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51 Cards in this Set
- Front
- Back
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hyemodynamic classification of valvular heart dz
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1. stenosis: not completely open, effects cusps/leaflets, chronic process
2. insufficiency: not close completely; valve or supporting structures affected; acute or chronic process 3. mixed |
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aortic insufficiency
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dilation of ascending aorta associated with HTN/aging
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mitral insufficiency
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mitral valve prolapse (floppy mitral valve)
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mitral valve prolapse seen in...
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7%
young women myxoid degen of ground substance of the valve (marfans) |
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what is rheumatic fever and RHD
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acute, recurrent, inflammatory dz due to immune cross-reaction between streptococcal and tissue antigens or streptococcal-induced autoimmune reaction against normal tissue Ags
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pathophysiology of ARF
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-antibodies to strep Ags (M Prs) cross-react with host glycoprotein tissue Ags
-step induced autoimmune reaction |
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ARF follows what infection
first attack seen when? (lab test) |
group A streptococcal pharyngitis
5-15 years ASO |
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acute forms of ARF
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1. migratory polyarthritis
2. carditis 3. chorea 4. erythema marginatum 5. subcutaneous nodules |
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symptoms of acute ARF
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fever
malaise increased erythocyte sedimentation rate |
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migratory polyarthirtis characteristics
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-most common feature
-large joints, no sequelae -painful, hot, red, swollen |
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carditis characteristics
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-most feared
-initial attack in childhood -MORTALITY!! |
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erythema marginatum characteristics
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-evanescent
-bathing suit distribution -trunk and extremities -children > adults |
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subcutaneous nodules characteristics
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-firm
-painless -over bony prominences -children > adults -overlies extensor tendons |
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chronic RHD
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-deformed, scarred valves
-acquired mitral stenosis -diastolic pressure is higher in LA than LV |
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pathology of ARF
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-fibrinous pericarditis (pleural and other serous effusions)
-myocarditis (aschoff bodies) -endocarditis (primarily valvular) |
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aschoff body
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-perivascular
-exudative: local interstitial myocardial inflammation -cellular: swollen, fragmented collagen, anitschkow cells (owls eye), multinucleated giant cells |
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cuase of most deaths in early stages of ARF
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myocarditis - may lead to HF
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endocarditis in ARF
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-valve swollen, inflamed, red
-fibrin verrucae along forward flow line of closure (beadlike, tiny, warty, rubbery veggies; non-friable, not a source of PE) -areas subject to greatest hemodynamic stress (valve closure, posteral wall of LA - McCallum Patch) |
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chronic RHD pathological findings
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as a consequence of healing:
-progressive scarring and deformation lead to commisural fusion, leaflet thickening, mitral stenosis, and short, thick fused chordae -LA dilation +/- mural thrombus |
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fish mouth or buttonhole valve seen in
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chronic RHD
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types of aortic stenosis
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-valvular
-subvalvular -supravalvular |
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types of valvular aortic stenosis
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-congenital bicuspid
-senile calcific -post-inlammatory RHD |
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pathophys of congentical bicuspid
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degenerative commisures not fused
assoc with aortic dissection |
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pathophys of senile calcific
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> 70 yo
-degenerative commisures not fused -normal valve, 3 cusps |
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pathophys of postinflamm RHD
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with mitral stenosis
-commisures fused |
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valvular insufficiency can be caused by
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-nondissecting aortic aneurysm
-rheumatic HD (with mitral valve dz) -syphilitic aortitis (w/ dilatation of aortic valve ring) |
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symptoms of aortic stenosis
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outflow obstruction:
-LVH -chest pain -syncope -dysrhythmia CHF IE |
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mitral valve prolapse epidem
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young female (32yo)
marfans, CT disorders |
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mitral valve pathophys
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-mitral valve leaflets prolapse into LA during systole
-stretching of posterior valve leaflet producing floppy cusp and prolapse into atria during systole |
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pathological findings of mitral valve prolapse
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myzomatous thickening of spongiosa and thinning of fibrosa - secondary fibrosis without commissural fushion
posterior > anterior -interchordal hooding -chordae tendineae: attentuation, rupture, distribution -annulus dilation |
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clinical presentation of mitral valve prolapse
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-benign
-midsystolic click +/- late systolic murmur (insufficiency) -palpitations, dypsna, chest pain, syncope |
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complications of mitral valve prolapse
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-valve insufficiency
-IE -embolism -dysrhythmia (tachy, sudden death) |
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predisposing conditions of IE
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-mitral valve prolapse
-calcifc aortic stenosis -bicuspid valve +/- calcification |
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organisms involved in IE
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early: s. aureus, s. epidermis
late: s. viridians, enterococcus |
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R sided IE think -- ?
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intravenous substance abuse
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clinical presentation of acute IE
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-virulent
-s. aureus (often secondary to infection occuring elsewhere in body) -fever, weakness, chills, murmur -CHF, sepsis, embolization, glomerulonephritis |
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clinical presentation of subacute IE
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-bacterial
-damaged valves -strep viridians -pts with congentical HD or preexisting valvular HD -mitral, mitral and aortic, tricupsid -insidious, weak, weight loss, night sweats, anemia, embolization, unchanging murmur, glomerulonephritis |
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tricupsid subacture IE --think ??
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intravenous drug user (staph)
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pathological presntation of IE
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-vegetations: large, soft, friable easily detached veggies consisting of fibrin and inflamm cells and bacteria
-ulceration often w/ perforation of the valve cusps or rupture of chordae tendineae -embolization: cns, kidneys, spleen |
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embolization of IE
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-can result in septic infarct
-focal necrotizing glomerultisi cuased by immune complex disorder by septic emboli |
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external signs of IE
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-splinter hemorrhages
-janeway lesions -olser's nodules -conjunctival petechiae |
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2 types of non infective endocarditis
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-nonbacterial thrombotic endocarditis
-libman-sacks endocarditis |
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marantic endocarditis presentation
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-small, sterile, fibrin randomly arranged along line of closure of valve leaflets
-mitral valve -debilitation (cancer, cachectic), coagulopathy -PE emboli!! STERILE |
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libman-sacks presentation
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-SLE
-mitral +/- tricuspid valvulitis -berry verrcuae anywhere! -on either side of valve leaflets |
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mitral annulus calcification pathophys
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-non-inflamm calcific deposits
-mitral valve prolapse -elderly women -inc LV pressure -dysrhythmias |
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complicatiosn of mitral annulus calcification
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-malfunction
-infection -hemorrhage -thrombosis/embolism |
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pathophys of carcinoid syndrome
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release of bioactive products by carcinoid tumors esp serotonin (vasoactive peptides and amines)
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clinical features of carcinoid syndrome
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episodic flushing of skin
cramps nausea, vom, diarrhea |
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tumor assoc with carcinoid syndrome
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-GI with liver mets
-non-GI carcinoids without mets |
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lesions seen in carcinoid syndrome
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-endocardial fibrointimal foci of thickening involving predom the RV, tricuspid valve and pulmonic valve
-areas of thickening due to prolif of smooth m and collagen fibers in mucopolysacc matrix **endocardial plaques involving mural endocardium |
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location of carcinoid syndrome
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Right Side
lung MAO inactivated serotonin and bradykinin L side: phen-fen; methylsergide and or ergotamine tx |
