Rheumatic Heart Disease and Mitral Valve Disease

Questions and Answers

What percentage of patients infected with streptococci develop rheumatic heart disease?

10%

25%

3% (correct)

Which of the following complications is associated with rheumatic heart disease?

Pulmonary hypertension

Aortic stenosis

Increased nitric oxide production

Fibrosis of the mitral valve (correct)

What role do CD4+ T cells play in the context described?

Suppress inflammation in rheumatic fever

Recognize streptococcal peptides and host antigens (correct)

Directly kill streptococcal bacteria

Inhibit cytokine production

What is suggested to influence susceptibility to rheumatic fever?

Genetic variants Signup and view all the answers

What is a possible consequence of acute rheumatic fever on the heart's chordae tendineae?

Inflammatory changes Signup and view all the answers

Which part of the heart is primarily affected by rheumatic heart disease?

Mitral valve Signup and view all the answers

What percentage of cases affect the aortic valve in rheumatic heart disease?

25% Signup and view all the answers

Which condition is NOT typically associated with rheumatic fever?

Atrial fibrillation Signup and view all the answers

What is the primary cause of myxomatous degeneration of the mitral valve?

Rheumatic heart disease Signup and view all the answers

Which group of bacteria is associated with triggering rheumatic fever?

Group A β-hemolytic streptococci Signup and view all the answers

What characterizes the mitral valve in cases of myxomatous degeneration?

Floppy and prolapsing leaflets Signup and view all the answers

What condition is a direct consequence of rheumatic fever?

Rheumatic heart disease Signup and view all the answers

What is the typical incidence range of rheumatic fever affecting adults?

0.5% to 2.4% Signup and view all the answers

In myxomatous mitral valve disease, during which phase does the mitral leaflets prolapse into the left atrium?

Systole Signup and view all the answers

What is the underlying mechanism of primary mitral valve prolapse?

Valvular inflammation and scarring Signup and view all the answers

What type of disease is rheumatic fever categorized as?

Acute immunologically mediated disease Signup and view all the answers

What is the primary purpose of microbiome analysis in diagnosing certain conditions?

To determine the presence of specific pathogens Signup and view all the answers

Which factor is critical in assessing the prognosis of an infection?

The infecting organism and extent of complications Signup and view all the answers

What type of quiz is typically utilized to identify positive blood cultures?

Ecocardiography Signup and view all the answers

Which condition may likely result from a severe microbiome imbalance?

Digestive issues and inflammation Signup and view all the answers

What diagnostic method is applied to examine the effect of microbiomes on health?

Microbiome analysis Signup and view all the answers

Which of the following represents a complication that may affect diagnosis accuracy?

Use of antibiotics prior to testing Signup and view all the answers

What characterizes acute endocarditis compared to subacute endocarditis?

It causes destructive infections. Signup and view all the answers

Which group is most frequently associated with infections affecting the tricuspid valve?

Narcotics drug users. Signup and view all the answers

What is a common outcome of vegetations formed during acute endocarditis?

They can erode into the underlying myocardium. Signup and view all the answers

Which statement regarding the nature of infective endocarditis is accurate?

It is primarily caused by virulent organisms. Signup and view all the answers

What complication can arise from morbid vegetation in infective endocarditis?

Formation of a ring abscess. Signup and view all the answers

In terms of valves affected, which is typically more common in non-drug users?

Mitral valve. Signup and view all the answers

Which characteristic is not commonly associated with virulent infections in endocarditis?

Prolonged duration of infection. Signup and view all the answers

Which of the following correctly describes subacute endocarditis?

Often occurs in previously abnormal heart valves. Signup and view all the answers

What is the primary characteristic associated with pericarditis, as mentioned in the text?

It involves a fibrous exudate within the pericardium. Signup and view all the answers

Which of the following statements is NOT supported by the provided text?

Pericarditis is characterized by an inflammatory response leading to Aschoff bodies. Signup and view all the answers

Based on the text, what is the most common age group affected by acute rheumatic fever?

Children Signup and view all the answers

What is the primary pathological hallmark of myocarditis, as described in the text?

Aschoff bodies Signup and view all the answers

Which of the following accurately describes the text's reference to "Aschoff bodies"?

They are characteristic of myocarditis, representing inflammatory lesions within the heart muscle. Signup and view all the answers

Which of the following statements accurately reflects the text's explanation of the development of acute cardiac involvement?

It can arise from various factors, including inflammation of the heart muscle and the pericardium. Signup and view all the answers

Acute rheumatic fever is typically characterized by a gradual onset of cardiac involvement.

False Signup and view all the answers

The presence of Aschoff bodies is diagnostic for rheumatic heart disease.

False Signup and view all the answers

Myxomatous degeneration of the mitral valve is a consequence of acute rheumatic fever.

True Signup and view all the answers

Rheumatic fever can occur at any age, but it is most commonly seen in adults.

False Signup and view all the answers

The aortic valve is the most commonly affected valve in rheumatic heart disease.

False Signup and view all the answers

Aschoff bodies are typically found in the myocardium of patients with rheumatic fever.

True Signup and view all the answers

Marfan syndrome is the most common cause of acquired valvular disease.

True Signup and view all the answers

The mitral valve is not typically affected by rheumatic heart disease.

False Signup and view all the answers

Antibodies against M proteins cross-react with proteins found in the myocardium.

True Signup and view all the answers

The chordae tendineae are not affected in rheumatic heart disease.

False Signup and view all the answers

Macrophages are not involved in the pathology of rheumatic heart disease.

