Cardiac 4 Shea Flashcards
- Progressive chamber dilation and ____ dysfunction, resulting in a reduction of EF to less than ___%.
- The most common type of cardiomyopathy.
- Systolic dysfunction
- 25%
3 secondary causes of Dilated Cardiomyopathy
- Alcohol induced
- Viral myocarditis
- Anti-cancer drugs (Adriamycin) *cardiotoxic drug*
Morphology reveals a “heavy heart” which is large and flabby and would collapse if placed on hard surface.
Dilated Cardiomyopathy (dilation of all chambers)
Walls are thin and partially replaced by fibrous tissue as a result of what?
- This is Dilated Cardiomyopathy.
- As a result of dilation.
- Heart is 2 - 3 times normal size
- Impaired contractility
- CHF eventually occurs
Dilated cardiomyopathy
Describe the coronary arteries of a heart w/ dilated cardiomyopathy.
Usually normal
Is Dilated Cardiomyopathy Primary or Genetic or Idiopathic?
All 3
- Primary
- Genetic
- Idiopathic
- How is genetic form of Dilated Cardiomyopathy most often transmitted?
- What are the other 2 ways?
- Which sex are carriers?
- Which sex have disease?
- Autosomal Dominant trait (most common)
- Autosomal recessive
- Sex linked recessive
- Carriers: females
- Have disease: males
What are the 4 causes of Secondary Dilated Cardiomyopathy?
- Toxic
- Viral Myocarditis
- Pregnancy
- High Catecholamines (pheochromocytoma)
- What is the most common substance for Toxic Secondary Dilated Cardiomyopathy?
- What are the other 3 causes?
- # 1 ethanol
- Anticancer drugs (Adriamycin and Cytoxin)
- Long standing Cocaine use
- Cobalt exposure (inhaled usually from occupation)
Extensive hypertophy of the LV myocardium
Hypertrophic Cardiomyopathy
What are other names for hypertrophic cardiomyopathy?
- Hypertrophic Obstructive Cardiomyopathy, bc/ possible LV outflow tract obstruction
- Idiopathic Hypertrophic Subaortic Stenosis (IHSS) - heart is enlarged, heavy, muscular, exceeding 1200 grams with or without chamber dilation
- Heart is enlarged, heavy, muscular, exceeding 1200 grams with or without chamber dilation
- Genetic
Idiopathic Hypertrophic Subaortic Stenosis (IHSS)
- Usually asymmetrical thickening of the ventricular septum as compared to the left ventricular free wall
- On cross-section, septum looks like what?
- May be endocardial thickening w/ mural plaque formation of outflow tract. What % travel to the brain?
- Hypertrophic Cardiomyopathy
- Septum looks like “banana shaped”
- 70%
- Decrease in ventricular compliance which results in impaired ventricular filing during ____ w/ normal ____ function.
- The heart cannot expand adequately to receive the inflowing blood.
Restrictive Cardiomyopathy
- Impaired during diastole
- Normal Systolic
What are the 5 etiologies of Restrictive Cardiomyopathy?
- Idiopathic
- Radiation fibrosis
- Abnormal infiltrate:
- Amyloid
- Sarcoidosis
- Metastatic Tumor (breast cancer)
Abnormal protein which deposits in kidney or heart
“amyloid”
(Cardiac Amyloid)
Metastatic Colon Cancer spreading to heart is what type of heart condition?
Restrictive Cardiomyopathy
Gross findings:
- Ventricles normal in size or slightly enlarged
- Chambers usually not dilated
- Myocardium is firm
Histologically/Microscopic:
- Patchy or diffuse interstitial fibrosis
Restrictive Cardiomyopathy
What are 3 methods of diagnosing Cardiomyopathies?
Non-invasive:
- ECGs
- Echocardiograms
Invasive:
-
Endomyocardial Biopsy *punch biopsy* to obtain 3 - 4 pieces for pathologist
- (inserting catheter through groin such as femoral artery or vein)
- (insterting catheter through neck such as jugular vein to the left or right side of heart)
Systemic, immunologically mediated disease related to a streptococcal infection
Acute Rheumatic Fever
A delayed non-suppurative sequelae to an upper respiratory infection w/ Group A. beta hemolytic Streptococcus (not active) (dead)
Acute Rheumatic Fever
Typically, how soon does Acute Rheumatic Fever occur after a Strept throat infection?
2 weeks
The immune response elicted by the streptococcus antigens provides the body w/ a defense mechanism against which organism?
Strept. Pyogenes
Gram positive cocci, purple, chains
Strep
What lab value will be high if patient has rheumatic fever?
ASO titer (Antistreptolysin O antibodies)
10 to 14 days after strep infection, the patient develops what 3 sxs of rheumatic fever?
- Cardiac issues
- Joint issues
- Rash
- What is the #1 reason for heart disease WORLWIDE?
- Which age range?
- Why is this not the #1 for the U.S. ?
- Rheumatic Fever
- 5 to 25 years
- Good abx, compliance, less crowded living conditions
*
How does our immune reaction cause Acute Rheumatic Fever after a strep infection?
- Strep leaves behind a protein, then our B and T cells produce antibodies which destroy all 3 layers of heart (pancarditis)
- Damages connective tissue of heart and several other organs/tissues
Most people who need a ___ valve replacement had this as a child in 1950 - 1960s.
