Term
| what are the major causes of endocarditis? |
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Definition
| immunologically mediated endocarditis (such as rheumatic heart disease and SLE), bacterial endocarditis, nonbacterial thrombotic endocarditis, metabolically mediated endocarditis, and degenerative disease of old age |
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Term
| what is seen with immunologically mediated endocarditis? |
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Definition
| changes to the valve of the heart as well as the myocardium/epicardium to some degree |
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Term
| what is seen with bacterial endocarditis? |
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Definition
| the kind of bacteria will vary w/different pt populations - people with prosthetic valves are more susceptible to different bacteria than IV drug users |
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Term
| what is seen with nonbacterial thrombotic endocarditis? |
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Definition
| this is often associated with carcinomas - particularly mucin secreting adenocarcinomas (tend to produce a hypercoagulable state) that can leave small papillary wart-like lesions on the valve itself |
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Term
| when does valvular disease become clinically significant? |
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Definition
| when it produces a functional disorder |
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Term
| can both stenosis and insufficiency occur in the same valve? |
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Definition
| yes, though one usually will predominate |
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Term
| what is the disorder termed as if it only affects one valve? |
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Definition
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Term
| what is the disorder termed as if it only affects more than one valve? |
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Definition
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Term
| what is functional regurgitation? |
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Definition
| when a valve becomes incompetent because 1) dilation of the ventricle causes papillary muscles to be pulled down and outward or 2) when dilation of the aorta or pulmonary artery pulls the valve commissures apart, preventing full closure of the AV or PV (problem arises from surrounding structures, not the valve itself) |
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Term
| why is it better for valve disease to develop slowly over time as opposed to all at once (as w/rapid infectious valve disease)? |
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Definition
| so that the pt's body can develop some compensatory mechanisms |
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Term
| what can valve disease affect systemically? do pts with it need to be on prophylaxis? |
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Definition
| heart, blood vessels, and the lungs can all be affected if emboli break off due to turbulence - therefore pts need to be on anticoagulant therapy |
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Term
| what are the most frequent valve diseases? are these usually chronic or acute? |
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Definition
| aquired stenosis of the AV and MV |
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Term
| what are valvular stenosis and insufficiency usually due to? |
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Definition
| stenosis = usually due to a primary cuspal deformity, chronic. insufficiency = can be due to intrinsic disease of the cusps or damage/distortion of the supporting structures w/out primary cusp changes |
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Term
| when would rupture of a papillary muscle likely occur? |
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Definition
| several days after an acute MI |
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Term
| why might papillary muscles have various types of fibrosis? |
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Definition
| possibly from repeated bouts of ischemia |
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Term
| what is one of the most common valve changes seen in clinical practice? |
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Definition
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Term
| what kinds of things can lead to LV enlargement? |
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Definition
| myocarditis, dilated cardiomyopathy, calcification of mitral ring, and LV hypertrophy |
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Term
| does aortic stenosis likelihood increase with age? |
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Definition
| yes as senile calcific aortic stenosis, or as a result of rheumatic heart disease |
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|
Term
| can calcification of congenitally deformed valves occur? |
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Definition
| yes, which can lead to stenosis |
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|
Term
| what are some causes of intrinsic valvular disease? |
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Definition
| post inflammatory scarring from rheumatic heart disease and infective endocarditis |
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Term
| what are some causes of aortic disease? |
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Definition
| aortic dilation, ankylosing spondylitis, marfan's, etc |
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Term
| how does calcified valvular degeneration occur? |
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Definition
| accumulation of calcium phosphate deposits is a relatively common chronic problem leading to aortic stenosis, particularly with congenital bicuspid aortic valves. the mitral valve can be subject to annular calcification |
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Term
| is valvular calcification dystrophic or metastatic? |
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Definition
| dystrophic, which is usually associated with a normal serum Ca++ level, and calcification only occurs on abnormal structures/organs whereas metastatic calcification is due to a high serum calcification and deposition is even throughout the body |
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Term
| **what is the most common of all valvular anomalies?** |
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Definition
| **acquired aortic stenosis** |
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Term
| what is acquired aortic stenosis usually due to? |
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Definition
| wear and tear, congenital bicuspid valves, calcification, or all of the above |
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Term
| what does aortic stenosis incur in the heart? how does it usually appear? |
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Definition
| LV hypertrophy. it usually appears as heaped up masses of Ca++ that can ultimately cause LV pressure overload |
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|
Term
| how common is rheumatic fever as a cause of aortic stenosis? |
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Definition
|
|
Term
| what can rheumatic and congenital aortic stenosis result in? |
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Definition
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|
Term
| is degenerative aortic stenosis associated with commissural fusion? |
