Valvular Hrt Disease Ii

Front 1

What is A multisystem disorder that develops as an autoimmune reaction to an infection by group A Streptococcus
• Affects many parts of the body: joints, heart (pericardium, myocardium, valves), skin, subcutaneous tissue, CNS
• Damage of cardiac valves is the most severe and clinically important, resulting in long-lasting

Back 1

Acute rheumatic fever

disease of poverty often due to overcrowding/hygiene used to be leading cause of child death 100 yrs ago

Front 2

1. ARF - acute rheumatic fever - involves what parts of heart tissue?
2. What is an Aschoff body associated w/ (what is it?)
3. 2 is composed of macrophages ka ?

Back 2

1. Pancarditis - endocardium, myocardium and pericardium
2. the RF myocarditis - it is a granuloma
3. Anitschkow cells / caterpillar cells due to wavy nucleus

Front 3

1. RF pericarditis is caused by? damage?
2. RF part that might cause arrhyghtmias like AV block, rarely leads to acute hrt failur?
3. the most imp. lesions in RF?

Back 3

1. fibrin exudate onto visceral surface, causes friction rub, resolves w/o damage
2. Myocarditis
3. Endocarditis - valvulitis - small vegetations develop along lines of closure of the valve, also involve valve leaflets and chordae tendinae

Front 4

1. Term for the small vegetation in RF endocarditis?
2. Organization of the vegetations result in?
3. meaning of term verrucous?

Back 4

1. Verrucous endocarditis -- verucous - wartlike
2. Scarring - fusion of lines of closure, thickening and fusion of chordae tendinae, distortion of valve leaflets
3. wart-like in latin

Front 5

1. types of inflammatory cells found in acute rheumatic valvulitis?
2. What is deposited on the endothelial surface?

vegetations are friable, can detach embolize and cause infarcts

Back 5

1. Lymphocytes, macrophages, plasma cells - no neutrophils
2. fibrin

Front 6

RHD - acute phase
1. Valve that is always involved? arrange others in order of involvement
2. Is regurg or stenosis more common?

Back 6

1. mitral > Aortic > tricuspid > pulmonic
2. Regurg in acute phase

Front 7

RHD - chronic phase
1. What is the defining feature due to?
2. progression of 1 is usu due to what?
3. Is regurg or stenosis more common?
Sx: fusion of valve leaflets, deformity of leaflets, thickening and fusion of chordae, 2nd calcification

Back 7

1. valvular damaging due to scarring
2. recurrent episodes of Group A strep
3. Stenosis

affected valves are at up risk of infective endocarditis, use 2nd antibiotic prophylaxis

Front 8

Chronic rheumatic mitral valvulitis:
1. term for appearance of mitral valve due to fusion of leaflets along lines of closure?
2. what happesn to mitral valve leaflet and chordae tendinae in this process?

Back 8

1. Fish mouth
2. Thickens

Front 9

1. What in RHD results from scarring and fusion of leaflets along lines of closure of the 2nd most commonly effected valve?
2. arrange following in order of causing aortic stenosis:
Congenital, Rheumatic, Calcific

Back 9

1. Rheumatic aortic stenosis
2. Calcific > Congenital > Rheumatic

Front 10

Bicuspid vs calcific aortic stenosis (AS)
1. often age releated, heaped up masses of calcium, lack of commissural fusion, due to wear and tear.. 30% of those >65 yo .. fxl stenosis is <1cm^2 or 1/3 of normal
2. Congenitally abnormal valve that becomes calcified later in life, partial fusion of cusps

Back 10

1. Calcific
2. Bicuspid

Aortic valve regurg is due to valvular or aortic root problems

Front 11

Age-Related Calcific AS
• Risk factors: Age, male sex, smoking, hypertension, high LDL cholesterol, low HDL cholesterol, diabetes, chronic kidney disease, elevated C-reactive protein
1. difference between AS & atherosclerosis?

Back 11

1. AS - activation of osteoblast-like cells
Atherosclerosis - activation and proliferation of smooth muscle cells

Front 12

1. Tertiary syphyllis leads to what?
2. A mitral valve leaflet that is floppy and moves into the lt atrium during systole? (underlying abnormality?)

Back 12

1. chronic inflammation of vasa vasorum resulting in necrosis and scarring of aortic wall - loss of elasticity leading to aneurysm and aortic regurg, narrows coronary ostia causes ischemic hrt disease
2. Mitral valve prolapse (myxomatous degeneration... mb due to Marfan syndrome (fibrillin gene)

Front 13

1. term that refers to interchordal ballooning of the poterior leaflet of the mitral valve, with prolapse into the atrial cavity
2. Condition in which chordae tendinae are elongated and thin?

Back 13

1. Hooding
2. mitral valve prolapse - mural thrombi may form at site where the prolapsing valve leaflet hits the atrial wall may lead to embolization

Front 14

1. What accumulates in the spongiosa in mitral valve prolapse?
2. What are complications of MVP?

vegetations are bulky & friable

Back 14

1. proteoglycans - leads to disorganization of collagen and elastin fibers
2. Mitral insufficiency
Arrhythmias
Infective endocarditis
iNfarcts from embolization

Front 15

1. Infective endocarditis is an infection of what?
2. Is fungus or bacteria more common?
3. condition that causes ruptured chordae?

Back 15

1. Hrt valve - often forms vegetations consisting of fibrin, inflammatory cells and bacteria
2. bacteria
3. Infectious endocarditis

Front 16

Infective endocarditis: Acute
1. Affects normal or abnormal valves
2. Caused by highly virulent bacteria, esp. S. aureus
3. Rapid progression over days
4. High mortality rate: >50%

Back 16

Infective endocarditis: Subacute
1. Affects abnormal valves/heart: MVP, calcific AS, bicuspid AV, artificial valves, congenital heart defects
2. Caused by organisms of low virulence, most often S. viridans
3. Slow progression over several weeks
4. Low mortality rate: 10%

Front 17

Infective endocarditis manifestations:
fever, hrt murmur, chills/night sweats, anorexia
Lab: elevated ESR, CRP, circulating immune complexes anemia

Back 17

peripheral manifestations of infective endocarditis:
1. Janeway lesions, Splinter (subungal) hemorrhages, Osler nodules, Roth spots

Front 18

Libman Sacks vs Marantic endocarditis:
1. Associated w/ cachexia, small thrombi on line of closure, from a combo of endothelial injury and thrombotic tendency small hrt effect but embolizes
2. Manifestation of SLE and antiphospholipid Ab syn. Thrombotic vegetations on valve cusps/leaflets, mb necrosis, may lead to valvular insufficiency or embolism

Back 18

1. Marantic - cachexia - marasmus
2. Libman-Sacks Endocarditis

Front 19

1. What is a well differentiated neoplasm of neuroendocrine origin, arise from gut cells of the diffuse component of the endocrine sys. Often secrete Serotonin
2. When does the syndrome of 1 manifest?
3. Description of the cells involved?

Back 19

1. Carcinoid
2. carcinoids metastasize to liver
3. Salt and pepper due to the chromatin

Front 20

1. episodic skin flushing, cramps, N/V/D, rt hrt disease due to effects of serotonin (fibrin deposition); tricuspid regurg is most frequent consequence
2. when is lt sided involvement seen?

Back 20

1. Carcinoid syndrome
2. Carcinoid metastasis to the lungs