Valvular Heart Disease Flashcards
1
Q
Cardiac Valves
- Components
- Covered in…
A
- Components
- Leaflet/cusp
- Commissure
- Annulus: anchors to heart wall
- Chordae tendineae & papillary muscle
- Covered in…
- Endothelium / endocardium w/ a fibrocollagenous core
2
Q
Types of Valvular Pathology
- Prolapse
- Stenosis
- Insufficiency
- Regurgitation
A
- Prolapse
- Leaflets reflect backwards
- Stenosis
- Orifice is narrowed
- Insufficiency
- Leaflets don’t come together
- Regurgitation
- Blood flows backwards
3
Q
Valve Disease
- Most common affected valves
- Most common etiology
- Pulmonic stenosis etiology
A
- Most common affected valves
- Mitral
- Aortic
- Most common etiology
- Calcific degeneration
- Pulmonic stenosis etiology
- Congenital
4
Q
Mitral Valve Prolapse
- General
- Signs & symptoms
- Pathology
- Histology
- Complications
A
- General
- Most common mitral valve disease
- Young to middle aged women
- ~3% of the adult population
- Signs & Symptoms
-
Mid systolic click w/ late systolic murmur
- Click: valve flapping backward
- Murmur: blood flowing backward
- Cardiac arrhythmia
- “Chest fluttering”
- No symptoms at all
-
Mid systolic click w/ late systolic murmur
- Pathology
- Myxomatous degeneration of the mitral valve
- Sometimes associated w/ connective tissue diseases (i.e. Marfan’s)
-
Hooding of valve leaflet
- AKA parachute deformity, billowing
- Redundant folds in valve leaflet
- Histology
- Acellular material accumulates in valve
- Disrupts normal fibrous structure of the valve
- Looks pink on H&E
- Complications
- Cardiac arrhythmia
- Valve incompetence or rupture
- Chordae tendinae can get thinned & elongated –> rupture
- Infective endocarditis (problem w/ all abnormal valves)
- Stroke from thrombus (problem w/ all abnormal valves)
5
Q
Mitral Valve Stenosis
- General
- Pathology
- Clinical findings & complications
- Which heart chamber would first become abnormal as a result of mitral stenosis
- Why atrial fibrillation
- Common causes
A
- General
- Thickenign & calcificaiton of mitral valve
- Almost always a result of rheumatic heart disease
-
Can be a result of calcific degeneration of valve annulus (ring)
- Age-related change
- Pathology
- Annular calcification
- Leaflet calcification
- Clinical findings & complications
- Diastolic murmur
- Cardiac arrhythmia (atrial fibrillation)
- Infective endocarditis (problem w/ all abnormal valves)
- Stroke from thrombus (problem w/ all abnormal valves)
- Which heart chamber would first become abnormal as a result of mitral stenosis
- Left atrium
- Why atrial fibrillation
- Atrial chamber dilates –> improper electrical signal conduction
- Mitral valve narrowed or blocked
- Common causes
- Degenerative (old age)
- Rheumatic heart disease
6
Q
Aortic Stenosis
- General
- 3 main causes
- Degenerative calcification
- Congential bicuspid valve
- General
- Clinical complications
- Clinical complications (regardless of cause)
- Difference b/n bicuspid & tricuspid aortic stenosis
- Rheumatic heart disease
A
- General
- Most common valvular disease
- 3 main causes
- Degenerative calcification
- Congenital bicuspid valve
- Rheumatic heart disease
-
Degenerative calcification
- 2% prevalence
- In a normal 3-cusp valve
- Age related (degenerative)
- 50-70 years old
- Cacified & stenotic valve
- Congenital bicuspid valve
- General
-
Most common congential CV abnormality (~1% incidence)
- Responsible for ~50% of aortic stenosis cases
- Aortic valve composed of 2 cusps instead of 3
- Cusps may be of equal size, or one might be slightly larger
-
Most common congential CV abnormality (~1% incidence)
- Clinical complications
- Aortic dissection
- Endocarditis (abnormal valve)
- Clinical complications (regardless of cause)
-
Massive left ventricular hypertrophy (caused by…)
- Aortic stenosis: valve disease
- Hypertension
- Hypertrophic cardiomyopathy: disease of young athletes
- Mitral regurgitation
- Increased pressure in left ventricle
- Aortic dissection
- Aortic valve perforation
- As valve degenerates
- Myocardial infarction
- Difficulty perfusing coronary arteries
- Supply-demand mismatch
- Cardiac arrhythmia
- Heart failure
-
Massive left ventricular hypertrophy (caused by…)
-
Difference b/n bicuspid & tricuspid aortic stenosis
- Bicuspid: younger (50s)
- Tricuspid: older (70s+)
- General
7
Q
Carcinoid Heart Disease
- General
- Clinical considerations
A
- General
- Unique cause of right-sided valve disease
- Carcinoid syndrome
- Tumor produces serotonin or other vasoactive compounds (bradykinin, histamine, prostaglandins, etc.)