False Signup and view all the answers

Rheumatic fever is not associated with valvular disease.

False Signup and view all the answers

The aortic valve is the most commonly affected valve in rheumatic heart disease.

False Signup and view all the answers

Rheumatic heart disease only affects the valves of the heart.

False Signup and view all the answers

Nonbacterial Thrombotic Endocarditis is characterized by the deposition of small, serous, and nondesstructive thrombotic masses on cardiac valves.

True Signup and view all the answers

Previous valvular damage is a prerequisite for the development of Nonbacterial Thrombotic Endocarditis.

False Signup and view all the answers

The masses on cardiac valves in Nonbacterial Thrombotic Endocarditis are typically larger than 5 mm in size.

False Signup and view all the answers

Nonbacterial Thrombotic Endocarditis can occur on any valve in the heart.

True Signup and view all the answers

The thrombotic masses in Nonbacterial Thrombotic Endocarditis are typically formed on top of pre-existing valvular lesions.

False Signup and view all the answers

Nonbacterial Thrombotic Endocarditis is a common complication of acute rheumatic fever.

False Signup and view all the answers

Rheumatic heart disease primarily impacts the aortic valve, leading to stenosis.

False Signup and view all the answers

Fibrous thickening and fusion of the chordae tendineae are hallmarks of previous rheumatic valvulitis episodes.

True Signup and view all the answers

The mitral valve leaflets are typically unaffected by rheumatic heart disease, maintaining their normal structure.

False Signup and view all the answers

The presence of small vegetations (verrucae) along the line of closure of the mitral valve leaflet is a characteristic of rheumatic heart disease.

True Signup and view all the answers

Left atrial dilation, as seen from above the valve, is a common finding associated with mitral stenosis caused by rheumatic heart disease.

True Signup and view all the answers

Neovascularization is a characteristic feature observed in rheumatic mitral valve disease, reflecting an inflammatory response.

True Signup and view all the answers

The development of rheumatic heart disease is directly linked to the presence of antibodies against streptococcal antigens, such as streptolysin O.

True Signup and view all the answers

Rheumatic heart disease primarily affects the mitral valve and, less commonly, the aortic valve, but never the tricuspid valve.

False Signup and view all the answers

Infective endocarditis is solely caused by bacterial infections in patients without any predisposing factors.

False Signup and view all the answers

The presence of vegetations in infective endocarditis primarily consists of fibrin, platelets, and microorganisms.

True Signup and view all the answers

Infective endocarditis can arise from surgical procedures that introduce contaminants into the bloodstream.

True Signup and view all the answers

Aneurysms may be a result of acute endocarditis due to direct damage to the vascular structures.

True Signup and view all the answers

Only intravenous drug users are at risk for developing infective endocarditis.

False Signup and view all the answers

Infective endocarditis is characterized by the formation of large, destructively bulky vegetations on heart valves.

True Signup and view all the answers

Antibiotic prophylaxis is not recommended for patients with predisposing factors to infective endocarditis.

False Signup and view all the answers

Microbial infections of heart valves in infective endocarditis only affect the left side of the heart.

False Signup and view all the answers

What is the primary cardiac manifestation of Marfan syndrome?

Acquired valvular disease Signup and view all the answers

What is the characteristic of the mitral valve in Marfan syndrome?

Enlarged, redundant, and floppy Signup and view all the answers

What is the role of antibodies against M proteins in rheumatic heart disease?

They cross-react with proteins found in the myocardium Signup and view all the answers

What is the characteristic of the affected myocardium in rheumatic heart disease?

Deposition of complement and Fc receptor-bearing cells Signup and view all the answers

What is the primary cause of myxomatous degeneration of the mitral valve?

Rheumatic fever Signup and view all the answers

What is the typical histopathological finding in rheumatic heart disease?

Aschoff bodies Signup and view all the answers

What is the primary mechanism of cardiac injury in rheumatic heart disease?

Autoimmune cross-reactivity Signup and view all the answers

What is the characteristic of the chordae tendineae in rheumatic heart disease?

Elonagation and thinning Signup and view all the answers

What is the characteristic feature of the mitral valve leaﬂet in rheumatic heart disease, as shown in the figure (D)?

Inflammatory neovascularization Signup and view all the answers

What is the effect of previous episodes of rheumatic valvulitis on the chordae tendineae?

Fibrous thickening and fusion Signup and view all the answers

What is the characteristic feature of the mitral valve in cases of rheumatic heart disease, as shown in the figure (C)?

Diffuse fibrous thickening and distortion Signup and view all the answers

What is the underlying mechanism of antibody-mediated heart damage in rheumatic heart disease?

Molecular mimicry Signup and view all the answers

What is the characteristic feature of the aortic valve in cases of rheumatic heart disease, as shown in the figure (E)?

Thickening and distortion of the cusps with commissural fusion Signup and view all the answers

What is the effect of rheumatic fever on the heart's chordae tendineae?

Fibrous thickening and shortening Signup and view all the answers

What is the characteristic feature of the left atrium in cases of rheumatic heart disease, as shown in the figure (C)?

Marked dilation Signup and view all the answers

What is the role of DNase in the context of streptococcal infections?

Evaluating the infectivity of streptococci Signup and view all the answers

What is the underlying immune response mechanism that leads to the development of rheumatic heart disease?

CD4+ T cells recognizing streptococcal peptides and antigens, leading to cytokine-mediated inflammation. Signup and view all the answers

How does acute rheumatic fever affect the morphology of the heart's mitral valve?

