Cardiac Path Flashcards
What is a cardiomyopathy
heart disease resulting from a primary abn. in the myocardium
long standing pressure changes -> hypertrophy
long standing volume changes -> dilated
What are the 3 types of cardiomyopathies?
dilated, hypertrophic, restrictive
Describe dilated CM
progressive chamber dilated, results in reduced EF
causes: ABCD PIG
Most common type of CM?
dilated CM
Two classes of drugs that can cause dilated CM?
Adriamycin (Doxorubicin)
Cytoxin
(both CA drugs)
What would a dilated CM heart look like pathologically?
heavy heart which is large and flappy with dilation of all chambers
gross/microscopic findings of dilated CM?
thin walls partially replaced w/ fibrous tissue
How is genetic idiopathic dilated cardiomyopathy transmitted?
autosomal dominant, but also autosomal and sex linked recessive
What is the most common identifiable cause of secondary dilated CM in the U.S? other causes?
alcohol
cocaine use, cobalt exposure, viral myocarditis, pregnancy, high catecholamines (pheochromocytoma)
Describe hypertrophic CM
extensive hypertrophy of LV
HCM is also known as…
IHSS (idiopathic hypertrophic subaortic stenosis)
heart enlarged >1200g
What can you see grossly in HCM?
asymmetrical thickening of the ventricular septum
“banana septum”
+/- endocardial thickening with mural plaque formation of outflow track
Describe restrictive CM
Decreased in ventricular compliance so decreased V filling during diastole with normal systolic func.
cannot expand appropriately to receive blood
causes of restrictive CM?
idiopathic, amyloid, sarcoidosis, metastatic tumor (radiation)
Gross/microscopic findings of restrictive CM?
chambers not dilated, myocardium firm.
Histologically: patchy/diffuse interstitial fibrosis
CM dx?
ECG/echo
definitive: endomyocardial biopsy
What is acute rheumatic fever?
A systemic, immunologically mediated disease related to a streptococcal infection
our immune cells can’t tell the dif. btwn our cells and bacteria
What causes RF?
a serotype called a rheumatic stain by group A hemolytic strep (strep pyogenes)
usually followed by strep throat infection- not treated appropriately/noncompliance
rheumatic heart diseases causes…
fibrinous pancarditits- covering all 3 layers of the heart
- bread and butter pericarditis
- Myocarditis with histologic aschoff bodies
- Endocarditis- valvular problems
What is the number one cause of death in acute RF?
arrhythmias
How does our immune rxn cause disease in RF?
immune rxn damages connective tissue of heart and several other organs
abs against strep antigens may cross react with similar antigens in the heart
Who is most susceptible to ARF?
children 9-11 yrs
Why is RF no longer common?
better abx
less crowed conditions
still worldwide leading cause of heart disease in ppl 5-25
What is rheumatic heart disease?
major comp of ARF
also involves joints, subcutaneous CT of skin, blood vessel and occasionally brain
Pathology of RHD?
nonbacterial sterile, inflammatory lesions and granulomas throughout connective tissue of body
What is characteristic about the heart valve ulcerations in RHD with time?
sterile vegetations (no bacteria)
located along the lines of closure of the valve leaflets
What is characteristic of the vegetations of RHD?
no bacteria within the vegetations
ongoing inflammation inside of the valves leads to destruction of the valves, followed by fibrous scarring
What is fish mouth stenosis
fibrous adherence across the commissures produce a fish mouth stenosis due to the mitral valve which are shortened and thickened, and become fused to one another in RHD -> stenosis
What side of the heart is usually affected in RHD?
left
How do valve changes in RHD affect the heart?
valves become incompetent and do not close completely during systole (valvular insufficiency)- regurg
can also become stenotic
What is cor pulmonale?
right heart failure
What is responsible for the most deaths after the acute phase in RHD?
endocarditis
What are the extracardiac findings in RHD?
Polyarthritis
Subcutaneous Nodules
erythema marginatum
Sydenhams chorea
Describe erythema marginatum
maculopapular erythematous rash mostly on truck and extremities, spares faces