Valvular Heart Disease
Terms
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- valvular stenosis
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failure of valve to open completely, impairs forward flow
usually from cusp abnormality - valvular insufficiency/regurg
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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
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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
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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
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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
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fibrosis and calcification of aortic valve
COMMISURAL FUSION IS ABSENT
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
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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
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- liebman sacks endocarditis
- NBTE that occurs in association with SLE