- Rheumatic Fever
- Left valve replacement
Not acute, it is DELAYED
Rheumatic Fever
- What % of manifestations of rheumatic fever are in the brain?
- What cardiac issues does the patient usually have?
- 20%
- Fatal arrhythmias
- Bread/Butter
- Who is most susceptible to ARF?
- Age, sex, race?
- How many out of 100,000 is the current rate of the US?
- Children (9-11 yrs), but can occur in adults
- Not related to sex or race
- 2
A major feature and complication of Acute Rheumatic Fever (ARF)
Rheumatic Heart Disease
In addition to the heart, what 4 areas of the body are affected by Rheumatic Heart Disease?
- Joints (migratory poly-arthritis)
- Subcutaneous connective tissue of skin
- Blood vessels
- Brain (occasionally)
What is the chief cause of heart disease in persons under 50 yrs?
Rheumatic Heart Disease
What disease is “chorea” associated with? What is it?
Rheumatic Heart Disease
- abnormal involuntary movement disorder
- Non-bacterial sterile inflammatory lesions and granulomas throughout the connective tissue of the body.
- Where are the lesions mostly located?
- Pathology of Rheumatic Heart Disease
- Heart
What is the characteristic heart pathology of RHD?
Pancarditis, involving all 3 layers of the heart
Which disease and what is this?
- Tenacious deposits of fibrin
- Shaggy surfaces of 2 slices of bread
- Pericardial friction rub
- If severe, leads to an adhesive type
Rheumatic Heart Disease
Pancarditis (Pericarditis)
What is this and what disease is it associated with?
- heart tends to be dilated
- Presence of Aschoff Bodies within the myocardium (histologically)
- With time –> granulomatous appearance, eventually replaced by scar causing dysrhythmias.
Myocarditis, associated w/ RHD
What is this? Which disease?
- Aggregates of lymphocytes and macrophages around a central zone of fibrinoid necrosis
Aschoff Bodies, Myocarditis, RHD
What is responsible for the majority of deaths in the acute phase of this disease (RHD) due to conduction system fibrosis?
Myocarditis, RHD
The most prominent changes are seen on the valves of the left heart. This valvulitis begins w/ inflammation of the valve surfaces, leading to what?
Endocarditis, RHD
Leads to ulceration
3 pathologic findings of RHD?
Pancarditis:
- Pericarditis
- Myocarditis
- Endocarditis
The surface defects of heart valve ulcerations are covered w/ what over time?
- Which valves are affected?
- Which side of heart? %?
Fibrin thrombi (they grow and assume form of larger vegetations along the lines of closure of valve leaflets).
- Mitral valve stenosis
- Aortic valve stenosis
- 95% left heart
- What are the 2 types of Acute Rheumatic Mitral Valvulitis?
- Which is early and which is late stage?
- Mitral Valve Regurgitation (insufficiency)/floppy = early
- Stenosis/stiffening, thickened chordae tendinae, so they shorten. Calcifications = late
Which bacteria causes pancarditis/RHD?
NONE, this is not bacterial. Strep died.
- Ongoing inflammation inside the valves, leads to destruction of the valves, followed by fibrous scarring that causes valve deformities
- NO bacteria
Vegetations of RHD
RHD
- The chordae tendinae inserting into the mitral valve are typically shortened/thickened and become fused. This fibrous adherence across the “commissures” of the valve produce a _____.
- Which valve is mostly affected?
- “Fish-Mouth Stenosis”
- Aortic/Semilunar valve
RHD
- Deformity of leaflets, changes of chordae tendinae, valves become incompetent and do not close completely during ____.
- What is this called?
- Valvular insufficiency
(redundancy, floppy, regurgitant)
- Systole
RHD
- Orifice may become stenotic, preventing normal flow of blood from one chamber into another
stiffness, stenosis
Which chambers of the heart are most likely to become dilated due to aortic valve stenosis?
LV and LA
Valvular heart disease is a very common cause of ____. ***
CHF
RHD
What are the 2 end results of valve insufficiencies?
- Mitral Valve Insufficiency
- Aortic Insufficiency
RHD
- Causes reflux of blood across the ___ from the left ventricle into the left atrium during systole.
(floppy/regurg)
Mitral Valve Insufficiency
RHD
- In this condition, blood flows back from the aorta into the left ventricle during diastole, leading to left ventricular hypertrophy and dilation
Aortic insufficiency
RHD
- Is the pulmonary system high or low pressure?
Low
RHD
- What condition causes “stagnation of blood in left atrium,” with possible clot formation, which is later transmitted into the pulmonary circulation and into the right ventricle?
Mitral Stenosis
RHD
Which type of stenosis leads to:
- Left atrial HTN
- Pulmonary HTN
- Right ventricular HTN
(which all lead to what?)
Mitral Stenosis
- All lead to Cor Pulmonale (right heart failure) - right ventricle
RHD
Which type of stenosis:
- Impedes blood flow from left ventricle into the aorta
Aortic Stenosis
RHD
What is the end result of aortic stenosis?
- There is increased resistance at the outflow tract, so to overcome this, the left ventricle increases the ejection pressure causing LVH (left ventricular hypertrophy)
- When the hypertrophic heart fails, the back pressure of the blood is transmitted from the LV to LA and into _______–> resulting in _______.
- pulmonary circulation–>
- resulting in Cor Pulmonale
What is responsible for the most deaths after the acute phase of RHD?
Endocarditis
