Z-Patho Of Valvular And Neoplastic Heart Disease

Front 1

What is cardiac stenosis?

Back 1

Failure of valve to open fully - impeding forward flow. Valvular stenois is almost always due to a cuspal abnormality and is usually a chronic process.

Front 2

What is cardiac insufficiency?

Back 2

Failure of valve to close completely allowing reversed flow (regurgitation). Insufficiency may result from an intrinsic disease of the valve cusps or damage to or distortion of supporting structures. If may appear acutely or chronically.

Front 3

What is valve prolapse?

Back 3

When valve leaflets are "floppy" and prolapse or balloon back into the left atrium during systole.

Front 4

Describe the different layers of a valve.

Back 4

Valves are lined by endothelium, have a loose connective tissue near their core, as well as a very thick dense collagenous core (called fibrinosum) near the outflow surface, and lastly have an elastin layer below the inflow surface.

Front 5

What are two causes of Bicuspid aortic valve?

Back 5

1. genetic - incomplete separation as an embryo resulting in one larger cusp with a midline raphe
2. developed bicuspid valve due to progressive degenerative calcification (usually occurs in 50-60's)

Front 6

What does a bicuspid aortic valve predispose you to?

Back 6

Infective endocarditis

Front 7

Describe what has happened in calcific aortic stenosis. What ages present with this?

Back 7

Calcific aortic stenosis can occur as a result of calcium phosphate deposits on the valves that protrude through outflow surfaces and prevent opening of cusps. This occurs in nL Px ages 70-80's and in Px with bicuspid valve in 50-60's

Front 8

What three things are Px c calcific aortic stenosis predisposed to getting?

Back 8

1. angina/MI
2. CHF
3. syncope

Front 9

Describe mitral annular calcification. Who is predisposed?

Back 9

This disease involves calcific deposits forming in a ring on the mitral valve. These do not usually affect valve function but are predisposed in patients with myxomatous degeneration (MVP) and elevated L ventricular pressure (from high BP, aortic stenosis, and hypertrophic cardiomyopathy). In Px over 60y/o

Front 10

What is another name for mitral valve prolapse? Describe the pathology.

Back 10

Myxomatous Degeneration of the Mitral Valve - disease enlarged leaflets of the mitral valve that prolapse into the L atrium during systole. These leaflets have a characteristic mucoid/myxomatous material (turn blue in musin stain). Also the chordae tendinae are elongated and thinned.

Front 11

What causes mitral valve prolapse? Who is predisposed?

Back 11

It is really unknown but many believe it is a systemic developmental defect of connective tissue. Px with Marfan's are predisposed.

Front 12

What are the symptoms of myxomatous defeneration of the mitral valve?

Back 12

Often asymptomatic but will have a midsystolic click. Px can have chest pain, dyspnea, fatigue, and psych problems

Front 13

What is the Hallmark pathological finding of a valve with Infective Endocarditis?

Back 13

Tons of neutrophils found on valve.

Front 14

Describe the pathology of Infective Endocarditis:

Back 14

This is caused by invasion of heart valves of myocardium by an organism leading to formation of bulky vegitations. Has many causes: RHD, MVP, Calcific aortic stenosis, Strept viridans (damaged valves), Strept aureus (nondamaged valves), and Staph epidermis (prostetic valves)

Front 15

A patient that is a drug user or has just had an invasive dental procedure may have what type of valvular disorder?

Back 15

Infective endocarditis

Front 16

Describe the differences in types of heart disease caused by Staph Aureus and Strept Viridians (alpha hemolytic):

Back 16

Staph Aureus - a highly virulent organism that can cause acute infective endocarditis that causes severe destruction of previously nL valves.

Stept Viridians - is a low virulence organism that can cause Subacute infective endocarditis, causing a lesser degree of valular damage on already damaged valves (MVP, AS, etc)

Front 17

What are vegetations composed of?

Back 17

Thrombotic debris, fibrin, inflammatory cells, microorganisms.

Front 18

Six risk factors for developing endocarditis:

Back 18

1. preexisting valvular disease
2. prosthetic valves
3. immune deficiency
4. diabetes mellitus
5. IV drug user
6. alcoholism

Front 19

VIP

What is the main complication of infective endocarditis? What symptoms does this main complication cause? (4)

Back 19

Vegetations can flick off and cause systemic microemboli that present as:
1. splinter hemorrhages - in nail bed
2. Roth spots - retinal hemorrhages
3. Janeway lesions - hemorrhagic nontender lesions on palms and soles
4. Osler nodes - painful raised subQ nodules on palms, fingers, and toes.

Front 20

If a Px comes in with a new regurgitant murmur and a blood culture showing infection, what disease can be suspected?