Acute rheumatic fever leads to myxomatous degeneration of the mitral valve, characterized by thickening and fibrosis of the valve leaflets. Signup and view all the answers

What is the relationship between rheumatic fever and the development of valve disease?

Rheumatic fever can lead to the development of valve disease, primarily affecting the mitral valve, and potentially the aortic valve in 25% of cases. Signup and view all the answers

What is the significance of fibrosis in the context of rheumatic heart disease?

Fibrosis leads to the formation of scar tissue, which can result in valve stenosis and regurgitation, compromising heart function. Signup and view all the answers

How does the immune response to streptococcal infection contribute to the development of rheumatic heart disease?

The immune response to streptococcal infection leads to cross-reactivity between streptococcal antigens and cardiac tissue, resulting in inflammation and damage to the heart valves. Signup and view all the answers

What is the impact of rheumatic heart disease on the heart's chordae tendineae?

Rheumatic heart disease can lead to the formation of fibrous adhesions, which can cause the chordae tendineae to rupture, resulting in mitral valve prolapse. Signup and view all the answers

What is the significance of susceptibility to rheumatic fever in the context of genetic variation?

Susceptibility to rheumatic fever may be influenced by genetic variation, which can affect the immune response to streptococcal infection and increase the risk of developing rheumatic heart disease. Signup and view all the answers

What is the relationship between rheumatic heart disease and the development of severe mitral stenosis?

Rheumatic heart disease can lead to the development of severe mitral stenosis, which can result in heart failure and other complications. Signup and view all the answers

What are the main causes of increased susceptibility to bacterial infections in endocarditis?

Damaged endocardium and conditions like myocarditis or rheumatic fever increase susceptibility. Signup and view all the answers

Describe the role of Streptococcus viridans in endocarditis.

Streptococcus viridans can cause additional injury to the heart valves, especially in cases of damaged or deformed valves. Signup and view all the answers

What percentage of endocarditis cases is associated with acute rheumatic fever, and how does it lead to valve issues?

50% to 60% of cases of endocarditis are associated with acute rheumatic fever, leading to damage to heart valves. Signup and view all the answers

What clinical features would you expect to see in a patient with endocarditis?

Clinical features may include cardiac murmurs, fever, and signs of embolization. Signup and view all the answers

How does infective endocarditis generally present itself, and what factors affect its outcomes?

Infective endocarditis presents with fever and heart murmurs, and outcomes are affected by prior infections and patient risk factors. Signup and view all the answers

What are the risks associated with intravenous drug abuse and its relation to endocarditis?

Intravenous drug abuse increases the risk of endocarditis due to potential for sterile needle use and bacteria exposure. Signup and view all the answers

Identify the potential complications of myocarditis as stated in the content.

Complications include worsening heart function and the possibility of acute heart failure. Signup and view all the answers

Explain the significance of prior streptococcal infections in relation to endocarditis.

Prior streptococcal infections increase the risk and can adversely affect outcomes in cases of endocarditis. Signup and view all the answers

Explain the relationship between bacterial infections, particularly those caused by Staphylococcus aureus, and the development of infective endocarditis. Discuss the potential complications that can arise from this condition.

Infective endocarditis is a serious condition where bacteria, like Staphylococcus aureus, colonize the heart valves. This colonization can lead to the formation of vegetations, which are clumps of bacteria, blood clots, and inflammatory cells. These vegetations can damage the heart valves, causing them to leak or become stiff. Infective endocarditis can also lead to other complications such as heart failure, stroke, and even death. Signup and view all the answers

What are the key differences between acute and subacute endocarditis? Discuss the potential causes, clinical presentation, and likely outcomes for each type.

Acute endocarditis is a rapidly developing infection characterized by a high fever, chills, and heart murmurs. It's often caused by virulent bacteria like Staphylococcus aureus. Subacute endocarditis, on the other hand, progresses more slowly and might present with milder symptoms like fatigue and low-grade fever. This form is more commonly associated with less virulent bacteria like Streptococcus viridans. The outcome of acute endocarditis is more severe, potentially leading to complications like heart failure, stroke, and even death, while subacute endocarditis is generally manageable with appropriate antibiotic treatment, but can lead to valve damage and replacement in the long term. Signup and view all the answers

Explain how rheumatic fever can affect the heart valves. What is the mechanism by which this happens, and what are the potential long-term consequences of such damage?

Rheumatic fever, a complication of untreated group A streptococcal infections, can cause damage to the heart valves through a process called autoimmune reaction. The body's immune system mistakenly attacks the heart tissue, specifically the valves, as if they were the original bacteria. This leads to inflammation and scarring of the valves, making them leak or become stiff. These damaged valves can lead to heart failure, stroke, and other long-term complications, affecting the overall quality of life and potentially requiring valve replacement surgery. Signup and view all the answers

What are the potential consequences of infective endocarditis on the heart, and how can these consequences impact the overall health of the individual?

Infective endocarditis can cause significant damage to the heart valves, leading to heart failure, stroke, and even death. The damaged valves can leak, making it difficult for the heart to pump blood effectively. They can also become stiff, obstructing blood flow. In addition, the infection can spread to other parts of the body, causing abscesses or other complications. The overall impact on health is significant, potentially leading to long-term disabilities and a reduced quality of life. Signup and view all the answers

Explain the connection between bacterial infections and the development of rheumatic fever. Discuss the importance of early diagnosis and treatment of bacterial infections in preventing this complication.

