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Valvular Heart Disease


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valvular stenosis
failure of valve to open completely, impairs forward flow
usually from cusp abnormality
valvular insufficiency/regurg
failur of valve to close completely, allows backward flow
many causes including cusp perf, chordae rupt, pap muscle infarct
mitral stenosis
rheumatic heart disease
mitral regurgitation
mitral valve prolapse
acute rheumatic fever
acute inflammatory disease, fever, polyarthritis, nodules EM, chorea, pancarditis, aschoff bodies are pathognomonic, bread and butter pericarditis
chronic rheumatic fever
repeated attacks of acute RF, extensive scarring, mitral valve alone in 70%, mitral aortic in 25%,
valves are almost always stenotic with commisural chordae fusion, severe MC stenosis, LA dilation, pul congestion, RV hypertrophy,
leads to CHF,
etiology of rheumatic fever
immunologic pathogenesis, anti strep ab which react with myocardial and valvular antigens
1)crossreaction of ab with ag
2)infection stimulates autoimmune response against heart
mitral valve prolapse
occurs during systole into LA. elarged leaflets with parachute like outpouchings, chordae prone to rupture,
myxoid degeneration
mid systolic click
usually asymptomatic, can lead to regurg
aortic stenosis
fibrosis and calcification of aortic valve
congenital the valve is too small
acquired mostly due to wear and tear not RG, bicuspid might have accelerated rate
both lead to LV outflow obstruction, LVH, CHF
distinguish infected valve leaflet from non infective endocarditis
infective: large bulky friable valvular vegetations, bacteria, fibrin, inflammatory cells,
NBTE: multiple small vegetations on either side of valve along the line of closure, fibrin and entrapped blood elements
complications of prosthetic heart valves
liebman sacks endocarditis
NBTE that occurs in association with SLE

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