Pathoma - Valvular Disorders - Fundamentals Of Pathology

Front 1

What types of valvular disorders may we get?

Back 1

(1) Stenosis (narrows)
(2) Regurgitation (backflow)

Front 2

What is acute rheumatic fever?

Back 2

Systemic complication of pharyngitis due to GAS.

Front 3

Acute rheumatic fever affects which age group of patients and when does it present?

Back 3

Affects children 2-3 weeks after strep throat

Front 4

Acute rheumatic fever is caused by _____________.

Back 4

molecular mimicry; bacterial M protein resembles human tissues

Front 5

Diagnosis of ARF is based on what?

Back 5

You need evidence of a prior GAS infection (ASO or anti-DNase B titer) and the above.

Front 6

What might this be? What could it lead to?

Back 6

Tiny vegetations on heart seen in ARF due to endocarditis. May lead to mitral regurgitation.

Front 7

As far as myocarditis in ARF is concerned, what may we see on histology?

Back 7

The image shows an aschoff body. It's a focus of chronic inflammation with giant cells and fibrinoid material (degenerated collagen) with a group of cells called the Anitschkow cells.

Front 8

These cells are seen in a biopsy of the myocardium of a child with a previous strep throat. What are they called?

Back 8

Anischkow cells, seen in Aschoff bodies. It's a hallmark cell.

Note the "caterpillar" nucleus.

Front 9

What is the MCC of death during the acute phase of acute rheumatic fever?

Back 9

Myocarditis (may show as friction rub)

Front 10

What is chronic rheumatic valve disease?

Back 10

Repeated infections lead to persistent attacks on valves with scarring. Scarring results in stenosis. Almost always involves the mitral valve.

Front 11

If ARF does involve a valve outside of mitral valve it will involve what?

Back 11

aortic valve

Front 12

Complication of chronic rheumatic valve disease?

Back 12

Damage to the valves may lead to endocarditis.

Front 13

What is this?

Back 13

"Fishmouth appearance" of aortic valve. Fusion of commissures is seen. Due to chronic rheumatic valve disease.

Front 14

Normally the aortic valve is ______ cm^2 but in aortic stenosis it becomes less than _____ cm^2.

Back 14

4;1

Front 15

Aortic stenosis is a ____________ disorder.

Back 15

"wear and tear"

It is usually due to fibrosis and calcification from "wear and tear".

Front 16

When does aortic stenosis typically present?

Back 16

Late adulthood (>60)

Front 17

What would hasten the disease onset of aortic stenosis?

Back 17

Bicuspid aortic valve

Front 18

What is this and what age would the patient present?

Back 18

Aortic stenosis.

Late adulthood, > 60 yo

Front 19

How to distinguish aortic stenosis from wear and tear with aortic stenosis from chronic rheumatic valve disease?

Back 19

(1) CRVD is going to have coexisting mitral stenosis
(2) CRVD is going to have fusion of the commissures

Front 20

Compensation by the heart to aortic stenosis leads to a _______________________.

Back 20

prolonged asymptomatic stage

Front 21

You auscultate a 70 year old man. He is known to have a mild anemia. You hear a "click" on auscultation during systole followed by a crescendo-decrescendo murmur. What could this be? Explain the findings.

Back 21

(1) Stenosed valve may lead to microangiopathic hemolytic anemia. Poor RBCs are smashed into the degenerated calcified valve.
(2) Heart will eventually blow open the stenosed valve (click) creating a rush of blood (crescendo) followed by a decrescendo.

Front 22

Complications of aortic stenosis include [...]

Back 22

(1) Concentric left ventricular hypertrophy
(2) Angina and syncope with exercise (limited ability to increase blood flow across the valve)
(3) Microangiopathic hemolytic anemia

Front 23

Treatment of aortic stenosis?

Back 23

You replace the valve. This is done after the onset of complications (normally).

Front 24

What is aortic regurgitation?

Back 24

Backflow of blood from the aorta into the left ventricle during diastole.

Front 25

Aortic regurgitation arises due to _________________ or ____________.

Back 25

aortic root dilation (e.g., syphilitic aneurysm); valve damage (e.g., IE)

Front 26

Clinical features of aortig regurgitation?

Back 26

(1) Early, "blowing" diastolic murmur
(2) Hyperdynamic circulation
- Bounding pulses (strong pulse)
- Pulsating nail bed
- Head bobbing
(3) LV dilation and eccentric (not concentric, or the entire ventricle) hypertrophy

Front 27

Why may the head of a patient with aortic regurgitation bob during regular heart beats?

Back 27

Hyperdynamic circulation. Due to a high pulse pressure.

Front 28

In aortic regurgitation the diastolic pressure ___________ and the systolic pressure ___________.

Back 28

decreases; increases

Front 29

Treatment of aortig regurgitation?

Back 29

Valve replacement when LV dysfunction develops.

Front 30

What is mitral valve prolapse?

Back 30

Ballooning (oppsvulming) of mitral valve into left atrium during systole.

Front 31

Mitral valve prolapse is due to what?

Back 31

Myxoid degeneration in valve making it floppy. Etiology however is unknown.

Front 32

A recent rigorous echocardiographic study indicated that MVP occurs in about _____% of the population and is more common among _________ (men/women), especially those with ______, ______ bodies.

Back 32

2%; women; thin; lean

Front 33

A person with mitral valve prolapse may have a comorbid conditions involving another organ. What is it?

Back 33

Adult polycystic kidney disease

Front 34

Mitral valve prolapse may be seen in these connective tissue diseases.

Back 34

Marfan's or Ehler's danlos

Front 35

You auscultate a patient with polycystic kidney disease. What might you expect to hear on auscultation?

Back 35

A midsystolic "click", like opening a parachute. May have some regurgitation murmur.

Front 36

Mitral valve prolapse is usually ____________, however in some cases it may lead to ________________.

Back 36

asymptomatic; sudden death

Front 37

Complications of mitral valve prolapse?

Back 37

They are rare.

(1) Infectious endocarditis (dmg valve over time)
(2) Arrhythmia
(3) Severe mitral regurgitation

Front 38

Treatment of mitral valve prolapse?

Back 38

Valve replacement

Front 39

What is this? We're looking from the atrium.

Back 39

Mitral valve prolapse.

Front 40

Mitral regurgitation usually arises as a complication of ______.

Back 40

MVP

Front 41

Except for MVP, what other causes of mitral regurgitation are there?

Back 41

(1) LV dilation
(2) Infective endocarditis (dmges valve leaflets)
(3) ARF
(4) Papillary muscle rupture after MI

Front 42

How does mitral regurgitation sound like on auscultation?

Back 42

Holosystolic and "blowing"

Front 43

A patient with known infective endocarditis has a holosystolic blowing type of murmur. You can barely hear it. How could you make it louder?

Back 43

Tell the patient to squat or expire (increased preload to LV)

Front 44

Mitral stenosis is usually due to what?

Back 44

Chronic rheumatic valve disease

Front 45

Acute rheumatic disease creates ____________ and chronic rheumatic disease creates___________.

Back 45

regurgitation; stenosis

Front 46

What would you hear on auscultation of a patient with mitral stenosis?

Back 46

Opening snap followed by a diastolic rumble

Front 47

A key complication of mitral stenosis.

Back 47

Volume overload leads to dilation of LA:

(1) Pulmonary congestion with pulmonary HTN
(2) Atrial fibrillation (abnormalities of conducting system due to dilation)

Front 48

What is this associated with?

Back 48

This is a mural thrombus in LA. Could be due to chronic mitral stenosis with LA dilation.