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CH 12 Hypertensive Heart Disease to Cardiomyopathies
Terms in this set (43)
hypertensive heart disease involves ___ overload and ___ hypertrophy
2 minimal criteria for Dx of systemic(Left sided) HHD
1) Left ventricular hypertrophy (usually concentric -->pressure=overload)
2)history or phatologic evidence of hypertension
Earliest change in Systemic HHD
INcrease in the transverse diameter of the myocytes
Describe morphology of Systemic HHD (4)
Disproportionate increase in weight and size
Weight may exceed 500 grams
Size may exceed 2.0 cm
usually without dilation
Which ventricle is more compliant ?
What can cause acute cor pulmonale ? What happens to myocyte arangement and the free wall ?
Myocytes go from haphazard arrangement to circumferential
NO hypertrophy but dilation (only chronic has hypertrophy with pulmonary hypertension caused by sytemic HHD)
Valvular Heart Disease: Difference between Insufficiency and stenosis of valve.
Insuff --> failure to close completely
Stenosis --> failure to open completely
Valvular stenosis leads to ____ overload, Valvular insufficiency leads to ___.
Stenosis --> pressure overload
Insufficiency --> volume overload
2/3 of all Valvular disease is ..
stenoses of the aortic and mitral valves ( 4 most frequent causes is each have stenosis or insufficiency
Frequent causes of :
AS --> calcification of aortic valves ( congenitally bicuspid or normal tricuspid)
AI --> dilation of aorta assoc with hypertension and aging
MS --> Rheumatic Heart disease
MI --> myxomatous degeneration (mitral valve prolapse)
What type of calcification occurs on what part of valves.
Dystrophic ( Ca independent)
Hinge points (Heart beats 40 mil a year ! )
Morphologic hallmark of nonrheumatic, calcific aortic stenosis.
Dystrophic calcification that begins in the fibrosa of the hinge points (Max flexion) and eventually protrudes intothe sinuses of Valsalva, preventing the opening of cusps.
Aortic valve sclerosis subects the LV to progressively
increasing pressure overload
What is main difference between Rheumatic (and congenital) and Non-rheumatic stenosis ?
Commissural fusion is NOT seen in NON-rheumatic
What three symptoms of Calcific Aortic stenosis hearld cardiac decompensation ?
angina, CHF, syncope
MOst frequent congenital cardio malformation in humans ? Major site of calcific depostis in this ?
Biscupid aortic valve (1%)
Ca deposits on midline raphe
IN unusual cases mitral annular calcification can lead to what 4 things ?
Char anatomic change in Mitral Valve Prolapse
MVP histological changes ?
attenuation of the collagenous fibrosa layer and mucoid deposition at the spongiosa layer
4 secondary changes in MVP ....
Calcific deposition on base posterior mitral valve leaflet
Thrombi on ATRIAL surface or ATRIAL wall
fibrous thickening at leaflet friction areas (and at mural endocardium of LV/LA
LINEAR fibrous thickening where chords snap against ventrcular wall
What factor causes char. structural laxity and myxomatous change ?
MVP: Dx via Auscultation
Four Serious complication ins 3% of people
MIDsystolic click or (systolic murmur if mitral regurg present)
1) Infective endocarditis
2) Mitral insufficiency
3) stroke (embolism)
Rheumatic fever occurs after an episode of ....... and rheumatic carditis occurs during the____ phase.
Group A streptococcal pharyngitis. (Ab against M proteins on strept)
Morphology of Acute RHD
1) Aschoff Bodies containig Anitschkow cells (activated macrophages causing pancarditis
2)Fibrinous Necrosis overlaid by Verrucae
3) Possible irregular plaques caused bu regurg jets --> MacCallum Plaques
Two cardinal anatomic changes in CHRONIC RHD.
Thickening and fusion of tendinous chords
Thickening and shortening commissural fusion of leaflets
You usually dont see Aschoff bodies
5 major clinical features of RF
Sydenham Chorea - involuntary rapid, pruposeless mvmts
Erythema margination of the skin
Migratory polyarthritis of LARGE joints
What is the Jones Criteria for RF?
1) streptococcal group A
2) 2 major manifestation OR 1 major + 2 minor (arthalgia, fever or elevated acute phase proteins)
4 clinical features assoc with acute carditis ?
pericaridal friction rub
weak heart sounds
Define INfective Endocarditis
A serious bacterial infection of the heart valve or mural endocardium that warrants prompt Dx into subacute or acute depending on virulence of microbe.
Which virus is most common in native/abnormal valves and which is next in commonality. Where are they found ? Which is most virulent ?
S.treptococcus VIRIDANS, found in the oral cavity flora. (the lesser in commonality involves the HACEK group)
Next is S. Aureus which is on the skin and therefre common in IV drug users
Prosthetic vlave endocarditis is most commonly caused by ....
coagulase-NEGATIVE staphylococci ( S. Epidermidis
Morphology of IE: hallmark ? most common sites ? 2 important Sequelae ?
Vegetations that are friable and bulky (erode into myocardium and produce a ring abcess at times)
mitral and aortic valves most common
Septic Infarct from lodged emboli or mycotic aneurysms from emboli
Describe Subacute endocarditis ...
Vegetations have granulation healing which undergo chronic inflammatory processes
Most consistent sign of IE
What Criteria is used for IE
Duke - CLinical criteria includes + blood culture, EEG evidence of abcess/vegetation or new valvular regurgittion
Describe the Vegetations in the 4 major forms of vegetative endocarditis
RHD - small,warty veg on closure lines
IE - large irregular masses on cusps that can extend into chordeae
NBTE- small BLAND veg on lines of closure
LSE- small or medium sized veg on either orboth sides of the valve leaflets
Three links to NBTE
2) Trousseau Syndrome of migratory thrombophlebitis
3) Swanz-Ganz pulmonary artery catheter trauma
What is Libman-Sacks endocarditis ?
Endocarditis of SLE, mitral and tricuspid valvulitis with small sterile pink vegetations
What is carcinoid syndrome (5 symptoms) and 2 general locations.
Nausea, cramping, diarrhea, episodic flushing of the face, vomiting
Endocardium or valves of the right heart
Describe the distinctive morphology of Carcinoid heart disease
Firm plaquelike fibrous thickenings on the inside surfaces of the cardiac chamber (including T/P valves, and BV of right side (IVC)) which are composed of collagenous material and smooth muscle in mucopolysaccharide matrix with NO elastic fibers.
What correlates with the severity of carcinoid heart disease ?
5-hydroxyindoleacetic acid (Serotonin metabolite) levels
What enzyme inactivates serotonin and bradykinin thus limiting cardiac changes to the right heart
CHD manifests as ____ ____ followed by ____ ___.
then PUlomanry valve insufficiency
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