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41 Cards in this Set

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What is cardiac stenosis?
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.
What is cardiac insufficiency?
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.
What is valve prolapse?
When valve leaflets are "floppy" and prolapse or balloon back into the left atrium during systole.
Describe the different layers of a valve.
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.
What are two causes of Bicuspid aortic valve?
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)
What does a bicuspid aortic valve predispose you to?
Infective endocarditis
Describe what has happened in calcific aortic stenosis. What ages present with this?
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
What three things are Px c calcific aortic stenosis predisposed to getting?
1. angina/MI
2. CHF
3. syncope
Describe mitral annular calcification. Who is predisposed?
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
What is another name for mitral valve prolapse? Describe the pathology.
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.
What causes mitral valve prolapse? Who is predisposed?
It is really unknown but many believe it is a systemic developmental defect of connective tissue. Px with Marfan's are predisposed.
What are the symptoms of myxomatous defeneration of the mitral valve?
Often asymptomatic but will have a midsystolic click. Px can have chest pain, dyspnea, fatigue, and psych problems
What is the Hallmark pathological finding of a valve with Infective Endocarditis?
Tons of neutrophils found on valve.
Describe the pathology of Infective Endocarditis:
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)
A patient that is a drug user or has just had an invasive dental procedure may have what type of valvular disorder?
Infective endocarditis
Describe the differences in types of heart disease caused by Staph Aureus and Strept Viridians (alpha hemolytic):
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)
What are vegetations composed of?
Thrombotic debris, fibrin, inflammatory cells, microorganisms.
Six risk factors for developing endocarditis:
1. preexisting valvular disease
2. prosthetic valves
3. immune deficiency
4. diabetes mellitus
5. IV drug user
6. alcoholism

What is the main complication of infective endocarditis? What symptoms does this main complication cause? (4)
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.
If a Px comes in with a new regurgitant murmur and a blood culture showing infection, what disease can be suspected?
Infective endocarditis

Px at risk for infective endocarditis should be treated with what before they undergo a dental or surgical procedure?
Antibiotic prophylaxis to treat any transcient bacteremia so it doesn't seddle on valves.
What are the characterisitics of Nonbacterial Thrombotic Endocarditis? (Marantic Endocarditis)
There are small, sterile vegetations on cardiac valves that are composed of fibrin and platelets and are loosely attached to valves.
Who is most suseptable to getting Nonbacterial Thrombotic Endocarditis? (5)
Debilitated Px having:
1. Hypercoagulable state
2. Cancer (especially advanced mucin producing pancreatic adenocarcinomas)
3. Severe burns
4. DIC
5. Indwelling catheters
Describe the characterisitics of Endocarditis of Systemic Lupus Erythematosus (Liebman-Sacks Endocarditis):
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
Describe the characterisitics of acute rheumatic fever:
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).
In what age group is Acute Rheumatic fever seen in?
Ages 5-15 but can affect adults
Once you get acute rheumatic fever are you immune?
No, often Px have repeated "attacks" of rheumatic fever
How does Chronic Rheumatic Heart disease develop?
Years to decades after an acute rheumatic infection mitral stenosis can appear!
Describe the pathogenesis of acute rheumatic fever:
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.
Do genetics play a role in acute rheumatic fever?
Yes, on 3% of Px that get ARF actually had Group A strept pharyngitis.
Five major criteria for acute rheumatic fever (VIP)

What are the three minor criteria for ARF?
1. migratory polyarthritis of joints
2. pancarditis
3. subcutaneous nodules
4. erythema marginatum of skin
5. sydenham chorea

1. fever
2. arthralgias - arthritis + pain from inflammation
3. eleveated acute-phase reactants
What are the Jones criteria for Acute rheumatic fever?
Preceeding Group A Strep Infection + 2 Major Manifestation + 1 Minor Manifestation
What is the histological presentation of Acute Rheumatic fever?
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
What are the features of the heart of a Px with Chronic rheumatic heart disease?
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
What is Carcinoid heart disease? What parts of heart does it effect?
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.
What hormone is involved in Carcinoid heart disease?
Serotonin is involved (though not well understood) and it is because of this only the right side of the heart is effected.
What is a myxoma?
A primary benign tumor in the heart of adults, most often in the Left atria.
Describe the appearance of a myxoma:
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.
What are the symptoms of a myxoma?
1. syncope
2. changing murmur
3. fatigue
4. malaise
What is Rhabdomyoma? Who is effected by it?
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.
What is angiosarcoma?
A rare malignant tumor of the heart that has a high mortality