Rheumatic fever is a complication that can occur after a group A streptococcal infection, like strep throat or scarlet fever. The body's immune system, while fighting the infection, can mistakenly attack heart tissue, leading to inflammation and scarring. Early diagnosis and treatment of bacterial infections, particularly with antibiotics, are crucial in preventing the development of rheumatic fever. By eliminating the bacteria early on, the immune system is less likely to trigger the autoimmune response that leads to rheumatic fever. Signup and view all the answers

Discuss the mechanism by which infective endocarditis can lead to the formation of vegetations on the heart valves. What are the potential consequences of these vegetations?

Infective endocarditis occurs when bacteria colonize the heart valves, often forming vegetations. These are clumps of bacteria, blood clots, and inflammatory cells that adhere to the valve surface. The bacteria can release toxins and trigger the body's inflammatory response, contributing to the formation of these vegetations. The vegetations can obstruct blood flow, causing heart valve dysfunction, and can even break off and travel through the bloodstream, potentially causing strokes or other complications. Signup and view all the answers

Describe the process by which the bacteria Staphylococcus aureus can cause infective endocarditis, highlighting the key steps involved in the infection process.

Staphylococcus aureus is a common bacteria that can cause infective endocarditis. The bacteria typically enter the bloodstream through a wound, IV drug use, or a recent surgery. Once in the bloodstream, they can travel to the heart and attach to the valves. The bacteria then multiply, forming colonies that can damage the valves, leading to leakage or obstruction of blood flow. This can result in a range of complications, including heart failure, stroke, and even death. Signup and view all the answers

Explain the relationship between rheumatic heart disease and infective endocarditis. Are they distinct conditions, or are they related in some way? Discuss their similarities and differences.

Rheumatic heart disease and infective endocarditis are both serious conditions that can affect the heart valves. However, they are distinct in their causes and mechanisms. Rheumatic heart disease is an autoimmune reaction that occurs after a streptococcal infection, leading to inflammation and scarring of the valves. Infective endocarditis is a bacterial infection of the heart valves, resulting in vegetation formation and valve damage. Both conditions can lead to valve dysfunction, heart failure, and other complications, but they have different underlying causes and often require different treatment approaches. Signup and view all the answers

About 3% of patients infected with ______ develop rheumatic heart disease.

streptococci Signup and view all the answers

In acute rheumatic fever, there are ______ responses involving various tissues.

inflammatory Signup and view all the answers

CD4+ T cells recognize ______ peptides and trigger inflammatory responses.

streptococcal Signup and view all the answers

Rheumatic heart disease is characterized by ______ degeneration of the mitral valve.

myxomatous Signup and view all the answers

The ______ valve is primarily affected in rheumatic heart disease.

mitral Signup and view all the answers

Fibrosis of the ______ valve leads to severe mitral stenosis.

mitral Signup and view all the answers

In rheumatic heart disease, the ______ tendineae may rupture, leading to severe mitral regurgitation.

chordae Signup and view all the answers

Rheumatic fever is associated with ______ valve disease in 95% of cases.

mitral Signup and view all the answers

Acue cardac nvovemen may ead o one or more o e oowng: becomes daed owng o ______ overoad.

pressure Signup and view all the answers

Percardts assocaed w a brnous ______

exudae Signup and view all the answers

Myocardts n e orm o ______ Ascof bodes wn e

scaered Signup and view all the answers

Acue reumac ever s mos common n c- ______

dren Signup and view all the answers

nersve connecve ssue; paognomonc Ascof ______

bodes Signup and view all the answers

Two o ree weeks ater ______

(Fg. Signup and view all the answers

Mur _______ are present in 90% of patients with rheumatic heart disease.

murs Signup and view all the answers

The prognosis of an infection depends on _______ organ system and the extent of the disease.

the underlying Signup and view all the answers

Rheumatic fever is categorized as a type of _______ disease.

inflammatory Signup and view all the answers

In rheumatic heart disease, the _______ valve is primarily affected.

mitral Signup and view all the answers

The primary purpose of _______ analysis is to diagnose certain conditions.

microbiome Signup and view all the answers

A _______ imbalance may result in a severe infection.

microbiome Signup and view all the answers

Adverse sequelae of rheumatic fever include ______ due to wrapping of antigen-antibody complexes in glomeruli.

glomerulonephritis Signup and view all the answers

Other adverse sequelae include ______ from invasion into the underlying myocardium and conduction system, and systemic embolization.

arrhythmia Signup and view all the answers

Unreacted, ineffective endocarditis generally is ______.

fatal Signup and view all the answers

Appropriate long-term ______ therapy and/or valve replacement may reduce mortality rates.

antibiotic Signup and view all the answers

For infections involving low-virulence organisms, such as S. viridans, the cure rate is ______%.

98 Signup and view all the answers

For S. aureus infections, cure rates range from ______ to 90%.

