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9.21 Rheumatic Heart DIsease
9am by Dr. Newman
52
Pathology
Professional
09/22/2011

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Cards

Term
What are the different components of rheumatic pancarditis?
Definition
endocarditis and valvulitis, pericarditis and myocarditis
Term
Which valves are more often affected by heart disease?
Definition
85% of valves affected are left heart valves (aortic and mitral), and the remaining 15% is right heart valves (pulmonic and tricuspid)
Term
What are the two major complications of rheumatic valvulitis?
Definition
cardiac failure and infectious endocarditis
Term
A vegetation on a valve leaflet that embolizes can lead to what complications?
Definition
infarct, abscess and sepsis
Term
What are the major causes of calcific aortic stenosis?
Definition
1) rheumatic 2)bicuspid valve 3)calcification of aging
Term
What is mitral valve prolapse?
Definition
interchordal ballooning (hooding) of mitral valve leaflets, i.e. when one or both "floppy" enlarged leaflets prolapse into left atrium during systole
Term
What are complications of valvular abnormalities?
Definition
infection, obstruction, thromboembolism, insufficiency
Term
What are the three types of cardiomyopathies?
Definition
dilated, hypertrophic, and restrictive
Term
What type of inflammation is associated with giant cell/temporal arteritis?
Definition
granulomatous
Term
Name two large-vessel vasculitides?
Definition
giant cell/temporal, and takayasu
Term
Which vasculitis is associated with polymyalgia rheumatica?
Definition
giant cell/temporal arteritis
Term
What age group is associated with temporal arteritis?
Definition
patients older than age 50
Term
What type of inflammation is associated with Takayasu arteritis?
Definition
granulomatous
Term
What age group is associated with takayasu arteritis?
Definition
younger than age 50
Term
Name 2 types of medium vessel vasculitises?
Definition
polyarteritis nodosa and kawasaki disease
Term
What type of inflammation is associated with polyarteritis nodosa?
Definition
necrotizing inflammation
Term
Which vessels are typically affected by polyarteritis nodosa?
Definition
involving the renal arteries but sparing pulmonary vessels
Term
Which vasculitis is most associated with children?
Definition
kawasaki disease
Term
What syndrome is associated with Kawasaki disease?
Definition
mucocutaneous lymph node syndrome (pharyngitis, enlarged LNs, fever, rash, swelling of hands and feet)
Term
What happens to the coronary arteries in kawasaki's disease?
Definition
coronary arteries can be involved with aneurysm formation and/or thrombosis
Term
Name three small vessel vasculitises.
Definition
wegener granulomatosis, churg-strauss syndrome, and microscopic polyangitis
Term
Describe Wegener granulomatosis?
Definition
granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small vessels, including glomerular vessels. associated with PR3-ANCA
Term
Describe Churg-Strauss syndrome.
Definition
eosinophil-rich granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small vessels. Associated with asthma and blood eosinophilia. associated with MPO-ANCAs
Term
Describe microscopic polyangitis.
Definition
necrotizing small-vessel vasculitis with few or no immune deposits; necrotizing arteritis of small and medium-sized arteries can occur. Necrotizing glomerulonephritis and pulmonary capillaritis are common. Associated with MPO-ANCAs
Term
Name a vasculitis that affects medium sized vessels and is immune complex mediated.
Definition
polyarteritis nodosa
Term
Name a vasculitis that affects medium sized vessels and is affected by anti-endothelial cell antibodies.
Definition
kawasaki disease
Term
Name some small vessel vasculitises that are immune complex mediated.
Definition
SLE, Henoch Schonlein pupura (IgA), Cryoglobulin, goodpasture disease
Term
What's the most common arteritis in adults?
Definition
temporal
Term
What arteries are commonly affected by temporal arteritis?
Definition
temporal, opthalmic and aorta
Term
What vasculitis typically presents in a forty year old female patient?
Definition
takayusu arteritis
Term
What is the typical patient with Buergers?
Definition
young adult smoker
Term
What percent of patients with Kawasakis dies due to rupture of coronary artery?
Definition
1%
Term
What is unique about Buerger's vasculitis?
Definition
affects both arteries and veins
Term
What type of inflammation is associated with Buergers vasculitis?
Definition
necrosis and abscesses
Term
Where are the vessels affected by Buergers typically located?
Definition
arteries and veins
Term
Which vasculitis can present as weak or absent pulses from the upper extremeties?
Definition
takayusu arteritis
Term
Which arteries are affected in takayasu arteritis?
Definition
aortic arch
Term
Fibrinoid necrosis is the hallmark of which type of necrosis?
Definition
polyarteritis nodosa
Term
Where do syphilitic or luetic aneurysms usually occur?
Definition
ascending aorta and arch
Term
What is the disease process of a syphilitic aneurysm?
Definition
medial destruction in tertiary syphilis following endarteritis obliterans
Term
Name a complication of syphilitic aneurysm that affects the heart.
Definition
involvement of aortic valve ring may lead to valvular insufficiency
Term
Which type of aneurysm is associated with wrinkling/"tree barking"?
Definition
syphilitic
Term
Where are artherosclerotic aneurysms usually located?
Definition
abdominal aorta or common iliac arteries; less often descending thoracic aorta
Term
What is the disease process of artherosclerotic aneurysms?
Definition
severe artherosclerosis with consequent thinning and destruction of media
Term
What is the typical pathogenesis of a dissecting aortic hematoma in a Marfan's patient?
Definition
cystic medial necrosis
Term
Intimal tears are found in ____% of dissecting hematomas.
Definition
85-90
Term
What are the different types of dissecting hematomas?
Definition
type A- ascending aorta involved
type B-ascending aorta not involved
Term
How do many patients with aortic dissection die?
Definition
pericardial tamponade
Term
Where do berry aneurysms occur?
Definition
at birfurcation of cerebral arteries
Term
What is the pathogenesis of berry aneurysms?
Definition
develop because of a discontinuity in smooth muscle of media at carina of arterial bifurcation
Term
What is a dangerous sequelae of a berry aneurysm?
Definition
subarachnoid hemorrhage
Term
What is a mycotic aneurysm?
Definition
infectious arteritis with direct invasion by infectious agents-usually bacteria and fungi. Weakening of arterial wall secondary to inflammation
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