1B: Pathology of Heart Wall disorders

Question 0

How does Acute pericarditis present (Manifestations?)

Answer 0

• Triad of chest pain (abrupt, precordial, sharp)
• Friction rub (rubbing and friction betwn the inflammed pericardial surfaces)
• ECG changes

Question 1

What is acute pericarditis?

Answer 1

• Acute inflammation (< 2 weeks) of the pericardium
• Often infectious (bacterial, viral or fungal)
• Can be due to an autoimmune disease (RA, SLE), trauma, drug toxicity

Question 2

How does this affect the heart?

Answer 2

1) Fluid around the heart compresses heart wall
2) Heart cant expand to fill
3) Backup into systemic circulation
4) Decreased blood flow to the lungs
5) Decreased output to the body

Question 3

What is pericardial effusion?

Answer 3

-The accumulation of excess fluid (Exudate) in the pericardial
sac–>The amount of fluid, the rapidity with which it accumulates & the elasticity of pericardium determines the effect effusion has on cardiac fxn.

Question 4

____________ does not tolerate the sudden increase in heart size or the amount of fluid in the pericardial sac.

Answer 4

Pericardial sac

Question 5

What are the types of pericarditis?

Answer 5

1) Serous pericarditis
2) Fibrinous pericarditis
3) purulent pericarditis
4) hemorrhagic pericarditis

Question 6

What is serous pericarditis?

Answer 6

associated with systemic lupus erythematosus (SLE), Rheumatic fever, and a variety of viral infections.
-Characterized by production of clear, straw-colored, protein rich exudate containing small numbers of inflammatory cells.

Question 7

What is Fibrinous pericarditis?

Answer 7

• Characterized by a fibrin-rich exudate.

- IT may be caused by uremia, myocardial infarction, or acute rheumatic fever

Question 8

What is purulent pericarditis?

Answer 8

• Characterized by a grossly cloudy exudate.

- Almost always caused by bacterial infections

Question 9

What is hemorrhagic pericarditis?

Answer 9

• Characterized by a bloody exudate

- Usually result from tumor invasion of the pericardium but also can result from TB or other bacterial infections.

Question 10

What is Cardiac Tamponade?

Answer 10

• An increase in pericardial sac pressure caused by an accumulation of fluid in the pericardial sac.
• This results in reduced ventricular filling and subsequent hemodynamic compromise

Question 11

Is cardia tamponade a medical emergency? explain

Answer 11

Yes, overall risk of death depends on the speed of diagnosis, the treatment provided, and the underlying cause of the tamponade.

Question 12

How is pericardiocentesis done?

Answer 12

using a subxiphoid approach or parasternal approach

Question 13

What is myocardial disease?

Answer 13

Disorders originating from within the myocardium, but not from cardiovascular disease

Question 14

What are the 2 major forms of myocardial disease?

Answer 14

1) Myocarditis

2) Primary cardiomyopathies

Question 15

What is myocarditis ?

Answer 15

• Inflammation of the heart muscle (and conduction system) without evidence of myocardial infraction
• Heart is thick and swollen

Question 16

What are the causes of myocarditis?

Answer 16

1) #1 cause is VIRAL
2) drug toxicity (e.g cocaine)
3) autoimmune diseases

Question 17

What does a myocarditis patient present as?

Answer 17

As bi-ventricular heart failure in young persons who do not have valvular, rheumatic or congenital heart disease.

Question 18

What is Primary Cardiomyopathies ?

Answer 18

Diseases of the heart muscle that are non-inflammatory and are not associated w/ hypertension, congenital heart disease, valvular disease, or coronary artery disease

Question 19

What is the onset of Primary Cardiomyopathies like?

Answer 19

Is silent, and symptoms do not occur until the disease is well advanced.

Question 20

When is the diagnosis of Primary Cardiomyopathies suspected?

Answer 20

is suspected when a young, previously healthy, normotensive person experiences cardiomegaly and heart failure.

Question 21

How are Primary Cardiomyopathies detected?

Answer 21

with PE Pulmonary Effusion (particularly in athletes )

Question 22

What is the most common form of Primary Cardiomyopathies?

Answer 22

Dilated Cardiomyopathy

Question 23

What is dilated cardiomyopathy ?

Answer 23

progressive cardiac hypertrophy and dilation & impaired pumping ability in one or both ventricles

Question 24

What is Mural thrombi?

Answer 24

are common in dilated cardiomyopathy and may be a source of thromboemboli

Question 25

What are the causes of Mural Thrombi?

Answer 25

Idiopathic, infectious myocarditis, alcohol

** Most common initial manifestations are those related to heart failure

Question 26

What is hypertrophic cardiomyopathy?

Answer 26

Characterized by Ventricular hypertrophy and impaired diastolic ventricular filling

Question 27

How can you get hypertrophic cardiomyopathy ?

Answer 27

It is often inherited as an autosomal dominant characteristic several genes have been implicated in the genesis of this disorder.

Question 28

What are the manifestations of hypertrophic cardiomyopathy ?

Answer 28

Variable for reasons that are unclear, some persons with the disorder remains stable for many years and gradually acquire more symptoms as the disease progresses but for other it may result in left ventricular outflow obstruction.

Question 29

What are the dangers of hypertrophic cardiomyopathy?

Answer 29

Danger of syncope(fainting) and even sudden death, which often occurs unexpectedly in young athletes.

Question 30

What is restrictive cardiomyopathy?

Answer 30

Ventricular filing is restricted because of excessive rigidity and stiffness of the ventricular wall.

Question 31

What is the least common primary cardiomyopathies?

Answer 31

Restrictive cardiomyopathy

Question 32

What is the cause of Restrictive cardiomyopathy?

Answer 32

Unknown; may be associated with various infiltrations

Question 33

What is Infective Endocarditis ? (Bacterial Endocarditis)

Answer 33

Uncommon, life-threatening condition of the endocardial surface of the heart, including the heart valves.

Question 34

For infective (capable of causing disease) endocarditis to develop what 2 independent factors are normally required?

Answer 34

1) A “damaged” endocardial surface (presence of valvular disease, prosthetic heart valves, or congenital heart defects provide an environment conducive to bacterial growth.
2) A portal of entry by which the organism gains access to the vasculature (e.g innocuous oral lesion, upper respiratory tract infection, skin lesion, dental procedure)

** Staphylococcus aureus is the pathogen in 50% of cases!!!

Question 35

When does Infective Endocarditis (Bacterial endocarditis) occur?

Answer 35

Usually occurs when persons with pre-existing heart lesions, it also develops in normal hearts of IV drug abusers.

Question 36

What are the characteristics of infective endocarditis (bacterial endocarditis)

Answer 36

-Large, soft, friable, easily detached vegetations consisting of fibrin and intermeshed inflammatory cells and bacteria.

Question 37

What can infective endocarditis cause ?

Answer 37

May cause ulceration, often with performation of the valve cusps or rupture of one of the chordae tendinaeae.

*** Mitral valve is MOST frequently involved

Question 38

During infective endocarditis when does distal embolization occur?

Answer 38

When vegetations fragment; Embolization can occur almost anywhere in the body and can result in septic infarcts in the brain or in other organs.

Question 39

What is the antibiotic regiment for most patients with infective endocarditis?

Answer 39

Amoxicillin , 2g orally 30-60 min before the procedure.

Note: Pt. allergic can take Cephalexin (2g) or azithromycin or clarithromycin (500mg) also 30-60 min before procedure.