60 Signup and view all the answers

However, with infections due to aerobic gram-negative bacteria or fungi, patients ______ succumb.

usually Signup and view all the answers

Rheumatic heart disease is categorized as a ______ disease.

post-infectious Signup and view all the answers

These diseases are characterized by cardiac myocyte dysfunction that may be confined to the myocardium (primary) or may be a ______ of a systemic disorder (secondary).

manifestation Signup and view all the answers

Included among the diverse diseases that lead to myocyte dysfunction are infectious, immunologic, metabolic, and ______ disorders.

genetic Signup and view all the answers

Those that are inflammatory in nature are generally considered forms of ______.

myocarditis Signup and view all the answers

These diseases are characterized by changes in atrial and/or ventricular dilation and in ventricular wall ______.

thickness Signup and view all the answers

Genes that encode cytoskeletal proteins or proteins that link the sarcomere to the cytoskeleton are most commonly ______, typically by mutations that result in loss-of-function.

involved Signup and view all the answers

Dilated cardiomyopathy is considered hereditary in 20% to 50% of ______.

cases Signup and view all the answers

Mutations in over 50 genes have been implicated, usually with autosomal dominant ______.

inheritance Signup and view all the answers

Ao, aorta; LA, left atrium; LV, left ______.

ventricle Signup and view all the answers

Match the following cardiac valve abnormalities with their descriptions:

Calcific aortic stenosis = Stenosis occurring on a congenitally bicuspid valve with a raphe at its center. Mitral calcification = Calciﬁc nodules within the annulus of the mitral leaﬂets, extending into the underlying myocardium. Aortic regurgitation = A murmur associated with calcific aortic stenosis. Mitral valve prolapse = A condition not described in the text, but sometimes associated with mitral valve abnormalities. Signup and view all the answers

Match the following clinical features with their associated cardiac condition:

Dyspnea = Aortic stenosis, mitral calcification, or other valvular abnormalities Asymptomatic = Aortic stenosis or mitral calcification in early stages Auscultation of a midsystolic click = Mitral valve prolapse Cardiac conduction system impingement = Calcific aortic stenosis near the interventricular septum Signup and view all the answers

Match the following anatomical structures with their relevant descriptions:

Raphe = A partial fusion at the center of a bicuspid valve cusp Annulus = The attachment margin of the mitral leaﬂets Chordae tendineae = Fibrous cords that attach the valve leaflets to the papillary muscles Myocardium = The muscular wall of the heart Signup and view all the answers

Match the following terms with their definitions:

Stenosis = Narrowing of a valve opening Regurgitation = Backflow of blood through a valve Calcification = Deposition of calcium salts in tissues Conduction system = The pathway for electrical impulses that regulate heart rhythm Signup and view all the answers

Match the following cardiac conditions with their primary characteristics:

Subacute endocarditis = Causes valvular disease and may lead to mycotic aneurysms Acute endocarditis = Results in rapid valvular destruction and is often life-threatening Myxomatous mitral valve disease = Causes mitral valve prolapse into the left atrium Rheumatic heart disease = Is an autoimmune response to group A streptococcal infection Signup and view all the answers

Match the following cardiac conditions with their effects on heart valves:

Rheumatic heart disease = Causes valve deformity and scarring Acute endocarditis = Results in rapid valve destruction Subacute endocarditis = May lead to valve stenosis or regurgitation Myxomatous mitral valve disease = Causes mitral valve prolapse and regurgitation Signup and view all the answers

Match the following cardiac conditions with their underlying causes:

Rheumatic heart disease = Autoimmune response to group A streptococcal infection Acute endocarditis = Infection with high-virulence bacteria Subacute endocarditis = Infection with low-virulence bacteria Myxomatous mitral valve disease = Degenerative changes in the mitral valve Signup and view all the answers

Match the following cardiac conditions with their complications:

Rheumatic heart disease = Chordae tendineae rupture Acute endocarditis = Septic embolism and heart failure Subacute endocarditis = Mycotic aneurysm formation Myxomatous mitral valve disease = Mitral valve regurgitation and heart failure Signup and view all the answers

Match the following cardiac conditions with their treatment options:

Rheumatic heart disease = Antibiotic therapy and valve replacement Acute endocarditis = Aggressive antibiotic therapy and possible surgery Subacute endocarditis = Antibiotic therapy and monitoring for complications Myxomatous mitral valve disease = Mitral valve repair or replacement Signup and view all the answers

Match the following cardiac conditions with their characteristic lesions:

Rheumatic heart disease = Aschoff bodies Acute endocarditis = Vegetations on heart valves Subacute endocarditis = Valve scarring and thickening Myxomatous mitral valve disease = Myxomatous degeneration of the mitral valve Signup and view all the answers

Match the following types of endocarditis with their characteristics:

Nonbacterial thrombotic endocarditis = Characterized by the deposition of small, sterile, non-destructive thrombotic masses on cardiac valves Infective endocarditis = Typically affects previously normal valves Acute endocarditis = Has a gradual onset of cardiac involvement Rheumatic endocarditis = Is typically associated with(valve) damage prior to the infection Signup and view all the answers

Match the following valve diseases with their characteristics:

Myxomatous degeneration of the mitral valve = Is a consequence of acute rheumatic fever Rheumatic heart disease = Only affects the valves of the heart Acute endocarditis = Typically affects the aortic valve Nonbacterial thrombotic endocarditis = Is characterized by the deposition of small, sterile, non-destructive thrombotic masses on cardiac valves Signup and view all the answers

Match the following cardiac conditions with their age groups:

Rheumatic heart disease = Most commonly seen in children and young adults Acute endocarditis = Can occur at any age, but more common in IV drug users Subacute endocarditis = More common in older adults Myxomatous mitral valve disease = Most commonly seen in adults over 40 Signup and view all the answers

Match the following cardiac conditions with their effects on the heart:

Rheumatic heart disease = Causes cardiac inflammation and scarring Acute endocarditis = Results in rapid cardiac deterioration Subacute endocarditis = May lead to cardiac enlargement and failure Myxomatous mitral valve disease = Causes mitral regurgitation and cardiac remodeling Signup and view all the answers