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Definition
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Term
| what kind of ventricular hypertrophy is associated with calcific aortic stenosis? what can this lead to? |
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Definition
| concentric LVH - which may lead to ischemia, which can then lead to angina pectoris and CHF |
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Term
| does pulmonary backflow occur in early forms of calcific aortic stenosis? |
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Definition
| no, later - and if the lungs are congested, it can lead to *cor pulmonale |
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Term
| what is the prognosis for asymptomatic calcific aortic stenosis pts? |
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Definition
| good, symptomatic pts will generally require sx |
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Term
| what heart sounds are associated with calcific aortic stenosis? |
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Definition
| a high pitched systolic murmur |
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Term
| *what is the most frequent congenital cardiovascular malformation?* is this symptomatic at birth/early life? what are pts w/this predisposed for? |
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Definition
| bicuspid aortic valve, which is usually nonsymptomatic at birth/early life. pts with this are predisposed to progressive degenerative calcification or infectious endocarditis |
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|
Term
| how do the cusps in calcific AV stenosis appear? |
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Definition
| the cusps are generally of unequal size, and the larger cusp will generally have a midlike rafe that is often the major site of calcific deposits |
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Term
| how does the aortic wall in a pt with congenital AV stenosis appear? |
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Definition
| structural abnormalities are commonly seen |
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Term
| what are reasons that a stenotic calcific AV might be incompetent? |
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Definition
| aortic dilation, cusp prolapse or infectious endocarditis |
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|
Term
| how does the mitral valve generally appear in pts with a congenitally bicuspid aortic valve? |
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Definition
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Term
| what is mitral annular calcification? does it affect valvular function? |
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Definition
| degenerative Ca++ deposits that develop in the fibrous ring around the MV (annulus), causing irregular, hard, stony nodules behind the leaflets. generally this does not affect valvular function - but occasionally it can result in regurgitation, stenosis, and rarely, arrhythmia and sudden death |
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Term
| what is a danger with calcifications beyond physiological hampering of valve movement? |
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Definition
| the Ca++ nodules may embolize, leading to stroke and they may provide a nidus for infection (why IE can be so hard to treat) |
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Term
| can MV calcific deposits be seen w/echocardiography? |
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Definition
| yes, and they also appear as ringlike opacities on CXRs |
|
|
Term
| who are MV calcifications most common in? |
|
Definition
| women over 60 with MVP elevated LV pressure, such as that seen in systemic HTN, aortic stenosis, or hypertrophic cardiomyopathy |
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Term
| what is myxomatous degeneration of the mitral valve? |
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Definition
| mitral valve prolapse, or ballooning of the mitral leaflets (one or more is floppy, tend to prolapse into the L atrium) often affects young women (20-40) |
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Term
| what is the degeneration like in MVP? |
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Definition
| soft and gelatinous, infiltrated by loose edematous tissue |
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Term
| how do pts with MVP/myxomatous degeneration present? |
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Definition
| generally asymptomatic, but they can present with chest pain (can be sharp or diffuse), heart palpitations, irregular beating, and syncope |
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Term
| is there an audible component to MVP/myxomatous degeneration? |
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Definition
| there is a midsystolic click, where the valve pops up as systole begins to increase. it may not be initially audible, but heard as changes progress |
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Term
| can MVP cause sudden death? |
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Definition
|
|
Term
| what happens to the valve leaflets in MVP? |
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Definition
| the leaflets become enlarged, redundant, thick, and rubbery |
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|
Term
| what happens to the valve tendinous cords in MVP? |
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Definition
| the tendinous cords may become elongated, thinned, and more likely to rupture |
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Term
| what happens to the different layers that make up the valves in MVP? |
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Definition
| the collagenous fibrosis layer of the valve becomes attenuated, the spongiosa layer becomes thickened, and there is deposition of mucoid material (=thick, floppy valve) |
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|
Term
| can annular dilation in MVP occur? |
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Definition
| yes, annular dilation in MVP is common |
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|
Term
| are other valves affected by MVP? |
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Definition
| yes, the TV, AV, and PV may be affected by MVP |
|
|
Term
| what are secondary changes in MVP? |
|
Definition
| fibrous thickening of the valves (from valve striking and chordae tendineae striking), linear fibrous thickening of the L ventricular endocardial surface, thickening of the LA or ventricle endocardium from friction induced injury from prolapsing leaflets, and focal calcifications at the base of the mitral valve leaflet, and irregular bumping up and irregular blood flow can make a local hypercoagulable state (thrombi more likely to be thrown) |
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|
Term
| can MVP be associated with underlying disease? |
|
Definition
| yes, it may be seen in marfan's syndrome (caused by mutations in fibrillin-1 (FBN-1)), which alter the cell matrix interaction and also dysregulates transforming growth factor beta signaling. there also may be medial necrosis of the aorta b/c of defects in the elastic tissue -> leads to weakening |
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Term
| what are complications involved with MVP? what lends to a higher risk of complication? |
|
Definition
| IE, mitral insufficiency w/possible chordal rupture, emboli resulting in stroke, and ventricular and atrial arrhythmias. complications are more common in those with arhythmias to mitral regurgitation (in these cases, the valve may need to be replaced) |
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