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S4-Path-ValvularHD
Semester 4 Pathology -Valvular Heart Disease
| Question | Answer |
|---|---|
| What is the most common cause of aortic stenosis in the USA? | Calcific aortic stenosis. 2 types: Senile calcific aortic stenosis (MOST COMMON): "wear and tear" induced change that usually occurs during 8th or 9th decade. |
| What is the first site of calcification in calcific stenosis of congenitally bicuspid aortic valve. | In this disease there are two unequally sized cusps. The larger cusps contains the MEDIAN RAPHE, this is the first site of calcification. |
| myxomatous degeneration of the mitral valve is AKA | Mitral valve prolapse. |
| What is the histological appearance of MVP? | Accumulation of myxomatous material (proteoglycans) in the leaflet fibrous core and fragmentation of collagen fibers. |
| PE findings of MVP? | mid-systolic click due to prolapsing of valve into LA. Mid-late systolic murmur due to mitral regurg. |
| possible complications of MVP? | Mitral valve insufficiency (severe regurg), leaflet thrombosis with thromboembolism and stroke, infective endocarditis, arrythmia due to tissue of conducting system being effected, sudden cardiac death. (rare) |
| Bacterial cause of rheumatic fever | Group A strep pyogenes |
| Mechanism of Rheumatic Fever and Rheumatic Heart disease | Type II hypersensitivity rxn to antibodies against human glycoproteins. Healing and recurrent attacks of rheumatic fever progress to rheumatic heart disease (RHD) aka Chronic rheumatic carditis. |
| What is the difference between rheumatic fever and rheumatic heart disease? | RF = acute carditis after strep pharyngitis. RHD= Chronic rheumatic carditis after an attack of rheumatic fever |
| How is Rheumatic Fever dx'd | 1) pt had a preceding S. pyogenes infxon. 2) meets jones criteria (either 2 major or one major and two minor 3) elevated antistreptolysin O titers. |
| What are the major Jones criteria | Used in dx of rheumatic fever. They include: Carditis (murmor, HF, etc), migratory polyarthritis (large joints), erythema marginatum, subcutaneous nodules, sydenham chorea (involuntary uncoordinated jerking movements affecting face hands and feet) |
| What are the minor Jones criteria? | History of RF, Fever, arthralgia, EKG changes, Labs (ESR, CRP, leukocytosis) |
| Syndenham chorea is a symptom of ... | RF. It is one of jones MAJOR criteria. |
| What is an aschoff body? | A granuloma found in all layers of the heart (but primarily the myocardium) of pts with RF |
| What is an anitschkow body? | Activated macrophages with central round-ovoid nucleus with ribbon like aggregation of chromatin (aka caterpillar cells) found in pts with RF |
| Caterpillar cells are aka | anischkow bodies. Found in pts with RF |
| What are the two types of activated macrophages found in RF? | Caterpillar cells (anitschkow cells) and multinucleated anitschkow macrophages known as ASCHOFF GIANT CELLS |
| What is the morphological appearance of an Aschoff body? | Central focus of eosinophilic collagen, peripheral aggregates of T-lymphocytes, plasma cells, and activated macrophages (anitchkow caterpillar cells and multinucleated macrophages called ashkoff giant cells) |
| What is a verrucae | A thrombus. They form on valve margins and chordae tendinae in rheumatic fever. Along with sterile fibrin precipitation |
| What is the primary mechanism by which rheumatic heart disease damages the heart. | autoimmune Verrucae (thrombus) formation on valves and chordae tendinae and sterile fibrine deposition leads to valvular disease. NO BACTERIA IN THE HEART, THIS IS AN AUTOIMMUNE PROCESS |
| IV drug user presents with fevers, fatigue, weight loss, hemorrhagic lesions and heart murmums. What is the likely dx, what findings are likely to present with this dx? | infective endocarditis. Findings of bulky and friable vegetations. |
| What is the major cause of non-bacterial thrombotic endocarditis (NBTE) | mucus producing adenocarcinoma (any origin, but mainly pancrease) |
| Pt. With history of mucus producing adenocarcinoma is at increased risk for what cardiac disease? | non-bacterial thrombotic endocarditis. |
| What is the morphological finding of non-bacterial thrombotic endocarditis? | sterile vegetations n the leaflets or cusps of heart (usually mitral or aortic). |
| How is RF differentiated from NBTE? | By the pt hx. Child in developing country w/ recent strep - -> HF. Pt with cancer ‡ NBTE. Diseases have similar lesions on heart valves. |
| What is a carcinoid? | a tumor of neuroendocrine cells which secrete hormones. 5-HT. Kallikrien, histamine, bradkinin, etc |
| What side of the heart is effected by GI carcinoids? | Right side of heart |
| What side of the heart is effected by uterine or ovarian carcinoids? | right side of heart |
| What side of heart is effected by brochial carcinoid? | Left side of heart. |
| RHD most commonly effects what valve | Mitral valve (either stenosis or insufficiency or both.) Less commonly, it effects the aorta |
| Bulky and friable vegetetiation in the aortic or mitral valves are a feature of what disease | IE |
Created by:
rkirchoff
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