Match the following conditions with their effects on the heart:

Rheumatic fever = Can cause the chordae tendineae to be affected Myxomatous degeneration = Affects the cardiac valves Acute endocarditis = Can cause vegetations to form on the heart valves Nonbacterial thrombotic endocarditis = Can cause damage to previously normal valves Signup and view all the answers

Match the following characteristics with the type of endocarditis:

Affects previously normal valves = Infective endocarditis Characterized by the deposition of small, sterile, non-destructive thrombotic masses on cardiac valves = Nonbacterial thrombotic endocarditis Has a gradual onset of cardiac involvement = Acute endocarditis Typically affects the aortic valve = Rheumatic endocarditis Signup and view all the answers

Match the following valve diseases with their underlying mechanisms:

Rheumatic heart disease = Is triggered by group A streptococcal infection Myxomatous degeneration of the mitral valve = Is caused by a severe microbiome imbalance Acute endocarditis = Is typically associated with valve damage prior to the infection Nonbacterial thrombotic endocarditis = Is caused by the deposition of small, sterile, non-destructive thrombotic masses on cardiac valves Signup and view all the answers

Match the following conditions with their associations:

Rheumatic fever = Is associated with valvular disease Acute endocarditis = Is associated with vegetations on the heart valves Myxomatous degeneration of the mitral valve = Is typically seen in adults Nonbacterial thrombotic endocarditis = Is characterized by the deposition of small, sterile, non-destructive thrombotic masses on cardiac valves Signup and view all the answers

Match the following terms with their corresponding descriptions:

Iron overload = Can lead to deposition of iron in the heart, causing damage End-stage disease = Marked by poor heart function and secondary hemochromatosis Myocardial constriction = Caused by injury leading to scarring of the heart muscle Cardiomyopathy = May be caused by abnormal iron deposition in the heart Signup and view all the answers

Match the following conditions with their corresponding effects on the heart:

Rheumatic heart disease = May lead to scarring of the heart valves and chordae tendineae Infective endocarditis = May cause the formation of vegetations on the heart valves Myxomatous degeneration = May cause the mitral valve to prolapse into the left atrium Cardiac injury = May lead to inflammation and scarring of the heart muscle Signup and view all the answers

Match the following terms with their corresponding associations:

Aschoff bodies = Found in the myocardium of patients with rheumatic fever Iron-mediated production = May contribute to oxidative stress and cardiac damage Non-bacterial thrombotic endocarditis = May cause the formation of thrombotic vegetations on the heart valves Myocarditis = May be caused by viral or bacterial infections Signup and view all the answers

Match the following conditions with their corresponding characteristics:

Acute endocarditis = Characterized by a rapid onset of symptoms and vegetation formation Subacute endocarditis = Characterized by a slower onset of symptoms and less severe vegetation formation Rheumatic fever = Typically affects children and may lead to heart valve damage Cardiomyopathy = May be caused by genetics, viral infections, or other factors Signup and view all the answers

Match the following terms with their corresponding consequences:

Vegetation formation = May lead to embolism and infarction of tissues Scarring of the heart valves = May lead to heart failure and decreased cardiac function Chordae tendineae rupture = May lead to mitral regurgitation and heart failure Iron overload = May lead to deposition of iron in other organs, such as the liver and pancreas Signup and view all the answers

Match the following conditions with their corresponding effects on the mitral valve:

Rheumatic heart disease = May cause scarring and thickening of the mitral valve Myxomatous degeneration = May cause the mitral valve to prolapse into the left atrium Infective endocarditis = May cause the formation of vegetations on the mitral valve Cardiomyopathy = May cause the mitral valve to become contracted and non-functional Signup and view all the answers

Match the following terms with their corresponding associations:

Microbiome imbalance = May contribute to the development of rheumatic fever Environmental exposures = May contribute to the development of cardiomyopathy Aschoff bodies = Are diagnostic for rheumatic heart disease Iron-mediated oxidative stress = May contribute to the development of cardiac injury Signup and view all the answers

Match the following conditions with their corresponding characteristics:

Acute cardiac involvement = Typically characterized by a rapid onset of symptoms and inflammation Subacute cardiac involvement = Typically characterized by a slower onset of symptoms and less severe inflammation Rheumatic heart disease = Typically affects the mitral valve and may lead to heart failure Cardiomyopathy = May be caused by genetics, viral infections, or other factors Signup and view all the answers

Match the following terms with their corresponding descriptions in the context of heart disease.

Myxomatous degeneration = Degeneration of the mitral valve leaflets, often leading to prolapse Aschoff bodies = Characteristic granulomas found in the myocardium of patients with rheumatic fever Rheumatic heart disease = A chronic inflammatory disease affecting the heart valves and myocardium, often triggered by a prior streptococcal infection Pericarditis = Inflammation of the pericardium, the sac surrounding the heart, often causing chest pain and discomfort Signup and view all the answers

Match the following conditions with their primary cause.

Dilated cardiomyopathy = Various causes, including genetic factors, viral infections, and alcohol abuse Infective endocarditis = Bacterial infection of the heart valves, often involving vegetations Rheumatic fever = Immune response to a previous streptococcal infection Myocarditis = Inflammation of the heart muscle, often caused by viral infections Signup and view all the answers

Match the following terms with their corresponding structural features.

