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Semester 4 Pathology -Valvular Heart Disease

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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