Cardiac 1 Shea Flashcards
Inflammation of the pericardium (either visceral or parietal layers), but usually inflammation of one causes an inflammation of the other.
Pericarditis
Pericarditis is often associated w/ other infections of the heart such as _____ or infections involving the thoracic cavity such as _____.
- Myocarditis
- Tuberculosis
Simple squamous lubricating layer of the heart
Mesothelium
How many CCs of fluid is typically in the heart?
15 - 20
How many CCs of fluid in the pericardial sac will cause “cardiac stand still” making the heart too heavy causing the conduction system to stop?
350 - 375 CCs
What is the #1 cause of cardiac tamponade?
Penetrating trauma (MVC)
What are the 2 most common bacterial causes of Epimyocardial Microabscesses?
- Staph Aureus (gram positive cocci in grape clusters)
- Strep (gram positive in chains)
- Is caused by TB
- Can cause dysrhythmias
Constrictive Tuberculous Pericarditis
- What are 3 causes of pericarditis?
- Which of the 3 is least common cause?
- Bacteria
- Viruses
- Fungi (least common)
What are 2 other causes of pericarditis?
- Severe autoimmune diseases such as SLE (systemic lupus erythematosus)
- Metabolic waste products that accumulate in blood in chronic renal failure leading to Uremia (kidneys can’t breadk down nitrogenous waste, so it circulates in blood and affects the heart)
Uremia leads to what type of pericarditis?
(from nitrogenous waste, especially ammonia)
Fibrinous “fluffy” Pericarditis
What 3 things can lead to a “sterile inflammation” of the heart?
(pericarditis)
- Trauma
- Radiation injury
- Open heart surgery
Pathologically, pericarditis is always associated w/ which finding?
- Exudation of fluid into the pericardial sac.
Describe the pathological findings of the fluid for a viral pericarditis.
Clear yellow fluid (serous pericarditis)
Describe the pathological findings of a bacterial (suppurative) pericarditis. (more common than viral)
Purulent exudate, caused by pus forming bacteria (staph aureus or strep pyogenes)
What are the 4 types of pericarditis?
- Serofibrinous Effusion
- Fibrinous (bread & butter)
- Fibrous (adhesive)
- Constrictive
- Which type of pericarditis is associated w/ more severe damage such as Rheumatic Fever or early bacterial infections?
- Has orange fluid on pathologic exam
Serofibrinous Effusion/exudate
Which pericarditis?
- surface of heart w/ shaggy, yellowish layers which bridge the space between the 2 layers of the pericardial sac (obliterating cavity)
- When the friable strands are separated, the epicardium and pericardium resemble what?
FibriNous Pericarditis
“bread N butter”
In which type of pericarditis is there a collagen scar. The entire pericardial sac must be taken off or it can progress to constrictive pericarditis?
Fibrous (adhesive) Pericarditis
Which pericarditis?
- Looks white and stiff on pathologic examination
Constrictive Pericarditis
An acute inflammation of the myocardium typically caused by ____.
- Myocarditis
- Viruses
What are the 2 ways in which myocarditis can occur?
- Primary disease
- Or due to Secondary Disorder (Rheumatic Myocarditis due to Rheumatic Fever, lupus, or other autoimmne diseases)
- Over 80% of cases of myocarditis are caused by viruses.
- Which virus is most common cause?
- What are other 2 causes?
- Coxsackie B virus (picornavirus, an RNA virus)
- Fungi & Parasites
If there are “mononuclear cells” always think…?
Virus
- What are 4 other causes of myocarditis?
- Which is rare?
- Bacterial (rare)
- Radiation reaction
- Hypersensitivity reactions (SLE, Scleroderma, RF)
- Sarcoidosis (autoimmune disease more common in females due to estrogens)
A myocardial pyemic abscess has which type of necrosis?
Liquefactive
How does the virus in myocarditis survive?
By invading the myocardium, they cannot survive outside of the myocardial cells.
What does the virus do inside the myocardial cells?
Damage vital organelles & cause cell death of the heart muscle cells (weakening the myocardium –> HF)
Besides the virus of myocarditis, what else is invading the myocardium?
- T-lymphocytes (that are attracted to virus)
- Lymphokines are then secreted by the T-lymphocytes (Interleukins and TNF) which weaken the heart even more
(ACUTE, not chronic)
What role do lymphokines play in myocarditis?
They are supposed to kill the virus, but they also destroy the “virus infected cells” and contribute to HF
- Pale and congested areas w/ mild hypertrophy
- Biventricular dilatation
- Generalized hypokinesis of myocardium (tiger effect)
Pathology of Viral Myocarditis
Flabby and dilated heart
Describes hearts of people dying from Myocarditis
- Patchy, diffuse interstitial infiltrate composed of T-lymphocytes & macrophages
- Inflammatory cells surround individual myocytes w/ focal or patchy acute myocyte necrosis
Histology of Myocarditis
Clinically, how soon do sxs begin after the infection?
a few weeks
- What 3 sxs do patients w/ mild myocarditis present with clinically?
- What additional sxs do patients present w/ if it is severe?
Mild:
- mild fever
- SOB
- malaise
Severe: signs of HF
- tachycardia
- peripheral cyanosis
- pulmonary edema
Which sex is affected more by myocarditis?
2x more in males
Do patients usually die or survive from myocarditis?
Despite extensive inflammation, most will recover from ACUTE myocarditis, but a few will die from CHF or arrhythmias.
How do you dx viral myocarditis?
-
Endomyocardial Biopsy (insert catheter into femoral artery or neck vein, propell it through the aorta into left ventricle or left side of heart)
- “punch biopsies” , 1 - 2 mm pieces of myocardium are removed(3 to 5 pieces)
What is the tx for viral myocarditis?
No specific tx, supportive measures are needed
Atherosclerosis is only in the arteries and in 1 vein, which vein?
saphenous vein (have shown increased luminal narrowing)
The aorta has the same 3 layers as the heart, what are they?
- Intima
- Tunica media
- Adventitia
The first damage of atherosclerosis occurs where?
At the interface between the blood and the arterial wall
Endothelial cell injury of atherosclerosis is due to which 2 things?
(2 most common causes)
- Metabolic derangement (DM)
- Physical force / Hemodynamic disruption (HTN)
- Endothelial cell injury
- Deposition of platelets
- Deposition of serum lipoproteins (LDLs)
(depositions are under the endothelium which stimulates macrophages)
Etiology of atherosclerosis
Which location has the least amount of atherosclerosis?
Asia
Women have very high levels of ____ during their reproductive age due to estrogens. But once they reach menopause their risk of atherosclerosis increases to that of males.
HDLs
What stimulates the proliferation of smooth muscle cells in the wall of the artery?
(atherosclerosis etiology)
Growth factors released from platelets
Trapped LDLs inside the macrophages are transformed into what?
Foam cells
Some of the lipid laden smooth muscle cells die, releasing lipid into the intersitial spaces that is degraded and deposited in the form of ____.
Cholesterol