Chordae tendineae = Fibrous cords that anchor the valve leaflets to the papillary muscles Valve cusps = Flaps of tissue that control the flow of blood through the heart Papillary muscles = Muscle projections that control the tension of the chordae tendineae Pericardium = Sac surrounding the heart that protects and lubricates it Signup and view all the answers

Match the following functional patterns with their primary characteristic.

Dilated cardiomyopathy = Enlargement of the heart chambers with reduced ejection fraction Hypertrophic cardiomyopathy = Thickening of the heart muscle, often with impaired diastolic function Restrictive cardiomyopathy = Stiffening of the heart muscle, leading to reduced filling capacity Myocardial dysfunction = Impaired heart muscle function, often due to underlying conditions Signup and view all the answers

Match the following terms with their corresponding locations in the heart.

Myocardium = The muscular wall of the heart Endocardium = The inner lining of the heart chambers Pericardium = The sac surrounding the heart Valve leaflets = The flaps of tissue that control blood flow through the heart chambers Signup and view all the answers

Match the following terms with their corresponding characteristics in the context of valvular heart disease.

Mitral valve prolapse = A condition where the mitral valve leaflets bulge back into the left atrium during systole Aortic stenosis = Narrowing of the aortic valve opening, restricting blood flow out of the heart Mitral regurgitation = Leaking of blood back into the left atrium during ventricular contraction Aortic regurgitation = Leaking of blood back into the left ventricle during diastole Signup and view all the answers

Study Notes

Rheumatic Heart Disease

Cardiac manifestation of rheumatic fever, an acute immunologically mediated multisystem inflammatory disease.
Occurs following infection with group A β-hemolytic streptococci.
Characterized by myxomatous degeneration of one or both mitral valve leaflets, leading to "floppy" valves that prolapse during systole.
Mitral valve prolapse is associated with valvular inflammation and scarring.
Incidence of rheumatic fever varies between 0.5% to 2.4% in adults.

Myxomatous Mitral Valve Disease

Primary mitral valve prolapse is a form of myxomatous degeneration due to inflammation and scarring.
CD4+ T cells recognize streptococcal peptides, triggering cytokine-mediated inflammatory responses.
In rheumatic heart disease, 95% of cases exhibit mitral valve dysfunction, and 25% may also involve the aortic valve.
Genetic variants might influence susceptibility to rheumatic conditions.

Acute Rheumatic Fever and Valvular Injury

Fibrosis of the mitral valve leads to commisural fusion and severe mitral stenosis.
Accompanying acute rheumatic fever can involve inflammatory changes in other cardiac structures, including the chordae tendineae.
Leads to dysfunction affecting multiple heart tissues.

Clinical Features

Acute rheumatic fever primarily affects children but can also occur in adults, typically two to three weeks post-infection.
Infective endocarditis can be classified into acute or subacute based on tempo and severity.
Commonly involves the aortic and mitral valves, with vegetations observed in 90% of patients.
Acute endocarditis is associated with virulent organisms, leading to destructive infections.

Diagnosis and Prognosis

Diagnosis is confirmed through positive blood cultures and identification of vegetations via echocardiography.
Prognosis largely depends on the infecting organism and extent of complications.
Murmurs are prevalent in patients with infective endocarditis, often indicating valvular involvement.

Marfan Syndrome

Most commonly causes acquired valvular disease.
Resulting from mutation in the fibrillin gene.
Morphological changes include ballooning (flodding) of affected mitral valves.

Pathogenesis

Antibodies develop against M proteins from certain streptococcal strains.
Characterized by enlarged, redundant, thickened, and rubbery mitral valves.
Tendinous cords can become elongated and thinned, potentially affecting cardiac valves.

Histology and Clinical Features

Histological examination reveals deposition of varying components and Fc receptor-bearing cells like macrophages.
Acute cardiac involvement can manifest as pericarditis with fibrous exudate, myocarditis with scattered Aschoff bodies.
Acute rheumatic fever frequently occurs in children but can also affect adults.

Vegetations and Valve Changes

Small vegetations (verrucae) are noted along mitral valve leaflets.
Previous rheumatic valvulitis can lead to fibrous thickening and fusion of chordae tendineae.
Marked left atrial dilation is often observed.

Infective Endocarditis

A microbial infection affecting heart valves and key in patients with predispositions like prosthetic heart valves.
Characterized by vegetations made of thrombus and organisms, causing damage to cardiac tissues.
Acute endocarditis displays bulky, potentially destructive vegetations rich in fibrin, neutrophils, and microorganisms.

Nonbacterial Thrombotic Endocarditis (NBTE)

Characterized by small (1 to 5 mm) non-destructive thrombotic masses on cardiac valves.
Occurs without previous valvular damage, often on previously normal valves.

Marfan Syndrome

Most common cause of acquired valvular disease resulting from a mutation in the fibrillin gene.
Characterized by ballooning or prolapse of affected mitral valves.

Pathogenesis

Antibodies against M proteins from certain streptococcal strains react with proteins in the myocardium and pericardium.
Enlarged, redundant, thick, and rubri coccal strains exhibit cross-reactivity with myocardial proteins, which may cause injury.
Tendinous cords in the heart become elongated and thinned, potentially affecting cardiac valves.

Rheumatic Heart Disease

Post-infectious condition where only about 3% of patients infected with streptococcus develop rheumatic valvular disease.
Of those cases, 25% also involve the aortic valve, indicating a possible genetic susceptibility.
Fibrosis of the mitral valve leads to fusion of commissures and severe mitral stenosis.

