10/28-Myocardial Diseases Flashcards
What is pressure hypertrophy and what is it caused by?
- hypertrophy without dilatation
- caused by hypertension or aortic stenosis
What is volume hypertrophy and what is it caused by?
- hypertrophy with dilatation
- caused by Aortic and mitral regurgitation or L=>R shunts
3 Consequences of hypertrophy?
- angina (decreased perfusion to thickened myocardium)
- arrhythmias (sudden death)
- heart failure
Right ventricle hypertrophy is usually a combination of hypertrophy then dilation with either pressure or volume overload, what are three possible causes of this?
- pulmonary hypertension
- pulmonary stenosis
- tricuspid regurgitation
T/F- physiologic hypertrophy can lead to extra heart sounds and murmurs
true
T/F- left ventricular failure leads to an increase in LV end-diastolic volume and backup of blood into lungs
true
4 causes of systolic dysfunction?
-ischemic heart disease
-dilated cardiomyopathy
-hemochromatosis
-myocarditis
=>ejection fraction low
4 causes of diastolic dysfunction?
-hypertension
-hypertrophic cardiomyopathy
-restrictive cardiomyopathy
-other infiltrative disorders (amyloidosis, fibrosis)
=>ejection fraction normal to increased
4 causes of right ventricular failure?
- MOST COMMON cause is Left sided heart failure
- pulmonary HTN
- RV infarction
- tricuspid regurgitation
What is dilated cardiomyopathy?
Systolic disorder with hypertrophy, dilatation, and dysfunction
What is the etiology of primary dilated cardiomyopathy?
- idiopathic (most common)
- familial (genetic cases most commonly autosomal dominant), affecting cytoskeletal proteins and sarcomeric proteins
Etiology of secondary dilated cardiomyopathy?
- Alcoholism (20%)
- Myocarditis (10%)
- Peripartum (5%)
Pathological findings of primary dilated cardiomyopathy?
- hypertrophy
- fibrosis
- no other findings
Findings associated with secondary dilated cardiomyopathy?
myocarditis, hemochromatosis, other disorders
T/F- 90% of cases of arrhythmogenic right ventricular cardiomyopathy are inherited
False, only 25% (majority autosomal dominant)
T/F- pathologic changes in arrhythmogenic RV cardiomyopathy progress in the reverse direction (i.e. subepicardial=> subendocardial) of ischemic changes
true
Is the left ventricular ejection fraction decreased or increased in hypertrophic cardiomyopathy?
often normal or increased
What are causes of mortality with hypertrophic cardiomyopathy?
arrythmias
heart failure
thrombo-embolic phenomenon
T/F- hypertrophic cardiomyopathy is caused in most cases by mutations in genes that encode sarcomeric proteins (beta-myosin heavy chains)
true
Is primary or secondary restrictive cardiomyopathy more common?
Secondary is more common -amyloidosis (50%) -Eosinophilic myocarditis (35%) Primary -familial (<1%) -Idiopathic (10%)
Eosinophilic myocarditis is usually referred to as what?
Loeffler endomyocarditis
Gross appearance of primary restrictive cardiomyopathy?
- heart is normal size or enlarged
- ventricles normal to enlarged
- atria are dilated
Microscopic appearance of primary restrictice cardiomyopathy?
interstitial fibrosis
myocyte hypertrophy
T/F- isolated amyloid in heart is often related to senile cardiac amyloidosis and deposition of transthyretin
true
What do eosinophils release that causes myocyte necrosis in eosinophilic restrictive cardiomyopathy?
major basic protein
What are symptoms of myocarditis?
fatigue, dyspnea, palpitations, chest pain, fever (or may be asymptomatic)
What is the most common cause of myocarditis in the US?
viruses specifically Coxackie virus (molecular mimicry) most common. Other enteroviruses, influenza, CMV, HIV can also cause this.
T/F- bacteria such as C. diptheriae and Borrelia burdorferi as well as Fungi (candida), helminths (trichinosis), and trypanosome cruzi (chugs disease) can cause myocarditis as well
true
T/F- myocarditis can be caused by hypersensitivity rxns to drugs, autoimmune disorders (SLE, rheumatic fever, polymyositis), Sarcoidosis, and transplant rejection
true
What are the 3 common types of chronic pericarditis?
- fibrous plaques or delicate adhesions (no clinical significance)
- Adhesive mediastinopericarditis (obliteration of pericardial sac, strain on heart)
- Constrictive pericarditis (restrictive physiology)
What are 5 types of Acute pericarditis?
- Serous
- Fibrinous and serofibrinous
- Suppurative
- Caseous
- Hemorrhagic