Back 20

Infective endocarditis

Front 21

VIP VIP VIP

Px at risk for infective endocarditis should be treated with what before they undergo a dental or surgical procedure?

Back 21

Antibiotic prophylaxis to treat any transcient bacteremia so it doesn't seddle on valves.

Front 22

What are the characterisitics of Nonbacterial Thrombotic Endocarditis? (Marantic Endocarditis)

Back 22

There are small, sterile vegetations on cardiac valves that are composed of fibrin and platelets and are loosely attached to valves.

Front 23

Who is most suseptable to getting Nonbacterial Thrombotic Endocarditis? (5)

Back 23

Debilitated Px having:
1. Hypercoagulable state
2. Cancer (especially advanced mucin producing pancreatic adenocarcinomas)
3. Severe burns
4. DIC
5. Indwelling catheters

Front 24

Describe the characterisitics of Endocarditis of Systemic Lupus Erythematosus (Liebman-Sacks Endocarditis):

Back 24

SLE is a connective tissue autoimmune disease that causes:
1. small, sterile vegetations
2. most commonly on mitral and tricuspid valve
3. often associated with inflammation and necrosis of valve
4. can cause valve fibrosis and deformity

Front 25

Describe the characterisitics of acute rheumatic fever:

Back 25

An acute, immunologically mediated (body makes antibodies), multisystem inflammatory disease that often involves the heart. It occurs weeks after a Group A Strep Pharyngitis infection (beta hemolytic).

Front 26

In what age group is Acute Rheumatic fever seen in?

Back 26

Ages 5-15 but can affect adults

Front 27

Once you get acute rheumatic fever are you immune?

Back 27

No, often Px have repeated "attacks" of rheumatic fever

Front 28

How does Chronic Rheumatic Heart disease develop?

Back 28

Years to decades after an acute rheumatic infection mitral stenosis can appear!

Front 29

Describe the pathogenesis of acute rheumatic fever:

Back 29

ARF is a hypersensitivity reaction where the body creates antibodies directed against M protein of Streptococci cross-react with similar tissue glycoproteins of heart, joints, brain, skin, and other organs.

Front 30

Do genetics play a role in acute rheumatic fever?

Back 30

Yes, on 3% of Px that get ARF actually had Group A strept pharyngitis.

Front 31

Five major criteria for acute rheumatic fever (VIP)

What are the three minor criteria for ARF?

Back 31

MAJOR
1. migratory polyarthritis of joints
2. pancarditis
3. subcutaneous nodules
4. erythema marginatum of skin
5. sydenham chorea

MINOR
1. fever
2. arthralgias - arthritis + pain from inflammation
3. eleveated acute-phase reactants

Front 32

What are the Jones criteria for Acute rheumatic fever?

Back 32

Preceeding Group A Strep Infection + 2 Major Manifestation + 1 Minor Manifestation

Front 33

What is the histological presentation of Acute Rheumatic fever?

Back 33

1. Inflammation of all three layers of cardium
2. Aschoff bodies - made from tons of macrophages
3. Pericarditis with fibrinous exudates causing a "bread and butter" appearance
4. Verrucae - small sterile vegetations on valve cusps

Front 34

What are the features of the heart of a Px with Chronic rheumatic heart disease?

Back 34

Acute inflammation that resulted in fibrosis causing:
1. thickened valve leaflets
2. classic fish mouth stenosis of any valve but most frequently the MITRAL valve

Front 35

What is Carcinoid heart disease? What parts of heart does it effect?

Back 35

A plaque-like, MUCOPOLYSACCHARIDE MATRIX thickening of the RIGHT side of the hearts endocardium and valves. This is caused by the metastasis of carcinoid tumors of the GI, lung, and liver.

Front 36

What hormone is involved in Carcinoid heart disease?

Back 36

Serotonin is involved (though not well understood) and it is because of this only the right side of the heart is effected.

Front 37

What is a myxoma?

Back 37

A primary benign tumor in the heart of adults, most often in the Left atria.

Front 38

Describe the appearance of a myxoma:

Back 38

Is is a globular mass with gelatinous appearance that is formed from a mucopolysaccride matrix. It forms a ball-valve obstruction that moves through the AV valves during systole.

Front 39

What are the symptoms of a myxoma?

Back 39

1. syncope
2. changing murmur
3. fatigue
4. malaise

Front 40

What is Rhabdomyoma? Who is effected by it?

Back 40

A Rhabdomyoma is a tumor of the heart in children and infants caused by a defect in apoptosis during development. They protrude into the ventricular chambers of the heart.

Front 41

What is angiosarcoma?

Back 41

A rare malignant tumor of the heart that has a high mortality