Inflammatory Response

Acute rheumatic fever may show inflammatory changes affecting the chordae tendineae and other cardiac structures.
Small vegetations (verrucae) occur along the closure line of the mitral valve leaflets.
Previous episodes lead to fibrous thickening and fusion of chordae tendineae alongside left atrial dilation.

Clinical Manifestations

Symptoms include pericarditis, cardiac dysfunction, mitral insufficiency, and signs of congestive heart failure.
Increased susceptibility to bacterial infections due to damage to the endocardium.
Less than 1% of patients die from acute rheumatic fever, although subsequent infections can increase risk.

Infective Endocarditis

Often results from damaged or deformed cardiac structures, typically due to Streptococcus viridans.
Staphylococcus aureus is associated with more severe cases due to heightened virulence.
Chronic pulmonary venous congestion accounts for 10-20% of endocarditis cases.

Diagnosis and Risk Factors

Diagnosis relies on evidence of previous streptococcal infections and present clinical signs.
Risk factors for infective endocarditis include intravenous drug use and oral flora exposure.
10% of endocarditis cases show no identifiable organism, potentially leading to ineffective treatments.

Treatment Approaches

Surgical intervention like mitral valvuloplasty or repair aims to restore normal function and reduce complications.
Improved diagnostics and management strategies have significantly improved patient outcomes.
Blood seeding with microbes is identified as a primary cause of infective endocarditis.

Myxomatous and Rheumatic Heart Disease

Myxomatous (mucous) matter is associated with CD4+ T cells recognizing streptococcal peptides and host antigens.
CD4+ T cells can also contribute to cytokine-mediated inflammatory responses in rheumatic heart disease.
Approximately 3% of patients infected with streptococcus develop rheumatic heart disease; 95% of these cases involve valve dysfunction.
25% of patients with rheumatic heart disease may also have aortic valve involvement.
Genetic variations may influence susceptibility to rheumatic heart disease.
Fibrosis of the mitral valve leads to fusion of commissures and severe mitral stenosis.

Acute Rheumatic Fever

Acute rheumatic fever involves inflammatory changes affecting the heart's three layers.
Causes of acute cardiac injury include:
- Pericarditis associated with a fibrous exudate.
- Myocarditis resulting from scattered Aschoff bodies within the heart tissue.

Clinical Features of Acute Rheumatic Fever

Most common in children, though adults can also be affected.
Initial attacks can occur 2 to 3 weeks post-infection.
Presence of Aschoff bodies is seen in 90% of patients.
Symptoms of acute rheumatic fever include joint pains, carditis, and skin rashes.
Diagnosis confirmed through positive blood cultures and echocardiography.

Prognosis and Complications

Prognosis depends on the infecting organism and the extent of complications.
Potential adverse sequelae include:
- Glomerulonephritis due to antigen-antibody complexes.
- Septicemia and arrhythmias from microbial invasion into the myocardium and conduction system.
- Systemic embolization can occur if untreated.
Long-term antibiotic therapy and/or valve replacement can significantly reduce mortality rates.
Cure rates for infections by low-virulence organisms like Streptococcus viridans are about 98%.
Cure rates for Staphylococcus aureus infections range from 60% to 90%, with poorer outcomes for infections caused by aerobic gram-negative bacilli.

Cardiomyopathies and Myocarditis

Diseases characterized by cardiac myocyte dysfunction can be due to genetic defects.
Dilated cardiomyopathy is hereditary in 20% of cases and can involve the myocardium or be secondary to systemic disorders.
Mutations affecting over 50 genes linked to various forms of dysfunction.
Conditions linked to infectious, immunologic, metabolic, and genetic disorders are often inflammatory, resulting in loss of function.

Calciﬁc Aortic Stenosis

Associated with a congenitally bicuspid valve; one cusp shows partial fusion known as a raphe.
Presents as calcification affecting the aortic valve and may lead to obstruction.

Mitral Calcification

Features calcified nodules in the mitral valve annulus.
Calcification can extend into the underlying myocardium, impacting cardiac function.

Clinical Features

Patients often asymptomatic; conditions may be found incidentally during physical exams.
Symptoms may include palpitations, dyspnea, and atypical chest pain.
Auscultation can reveal a midsystolic click, potentially accompanied by a regurgitant murmur.

Septic Embolism

Significant morbidity and mortality can occur despite adequate antibiotic therapy.
Emboli originate from vegetations on affected valves, leading to septic infarcts and abscess formation.

Endocarditis Types

Subacute Endocarditis: Involves low-virulence organisms, typically on previously abnormal valves, leading to chronic inflammation.
Nonbacterial Thrombotic Endocarditis (NBTE): Characterized by small, sterile thrombotic masses on normal or previously damaged valves, not necessarily requiring prior valve damage for diagnosis.

NBTE Diagnosis

Associated with diagnosed cardiomyopathy, leading to severe disease and potential heart failure.
Iron overload conditions can exacerbate or mimic cardiomyopathy due to underlying heart damage and functional impairment.

Vegetations in NBTE

Often minimal inflammation noted in affected heart valve cusps as seen in histological examination.
Thrombus formation on valves appears loose and non-destructive, allowing for potential detachment.

Cardiomyopathies

Classification by functional patterns such as dilated cardiomyopathy where ejection fraction considerably diminishes.
Secondary causes of cardiac dysfunction must be differentiated from primary cardiomyopathy for appropriate management.

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Description

This quiz covers the cardiac manifestations of rheumatic fever, an acute immunologically mediated multisystem inflammatory disease. It also includes questions on Myxomatous Mitral Valve Disease.