Valvular Disease And Cardiomyopathies

Front 1

What are 3 forms of aortic stenosis?

Back 1

1. degenerative calcification of normal tricuspid aortic valve
2. degenerative calcification of a bicuspid aortic valve
3. aortic stenosis due to chronic rheumatic aortic valvulitis

Front 2

How does dystrophic calcification of the aortic valve lead to stenosis?

How does the effect compare between tricuspid and bicuspid aortic valves?

Back 2

Wear and tear on valves --> calcified nodules on outflow surface of valves, fused commissure--> more difficult for valves to open --> stenosis, concentric LV hypertrophy

Bicuspid accumulate damage and calcium sooner

Front 3

Clinical features of aortic stenosis?

Back 3

angina, syncope, CHF

Front 4

What is myxomatous mitral valve?

Back 4

Ballooning of mitral leaflets, chordae tendinae elongated, fibrosa thin

Front 5

Clinical features of myxomatous mitral valve?

Back 5

Mid-systolic click

Can have chest pain, palpitations, dyspnea, regurgitation

can develop regurgitation, infective endocarditis, sudden death due to ventricular arrhythmia

Front 6

What happens in acute rheumatic fever?

Back 6

antibodies against M proteins of Group A strep cross-react with glycoproteins in the body

Front 7

What are the clinical manifestations of acute rheumatic fever?

Back 7

migratory polyarthritis
carditis

Front 8

What are the Jones criteria for diagnosing acute rheumatic fever?

Back 8

1. carditis
2. migratory polyarthritis
3. subcutaneous nodules
4. erythema marginatum
5. Sydenham chorea (involuntary movements)

must have at least 2

Front 9

What are Aschoff bodies?

Anitschow cells?

Back 9

Aschoff bides = central zone of degenerating, hypereosinophilic material infiltrated by T lymphocytes and large macrophages (Anitschkow cells)

Front 10

What happens in chronic rheumatic fever?

Back 10

Scarring of valves (mitral, aortic)

Front 11

What is the morphology of chronic rheumatic valvulities?

Back 11

thick leaflets, chordae tendinae are short and thick

Left atrial dilation from stenosis of mitral valve
Fusion of all commissures in aortic valve

Front 12

What is infective endocarditis?

Back 12

infection of the cardiac valves, usually bacterial

Front 13

What are 2 traditional forms of infective endocarditis?

Back 13

acute - rapid, highly virulent
subacute - insidious, infects previous abnormal valve, low virulence

Front 14

How does infective endocarditis come about?

Back 14

Abnormal valve produces jet streams --> platelet-fibrin deposits form on valves --> become infected by bacteria

Front 15

What are the clinical features of infective endocarditis?

Back 15

acute: fever, chills weakness

Subacute: fever may be absent, non-specific

Both can have murmur, petechiae hemorrhages

Front 16

What are 3 complications of infective endocarditis?

Back 16

Glomerulonephritis, septicemia, emboization

Front 17

What are 3 agents of infective endocarditis?

Back 17

1. Viridans Strep - infects previously damaged valves
2. S. aureus - infects normal valves
3. HACEK group

Front 18

What is marantic endocarditis (non-bacterial)?

Back 18

Sterile vegetations (fibrin, platelets) on valves organize into strands called Lambl excrescences

Occurs in hypercoagulable states

Front 19

What is the difference between a primary and a secondary cardiomyopathy?

Back 19

Primary - disease confined to heart
Secondary - multi-organ disorder

Front 20

What is the morphology of dilated cardiomyopathy?

Back 20

Dilation of all four chambers from eccentric hypertrophy of the myocardium

Front 21

What are the causes of dilated cardiomyopathy?

Back 21

viral (Coxasackie B or enterovirus)
alcohol
genetic (lamins A and C, B-myosin heavy chain, dystrophin, a-cardiac actin mutations)
peripartum state (pregnancy-induced hypertension, volume overload, cardiac defect)

Front 22

What are the clinical features of dilated cardiomyopathy?

Back 22

CHF (dilation of LV), mitral insufficiency, abnormal cardiac rhythms, emboli

Front 23

What is the morphology of hypertrophic cardiomyopathy?

Back 23

Myocardial hypertrophy without dilation; thick interventricular septum;

Myofiber disarray, fibrosis, sclerosis of blood vessels

Front 24

What is the pathogenesis of hypertrophic cardiomyopathy?

Back 24

mutations in sarcomeric proteins (dominant) --> B-myosin heavy cahin, myosin-binding protein C, troponin T

Front 25

What are the clinical features of hypertrophic cardiomyopathy?

Back 25

Impaired diastolic filling --> reduced CO, increase in pulm pressure --> dyspnea

Systolic ejection murmur if outflow obstruction

Ischemia

Front 26

What are the complications of hypertrophic cardiomyopathy?

Back 26

arrhythmias, CHF, sudden death

Front 27

What is the morphology of restrictive cardiomyopathy?

Pathogenesis?

Back 27

Ventricles mostly normal (may be enlarged), chambers not dilated

Infiltrative process of myocardium --> reduced ventricular compliance --> impaired diastolic filling

Front 28

What are the causes of restrictive cardiomyopathy?

Back 28

idiopathic, amyloidosis, hemochromatosis, sarcoidosis, radiation fibrosis, inborn error of metabolism

Front 29

What are 2 variants of restrictive cardiomyopathy?

Back 29

1. Endomyocardial fibrosis - fibrosis of endocardium and subendocardium --> reduced compliance

2. Loeffler endomyocarditis - dense endocardial fibrosis + peripheral eosinophilia

Front 30

What is arrhythmogenic right ventricular carddiomyopathy?

Back 30

dilation of RV associated with thinning of the wall and fibrosis --> right heart failure or sudden cardiac death

Front 31

What is myocarditis?

3 variants?

Back 31

Inflammation of heart causing damage to myocardium

Lymphocyte, hypersensitivity (eosinophils), Giant cell (macrophages and giant cells)

Front 32

What are the clinical features of myocarditis?

Back 32

asymptomatic

fatigue, dyspnea, palpitations, pain, fever

sudden CHF, arrhythmias

Front 33

What is preicarditis?

3 types?

Back 33

Inflammatory infiltrate is in the pericardial sac

fibrinous (fibrin)
fibrinopurulent (bacteria)
fibrinohemorrhagic (malignancy)

Front 34

acute pericarditis?

chronic?

constrictive?

Back 34

acute = fibrinous and fibrinopurulent, can resolve completely

chronic = pericarditis with scarring

constrictive = fibrosis in pericarditis so extensive as to impair diastole

Front 35

clinical findings of pericarditis?

Back 35

atypical chest pain (not exertion related)
tamponade (fill sac with fluid --> compress LV, inhibit diasolic filling)

Front 36

What are 3 types of pericardial effusions and their cuases?

Back 36

Serous: CHF, hypoalbuminemia
Serosanguinous: trauma, malignancy, ruptured MI
Chylous: lymphatic obstruction