The document discusses different types of endocarditis including infective bacterial endocarditis, non-infective conditions like rheumatic endocarditis, and atypical forms. It provides details on non-bacterial thrombotic endocarditis which occurs in debilitated patients, showing sterile fibrin platelet vegetations with risk of embolization. Endocarditis of SLE is also described showing sterile vegetations on heart valves without valvular deformity.
The document discusses different types of endocarditis including infective bacterial endocarditis, non-infective conditions like rheumatic endocarditis, and atypical forms. It provides details on non-bacterial thrombotic endocarditis which occurs in debilitated patients, showing sterile fibrin platelet vegetations with risk of embolization. Endocarditis of SLE is also described showing sterile vegetations on heart valves without valvular deformity.
The document discusses different types of endocarditis including infective bacterial endocarditis, non-infective conditions like rheumatic endocarditis, and atypical forms. It provides details on non-bacterial thrombotic endocarditis which occurs in debilitated patients, showing sterile fibrin platelet vegetations with risk of embolization. Endocarditis of SLE is also described showing sterile vegetations on heart valves without valvular deformity.
The document discusses different types of endocarditis including infective bacterial endocarditis, non-infective conditions like rheumatic endocarditis, and atypical forms. It provides details on non-bacterial thrombotic endocarditis which occurs in debilitated patients, showing sterile fibrin platelet vegetations with risk of embolization. Endocarditis of SLE is also described showing sterile vegetations on heart valves without valvular deformity.
• Encountered in debilitated patients with cancer and
sepsis (marantic endocarditis) • Deposition of fibrin, platelets on the surface of valves • Sterile vegetations • Significant for risk of embolisation and infarction Pathogenesis
• Hypercoagulable state with systemic activation of
coagulation as in advanced cancer-mucin secreting adenoca, acute leukemia, extensive burns, sepsis • In young- allergy, DVT, endocardial trauma (indwelling catheter) Morphology
Gross • Small (1-5 mm), non-destructive vegetations • Single/ multiple along line of closure • More friable than RHD • Heal by organisation M/E • Composed of fibrin, entangled RBCs, WBCs, platelets • Sterile, bland without inflammation or valve destruction Emboli may be seen → infarcts of brain, lung, spleen, kidney Endocarditis of SLE (Libman‐Sacks Disease)
• Small, sterile vegetations
• Pathogenesis- manifestation of collagen diseases seen in 50% cases of SLE, systemic sclerosis, TTP • Gross- 1-4 mm, granular, multiple, occur on the undersurface of valves, cords or mural endocardium of atria, ventricles - no valvular deformity • M/E: fibrinous material with platelet thrombi, capillary proliferation, hematoxylin bodies - mitral/ tricuspid valvulitis with fibrinoid necrosis of valve substance Valvular heart disease • Stenosis: failure of valve to open completely, impeding forward flow • Insufficiency/ regurgitation: failure of valve to close completely, causing reverse flow • Pure: only stenosis or regurgitation • Mixed: both stenosis and regurgitation are present in the same valve • Isolated disease: only one valve is affected • Combined: > 1 valve dysfunctional • Congenital or acquired • Can be rapid onset and fatal like AR (IE) or asymptomatic and chronic like MS (RHD) Common causes • Aortic stenosis: calcification of normal or congenital bicuspid valve • Aortic insufficiency: dilatation of ascending aorta, related to HT, aging • Mitral stenosis: RHD • Mitral regurgitation: myxomatous degeneration (mitral valve prolapse) Most frequent are acquired AS & MS (2/3 of all valve dis) Valvular degeneration caused by calcification • Calcific aortic stenosis: aging (senile) • Calcific aortic stenosis of congenitally bicuspid valves • Mitral annulus calcification Myxomatous degeneration/ Mitral valve prolapse • Seen in Marfans synd • Asymptomatic/ murmur • Post leaflet of mitral valve- opaque, white, soft, floppy- Floppy valve syndrome • M/E- loose CT with abundant mucoid material due to MPS Complications of artificial valves 1. Mechanical prosthesis: composed of nonphysiological biomaterials 2. Tissue valves: bioprosthesis
- Thromboembolic – local obstruction by thrombus or
• Cardiac manifestation of systemic syndrome caused by
carcinoid tumor • Present in 50% of patients with Carcinoid syndrome: flushing of skin, cramps, nausea, vomitting, diarrhea • Release of vasoactive amines by carcinoid tumors: serotonin, histamine, kallikrien, prostaglandins • Levels of S. serotonin & urinary 5-OH-indole acetic acid are indicators of severity of cardiac lesions • Normally, metabolism of serotonin occurs in liver and in lung by monoamine oxidase • Primary carcinoid tumors of GIT rarely cause syndrome in absence of hepatic metastasis • Right heart more commonly affected • Left heart affected in pulmonary carcinoid or R-L shunt Morphology • R>L • Gross: fibrous intimal thickening in RV, tricuspid and pulmonary valves • Micro: plaque composed of smooth muscle cells, scanty collagen in a mucopolysaccharide rich matrix • Underlying structures are intact
