic regurgitation? |
early blowing diastolic murmur. Bounding pulses, pulsating nail bed, head bobbing (hyperdynamic circulation -- caused by widening of the pulse pressure (decreases diastolic p and increases systolic p).
LV dilatation and eccentric hypertrophy (involves one aspect of the ventricle... commonly seen with) |
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Treatment of aortic regurgitation? |
Replacement of valve when LV dysfunction develops |
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Cause of mitral valve prolapse? *also describe what happens during systole. |
Myxoid (more gel-like) degeneration of what should be a firm rubber-like valve making it floppy. Etiology is unknown; may be seen in marfans and EDS. Mitral valve balloons into LA during systole |
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Clinical features of mitral prolapse? (murmur, complications? Tx? |
Mid-systolic click followed by regurgitation murmur; usually asymptomatic Complications (IE, arrhythmia, severe mitral regurgitation) RARE Treatment is valve replacement |
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During which cardiac phase does mitral regurgitation occur |
During systole. |
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Main causes of Mitral regurgitation? |
Main is complication of mitral valve prolapse. Other causes include LV dilation, infective endocarditis, ARHD, and papillary muscle rupture after MI. |
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Murmur of mitral regurgitation? |
holosystolic blowing murmur (increased during squat, because increased resistance systemically). Results in volume overload. |
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Major cause of mitral stenosis |
Chronic rheumatic disease (acute rheumatic disease causes mitral regurgitation) |
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In mitral stenosis volume overload leads to _______ of the LA. |
dilation. |
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Complications of volume overload from Mitral stenosis? |
pulmonary congestion (two comps of pulm congestion causes edema and alveolar hemorrhage -- macrophages within airspace consume blood giving you hemociderin laden macrophages (aka heart failure cells)
pulmonary HTN due to extra volume in pulmonary circuit... RH failure eventually
atrial fibrilation due to stretching of circuit-- abnormal movement of the atrium resulting in stasis, increasing the risk of mural thrombi formation |
