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Vitium(valvular heart diseases and shunts)
Dr. Attila Zalatnai
Anatomical malformations + Valvular heart diseases
Congenital heart defects: Etiology:90 % multifactorialgenetic causes (Down-sy); exogeneous: chronic alcoholism….
PERSISTENT TRUNCUS
ARTERIOSUS
PATENT DUCTUS BOTALLI
ATRIAL SEPTAL DEFECTS (ASD)
Small opening: occurs in 20% of people
Larger opening: left-to-right shunt
pulmonary hypertension
right chamber hypertrophy
right-sided heart failure
Cyanosis: late event
Most severe form: one single, common atrium
VENTRICULAR SEPTAL DEFECTS (VSD)
Most common cardiac malformation
Mostly at the upper (membranous) part
Left-to-right shunt
Smaller ones: spontaneous closure is expected
Larger ones: pulmonary hypertension
TETRALOGY of FALLOT
1. Ventricular septal defect
2. Pulmonary stenosis
3. Right ventricle hypertrophy
4. Aortic dextroposition
Relatively frequent in diabetics
Right-to-left shunt
Cyanosis since birth
Susceptibility to endocarditis
Valvular heart diseases
Congenital or acquired
Mainly the left side of the heart is involved
Right-sided forms: mainly secondary, functional or in carcinoid heart
Susceptibility to infective endocarditis
Etiology: degenerative (atherosclerosis)rheumatic feverSLE infectionsmyxoid degeneration
Aortic stenosisAortic insufficiencyMitral stenosisMitral insufficiencyCombined
Aortic stenosis
Severe left ventricular hypertrophy
Aortic insufficiency
Mitral stenosis
Arteficial valve thrombosis
Endocarditis: inflammation of the endocardium, especially the
valves
1. Infective endocarditis: (bacteria, fungi)
Predisposing factors:
- septicemia
- valve malformations
- deformed, calcified valves
- arteficial valve implantation
- previous rheumatic fever
- peridontal, periapical foci!
Most important causative agents:
Strcc. viridans
Enterococcus (Str. fecalis)
Staphylococcus aureus
Candida species
Morphology:
Vegetations
Valve destruction
Both
Complications:
embolization (septic emboli, septic abscesses)
sepsis
„mycotic aneurysms”, subarachnoidal hemorrhage
acute left sided heart failure (regurgitation, chorda tendinea rupture)
healing by scarring and calcification
VITIUM
stenosis insufficiency combined
2. Non-infective endocarditis:
verrucous endocarditis (rheumatic fever)
SLE (Libman-Sacks endocarditis) – atypical
„marantic” endocarditis - paraneoplastic
Chronic obstructive lung diseases.
Cor pulmonale.
Chronic obstructive lung disease,
Chronic obstructive pulmonary disease, COPD
• diseases characterized by the presence of airflow obstruction
(expiration is impaired)
• airflow obstruction generally is progressive
• permanent structure destruction of the affected tissues
chronic bronchitis
emphysema
bronchiectasis
(bronchial asthma) (?)
Clinical definition of the chronic bronchitis:
presence of a chronic productive cough for 3 months during each of 2
consecutive years (other causes of cough being excluded).
Vast majority of cases are attributed to cigarette smoking, minority is due
to air pollution
Simple chronic bronchitis
Chronic mucopurulent bronchitis
Chronic bronchitis with exacerbation
Chronic bronchitis: pathology
• goblet cell metaplasia in the bronchioles
• mucous gland hyperplasia (Reid-index )
• mucous plugging in the small bronchi, bronchioles
• smooth muscle hypertrophy
• neutrophilic infiltrate accumulation
• continuous inflammation, mucopurulent exudate
• tissue destruction
• fibrosis of the brochial wall
• atrophy of the mucous membrane
• permanent dilatation of the small bronchi (distal to
the segmental bronci)
• pulmonalsclerosis
Emphysema:
• abnormal, permanent enlargement of the air spaces distal to the
terminal bronchioles, accompanied by destruction of their walls and
without obvious fibrosis
• commonly presents with chronic bronchitis
E K
Forms of the emphysema:
Centriacinar: focal destruction limited to the respiratory bronchioles and
the central portions of acinus. This form of emphysema is associated
with cigarette smoking and is most severe in the upper lobes.
Panacinar: involves the entire alveolus distal to the terminal bronchiole.
The panacinar type is most severe in the lower lung zones and generally
develops in patients with homozygous alpha1-antitrypsin (AAT)
deficiency
Paraseptal: least common form and involves distal airway structures,
alveolar ducts, and sacs. This form of emphysema is localized to fibrous
septa or to the pleura and leads to formation of bullae
Etiology:
Cigarette smoking (neutrophil activation, proteinase, elastase activities,
blocking the antiproteinase system)
Alpha-1-antitrypsin deficiency
bullous emphysema
Cor pulmonale:
Hypertrophy and/or dilatation of the right side of the heart as a result
of pulmonary hypertension (valve diseases, left heart problems
excluded!!)
1. Acute cor pulmonale (massive pulmonary embolus, air embolia,
amniotic fluid embolisation)
2. Chronic cor pulmonale
a. diseases of the lung parenchyma
(chronic bronchitis, emphysema, bronchiectasis, lung fibrosis,
sarcoidosis, massive tbc, asbestosis)
b. diseases of the chest wall impairing the respiration
(kyphoscoliosis, pleural callus, extreme obesity)
c. diseases of the lung vasculature
(multiplex pulmonary microembolisation)
Acute cor pulmonale – saddle embolus
R
septum
L
asbestosis
(Boeck) sarcoidosis
Consequences of right ventricular dilatation
(right sided heart failure)
Cyanosis
Hydrothorax
Hydropericardium
Ascites
Anasarca / generalized edema
Hepatosplenomegaly
Nutmeg liver
Congestion (passive hyperemia) of the internal organs
Congestive gastritis/duodenitis