Cardiac histopath

Question 1

Mechanical complications of MI (4)

Answer 1

1) Cardiogenic shock ( loss of muscle = ventricular dysfunction) 2) Heart failure 3) Rupture of papillary muscles - AR, rupture of ventricular wall - haemopericardium, septum - left to right shunt 4) Ventricular aneurysm

Question 2

Arrythmias following MI

Answer 2

Most common AF, most likely to die VF (within 24hrs)

Question 3

Pericardial complications following MI (3)

Answer 3

1) Pericarditis - just post MI 2) Dresslers - triad: chest pain + fever + effusion (weeks after) 3) Pericardial effusion

Question 4

Path - 6 hours post MI

Answer 4

Normal histology

Question 5

6-24 hours post MI histology (3)

Answer 5

Loss of nuclei homogenous cytoplasm Cell necrosis

Question 6

1-4 days post MI histology

Answer 6

Invasion of polymorphs followed by macrophages

Question 7

5-10 days post MI histology

Answer 7

Clearing of debris complete

Question 8

1-2 weeks post MI histology (4)

Answer 8

Myofibroblasts Collagen synthesis Angiogenesis Granulation tissue

Question 9

Weeks to months post MI histology(2)

Answer 9

Strengthening, decellularising scar tissue

Question 10

Causes of HF (6)

Answer 10

IHD Arrythmias Valve disease HTN DCM Myocarditis

Question 11

Complications of HF (7)

Answer 11

Arrythmias Sudden death Pulmonary oedema Pulmonary embolism Hepatic cirrhosis - nutmeg liver DVT Peripheral oedema

Question 12

LV failure signs (3)

Answer 12

Pulmonary congestion leads to pulmonary oedema: 1) Dyspnoea 2) Orthopnea 3) PND 4) Wheeze

Question 13

RV Failure signs (3)

Answer 13

Usually due to LHF, but can also be pulmonary HTN 1) Ascites 2) Peripheral oedema 3) Facial congestion

Question 14

3 types of cardiomyopathies

Answer 14

Dilated Restrictive Hypertrophic

Question 15

Causes of Dilated Cardiomyopathy (5) & mech (systolic or diastolic dysfunction)

Answer 15

Systolic dysfunction (LVEF) < 40%

1. idiopathic
2. alcohol
3. genetic
4. sarcoid
5. haemachromatosis

Question 16

Causes of Restrictive Cardiomyopathy

Answer 16

1) Amyloidosis 2) Sarcoidosis 3) Radiation induced fibrosis

Question 17

Causes of Hypertrophic Cardiomyopathy

Answer 17

1) Genetic 2) Storage disease

Question 18

Is there systolic or diastolic dysfunction in restrictive cardiomyopathy?

Answer 18

Diastolic

Question 19

Is there systolic or diastolic dysfunction in hypertrophic cardiomyopathy?

Answer 19

Diastolic

Question 20

What do you see in pt with HCM histologically? (1)

Answer 20

Myocyte disarray

Question 21

Inheritance pattern of HCM?

Answer 21

Autosomal Dominant

Question 22

Mutations in which genes in HCM? (3)

Answer 22

Genes encoding sarcomeric proteins:

1) bMHC - most common
2) Trop T - high risk of sudden death
3) MYBP-C

Question 23

Arrythmogenic Right Ventricular Cardiomyopathy (ARVC)

Answer 23

Myocyte loss with fibrofatty replacement seen in RV

Question 24

Which structure is affected in pt with ARVC?

Answer 24

Desmosomes of Cardiac muscle

Question 25

Most common causative pathogen in acute rheumatic fever?

Answer 25

Lancefield Group A Strep Peak age 5-15 yrs

Question 26

Pathophysiology of acute rheumatic fever (briefly)?

Answer 26

Antigen mimicry: react with myosin, troponin etc.

Question 27

Diagnosis of Acute rheumatic fever? (2 things)

Answer 27

JONES Criteria + ASOT titres +ve J - Joint involvement (migrating polyarthralgia) O - Heart is O shaped - myocarditis N - Nodules (sub cut) E - Erythema marginatum S - Syndenham's Chorea

Question 28

Histology of Acute rheumatic fever (3 things)

Answer 28

1**) Vegetations** - beady & fibrous like veruccae 2) **Aschoff bodies** - small giant cell granulomas 3) **Anitschkov myocytes** - regenerating myocytes

Question 29

Pathology & vegetation characteristics of infective endocarditis

Answer 29

Colonisation of valves by microbes Large, irregular masses on valve cusps **extending to chordae**

Question 30

Pathology of non-bacterial thrombotic endocarditis

Answer 30

DIC/ hypercoagulable states

Question 31

Vegetation characteristics of non-bacterial thrombotic endocarditis

Answer 31

vegetations are formed of thrombi and attached to lines of closure

Question 32

Path of Libman-Sacks endocarditis

Answer 32

Unknown, associated with SLE & anti-phospholipid syndrome

Question 33

Vegetation characteristics of Libman-Sacks endocarditis

Answer 33

**Small**, **sterile platelet rich** vegetations

Question 34

Bacteriaemia in IE causes: (5)

Answer 34

1) Poor dental hygeine 2) Dental treatments 3) Cannulae and lines 4) IVDU 5) Cardiac surgery and pacemakers

Question 35

Predisposing factors for IE - basically problems in valves ((5)

Answer 35

1) Calcified valves 2) Prosthetic valves 3) Prev rheumatic fever 4) Congenital defects 5) Mitral regurg

Question 36

2 most common pathogens causing SUBACUTE IE:

Answer 36

Strep. Viridans & S. Epidermis

Question 37

2 most common pathogens causing ACUTE IE:

Answer 37

Strep Pyogenes & S. Aureues

Question 38

Clinical features of IE ( at least 6)

Answer 38

Fever Malaise Rigors Roth Spots Janeway lesions Oslers nodes Splinter Haemorrhages New murmur

Question 39

Most common Valves affected in IE

Answer 39

Aortic or mitral UNLESS IVDU

Question 40

Treatment of IE

Answer 40

Benzylpenicillin + Gentamicin

Question 41

Mitral valve prolapse Signs + symptoms

Answer 41

SOB & Chest pain ## Footnote **Mid systolic click + Late systolic murmur**

Question 42

Causes of aortic regurg (3 categories)

Answer 42

1) **Rigidity** - rheumatic, degenerative 2) **Destruction** - IE 3) **Dilation** - valve can no longer cover increased SA: Marfans Cystic medial degeneration Dissecting aneurysm

Question 43

Types of Pericarditis (4) & causes

Answer 43

1) **Fibrinous** (MI, Uraemia) 2) **Purulent** (Staph) 3) **Granulomatous** (TB) 4) **Haemorrhagic** (Tumour, TB, Uraemia)