- Thickened valvular plaques made of smooth muscle, collagen, & matrix
- Clinical considerations (not important)
- Severity of lesions corresponds w/ amount of vasoactive peptide produced by tumor
- GI carcinoids don’t really caues heart lesions
- Carcinoids that would be exposed to the heart are filtered throught the liver
- Left-sided lesions are rare but can be seen in “exogenous” vasoactive peptide use
- i.e. Diet pills “fen-phen,” ergotamine for migraines
8
Q
Endocarditis
- General
- 4 types
A
- General
- Inflammation / infection of heart valves
-
4 types
- Bacterial (infective) endocarditis
- Rheumatic endocarditis
- Non-bacterial thrombotic endocarditis
- Libman-Sacks endocarditis
9
Q
Rheumatic Heart Disease
- Causes…
- Rheumatic fever
- Etiologic theory
- Endocarditis
- Summary
A
- Causes…
- Endocarditis: vegetations on heart vavle surfaces
- Myocarditis: inflammation of the mycoardium
- Pericarditis: inflammation of the pericardium
- Rheumatic fever
- Children (5-15 years old)
- 1-4 weeks after group A Streptococcal infection (“Strep throat,” Strep. pyogenes)
- Sydenham chorea, erythema marginatum, subcutaneous nodules, carditis, migratory polyarthritis
- Major Jones Criteria: carditis
- Etiologic theory
- Antigenic cross-reaction b/n Streptococcus & heart tissues
- Direct invasion by bacteria?
- Endocarditis
- Fibrinous necrosis on cusps & cords
- Vegetations (verrucae) overlying these areas of necrosis
- NOT INFECTIOUS
- Composed of fibrin, inflammatory cells
- Eventually leads to scarring & deformity of valve
- Result: valve stenosis or insufficiency
- Typical course of RF DOES NOT involve rheumatic heart disease
- Summary
- Gropu A Streptococcal infection (Strep throat)
- Immune cross-reaction to heart tissues
- Inflammation fo heart (i.e. myocarditis, endocarditis, & pericarditis [sudden death])
- Damage to heart tissues (i.e. valve stenosis, valve insufficiency, myocardial scarring [later in life])
10
Q
Non-Bacterial Thrombotic Endocarditis (NBTE)
- General
- Clinical manifestations
A
- General
- Bland thrombus that sits on valve surface
- No bacteria, no inflammation
- AKA Marantic endocarditis
- Occurs in debilitating disease (i.e. cancer or “wasting diseases”)
- Can flick off clots to other organs or tissues
- Clinical manifestations
- Valve stenosis or insufficiency
- Stroke
- Lower extremity ischemia
- Associated w/ hypercoagulable states
11
Q
Libman-Sacks Endocarditis
- General
- Valve lesions
A
- General
- Occurs in Systemic Lupus Erythematosis (SLE)
- Non-infectious small thrombi on outer & inner surfaces of mitral & tricuspid
- May also occur on chordae & ventricular wall
- Valve lesions
- Composed of fibrin, cellular debris (from ANA damage)
- Can become “active” w/ valvulitis
12
Q
Who is most likely to get marantic endocarditis?
A
- Patient w/ metastatic lung cancer
13
Q
Prosthetic Heart Valves
- 2 types
- Mian things to remember
- Complications
A
- 2 types
- Mechancial: made of metal or other material
- Biolgoical: composed of human heart or porcine valves
-
Main things to remember
- Can act as nidus of infection (i.e. endocarditis) or thrombus
- Mechanicals can damage erythrocytes
- Biologicals dont’ last as long (calcification primary problem)
- Complications
- Thrombosis
- Infection
- Valve failure
- Calcification
14
Q
Scenario 1
- 38-year-old woman with “chest fluttering”
- You hear a mid-systolic click w/ late systolic murmur
A
Mitral valve prolapse
15
Q
Scenario 2
- 53-year-old man w/ diastolic murmur
- Has history of rheumatic fever as a child
A
Mitral valve stenosis - rheumatic heart disease
