Valvular heart disease: Pathology review
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Valvular heart disease: Pathology review
Cardiovascular system
Cardiac arrhythmias
Atrioventricular block
Bundle branch block
Pulseless electrical activity
Atrial fibrillation
Atrial flutter
Atrioventricular nodal reentrant tachycardia (AVNRT)
Premature atrial contraction
Wolff-Parkinson-White syndrome
Brugada syndrome
Long QT syndrome and Torsade de pointes
Premature ventricular contraction
Ventricular fibrillation
Ventricular tachycardia
Cardiac tumors
Cardiac tumors
Shock
Shock
Vascular disorders
Arterial disease
Aneurysms
Aortic dissection
Angina pectoris
Coronary steal syndrome
Myocardial infarction
Prinzmetal angina
Stable angina
Unstable angina
Abetalipoproteinemia
Familial hypercholesterolemia
Hyperlipidemia
Hypertriglyceridemia
Coarctation of the aorta
Conn syndrome
Cushing syndrome
Hypertension
Hypertensive emergency
Pheochromocytoma
Polycystic kidney disease
Renal artery stenosis
Hypotension
Orthostatic hypotension
Lymphangioma
Lymphedema
Peripheral artery disease
Subclavian steal syndrome
Nutcracker syndrome
Superior mesenteric artery syndrome
Angiosarcomas
Human herpesvirus 8 (Kaposi sarcoma)
Vascular tumors
Behcet's disease
Kawasaki disease
Vasculitis
Chronic venous insufficiency
Deep vein thrombosis
Thrombophlebitis
Cardiovascular system pathology review
Acyanotic congenital heart defects: Pathology review
Aortic dissections and aneurysms: Pathology review
Atherosclerosis and arteriosclerosis: Pathology review
Cardiac and vascular tumors: Pathology review
Cardiomyopathies: Pathology review
Coronary artery disease: Pathology review
Cyanotic congenital heart defects: Pathology review
Dyslipidemias: Pathology review
Endocarditis: Pathology review
Heart blocks: Pathology review
Heart failure: Pathology review
Hypertension: Pathology review
Pericardial disease: Pathology review
Peripheral artery disease: Pathology review
Shock: Pathology review
Supraventricular arrhythmias: Pathology review
Valvular heart disease: Pathology review
Vasculitis: Pathology review
Ventricular arrhythmias: Pathology review
Assessments
Valvular heart disease: Pathology review
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Transcript
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On the Cardiology ward, there are two individuals. One of them is 75 year old Antonia, who’s complaining of chest pain and says she hardly catches her breath after walking. On clinical examination, her pulse feels pretty weak and on auscultation, a systolic murmur is heard. The murmur was louder just after S1 and got quieter and quieter by the end of S2.
The other individual is 38 year old Mark who has a history of rheumatic fever and is complaining of not being able to swallow properly. On clinical examination, his voice sounds raspy and on auscultation, a snap is heard after S2 along with a diastolic rumble. Based on auscultation, both individuals were sent for echocardiography.
Okay, so based on auscultation and symptoms, both individuals seem to have valvular heart disease. Valvular heart disease involves damage or a defect in one or more of the four valves of the heart, so the aortic and mitral valves on the left side of the heart, and the pulmonary and tricuspid valves on the right side of the heart.
Okay, now, before talking specifics about valvular disease, we’ll first talk about rheumatic fever, which can affect multiple valves. Rheumatic fever can develop after streptococcal infection like strep throat, which is caused by Streptococcus pyogenes. This particular group of streptococcus has an antigen that lumps it into a group called “group A”, and they also produce an enzyme called streptolysin, which causes hemolysis. Some of these strep bacteria have a protein on their cell wall called “M protein”, and this particular protein is highly antigenic, meaning that the immune system sees it and recognizes it as a foreign molecule and produces antibodies against it.
Now, this becomes a problem when these antigens cause a phenomenon called molecular mimicry. M proteins can be structurally similar to human proteins, which means the antibodies that target them will also target our own tissue. In this case, they are similar to proteins found in the myocardium and heart valves. Once bound to cardiac tissue, the antibodies activate nearby immune cells, which causes a cytokine-mediated inflammatory response and tissue destruction. This is also an example of what’s called a type 2 hypersensitivity reaction.
Summary
Valvular heart disease refers to a group of conditions that affect the heart's valves. The valves within the heart include the mitral, aortic, tricuspid, and pulmonary valves. Some examples of valvular heart disease include aortic stenosis, which is the narrowing of the aortic valve; aortic regurgitation in which blood leaks back through the aortic valve; mitral regurgitation in which there is a narrowing of the mitral valve; mitral stenosis characterized by blood leaking back through the mitral valve tricuspid regurgitation in which blood leaks back through the tricuspid valve; pulmonary stenosis that's characterized by the narrowing of the pulmonary valve; and finally; pulmonary regurgitation in which blood leaks back through the pulmonary valve.
Sources
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Robbins Basic Pathology" Elsevier (2017)
- "Rheumatic heart disease. 2012;379(9819):953-964" Lancet (2012)
- "2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines" Nishimura RA, Otto CM, Bonow RO, et al. (2014)
- "Comparison of Severity of Aortic Regurgitation by Cardiovascular Magnetic Resonance Versus Transthoracic Echocardiography" The American Journal of Cardiology (2011)
- "Pathophysiology of Heart Disease" Wolters Kluwer Health (2015)
- "Calcific aortic stenosis" Nature Reviews Disease Primers (2016)
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