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Cardiomyopathy Flashcards

1
Q

what is a cardiomyopathy

A

a disease affecting the cardiac muscle

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2
Q

what does a cardiomyopathy often result in

A

changes in the size and thickness of the heart chambers

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3
Q

describe the pathological and histological features of dilated cardiomyopathy

A

weak and flabby heart, 2 or 3 x bigger, floppy, non specific histological features

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4
Q

what are the causes of dilated cardiomyopathy

A

genetics (50%- genes that encode heart muscle proteins) toxins (alcoholics- ethanol toxicity), chemotherapy (doxorubicin), cardiac infection, pregnancy

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5
Q

what are the clinical features of dilated cardiomyopathy

A

heart failure, SOB, poor exercise tolerance, poor ejection

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6
Q

what are the physical characteristics of hypertrophic cardiomyopathy

A

thickened left ventricle, big strong heart, v heavy, bulging inter ventricular septum. LV luminal reduction,

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7
Q

what are the effects of hypertrophic cardiomyopathy on the circulation

A

strong contractions, diastolic dysfunction, outflow tract obstruction

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8
Q

what are the histological features of hypertrophic cardiomyopathy

A

disorganised myofibres, cant contract regularly

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9
Q

what is the extreme effect of hypertrophic cardiomyopathy in athletes

A

sudden death

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10
Q

what are the causes of hypertrophic cardiomyopathy

A

genetics (genes that generate cardiac muscle fibres (beta myosin heavy chain)

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11
Q

what are the physical features of restrictive cardiomyopathy

A

stiff heart (cant relax or expand properly), lack of compliance, diastolic dysfunction, bilateral dilation, cant eject properly, can look normal

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12
Q

why is bilateral dilatation a feature of restrictive cardiomyopathy

A

a result of back pressure

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13
Q

what are the causes of restrictive cardiomyopathy

A

deposition of something in myocardium;

  • amyloid
  • metabolic by-products
  • sarcoid
  • tumours
  • fibrosis following radiation
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14
Q

what is amyloid

A

abnormal deposition of abnormal protein, forms beta pleated sheets that body cant get rid of

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15
Q

what does amyloid breakdown

A

breakdown of every vessel and organ

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16
Q

how does amyloid affect the heart

A

uniformly thick heart, may be localised to the atrium, looks paler

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17
Q

describe the histological features of amyloid

A

waxy pink material, stains positively for congo red, exhibits apple green birefringence

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18
Q

what are the classifications of amyloid

A

AA- relates to chronic diseases (rheumatoid), AL- light chains, abnormal immunoglobulin, haemodialysis associated, familial forms, diabetes, alzheimers

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19
Q

what term describe how amyloid affects the body

A

pansystemic

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20
Q

what type of cardiac disease does amyloid resemble

A

restrictive cardiomyopathy

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21
Q

what can amyloid

A

arrhythmogenic death

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22
Q

what is arrhythmogenic right ventricular dysplasia

A

An inherited myocardial disease associated with paroxysmal ventricular arrhythmias and sudden cardiac death

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23
Q

what inheritance patter does ARVD follow

A

autosomal dominant

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24
Q

what are the pathological features of amyloid

A

right ventricle myocardium becomes replaced by adipose tissue

heart big and floppy

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25
what is myocarditis
inflammation of the heart
26
what are the two forms of myocarditis
infectious (most common) and non infecttious
27
what can cause an infectious myocarditis
viral (most), bacterial, fungal, protozoal and helminthic
28
name organisms that can cause myocarditis
coxasckie A and B and ECHO viruses most common
29
what are the pathological features of infectious myocarditis
thickened 'beefy' myocardium
30
what are the histological features of infectious myocarditis
inflammatory infiltrate
31
what causes non infectious myocarditis, give 3 examples
immune mediated hypersensitivity reactions; | -hypersensitivity to infection (rheumatic fever after strep throat), to drugs ro SLE (systemic lupus erythematosus)
32
what are the pathological features of rheumatic fever
thickening and fusion of valve leaflets causing mitral stenosis short thick chordae tendinae myocardium patchily inflamed
33
what are the histological feature of rheumatic fever
aschoff bodies
34
what is pericarditis
inflammation of pericardial layers
35
what are the causes of pericarditis
- Infection - Immune mediated (rheumatic fever) - Idiopathic - Uraemic (renal failure) - Post M.I. (Dressler’s syndrome) - Connective tissue dse. eg. SLE
36
what type of infectious pericarditis produces serous effusions
viruses, especially ECHO virus
37
what type of infectious pericarditis produces purulent effusions
bacterial (pneumonias), fungi (Immunosuppressed pts, post transplant)
38
what type of infectious pericarditis produces caseous material in sac
tuberculosis
39
what type of pericarditis does tuberculous pericarditis cause
constrictive pericarditis
40
what does uraemic pericarditis look like and what causes it
bread and butter, renal failure, accumulation of urea (nitrogen) inflames the pericardium
41
what is dresslers syndrome
pericarditis post MI (many weeks post)
42
what causes dressler's syndrome
immune mediated, damages heart muscle release previously un-encountered material that stimulates an immune response
43
what are 5 complications of pericarditis
pericardial effusion (inflammation= leajy vessels= fluid), tamponade, constrictive pericarditis (fibrotic healing response= collagen- if cross linked contracts and makes scar around heart compressing it), cardiac failure, death
44
what is endocarditis
affects heart lining but generally refers to inflammation of the valves
45
what are the two forms of endocarditis
infectious or non infectious
46
what can cause infectious endocarditis
very virulent organism, bacteria or fungi- IV drug abuse and septicaemia
47
when does infectious endocarditis affect the valves
can affect them when normal but usually when abnormal e.g. - rheumatic heart disease - prosthetic valves - congenital defects - bicuspid valves - MV prolapse - calcific disease
48
what microorganisms cause infectious endocarditis
HACEK haemophilus, actinbacillus, cardiobacteria, eikenella, kignella PWIDs- candida, staph aureus prosthetic valves- s. epidermis
49
what are the vegetations associated with infectious endocarditis
aggregates of organisms on heart valves
50
how do vegetations cause damage
Bacteria excite acute inflammation and bacterial and inflammatory cell products digest the valve leaflets Vegetations are also friable and can cause emboli
51
what are the cardiac complications of infectious endocarditis
Acute valvular incompetence High output cardiac failure Abscess, fistula, pericarditis
52
what other manifestations are common in infectious endocarditis
``` systemic; clubbing Oslers nodes Janeway lesions Roth spots Splinter haemorrhages Septicaemia Systemic septic emboli – brain, kidney etc. Mycotic aneurysms ```
53
what can cause non infectious endocarditis
rheumatic fever, SLE, non infectious thrombotic endocarditis (hypercoaguable states- cancer), carcinoid heart disease
54
describe non bacterial thrombotic endocarditis
non invasive, doesnt destroy valves, small multiple vegetations
55
what can NBTE cause
embolic disease
56
what is NBTE associated with
cancer, hypercoaguable states, mucinous adrenocarinomas
57
describe the presentation of lupus
Small sterile emboli Often undersurfaces of the valves or on chords Range of changes – often small asymptomatic deposits or significant valvulitis
58
what is LSE
lupus (libman-sacks endocarditis)
59
what is carcinoid heart disease
carcinoid tumours, common in GI tract and lung, release hormones carcinoid syndrome occurs when tumour had spread to the liver
60
what hormones are secreted by the hormone
serotonin, histamine, bradykinin
61
what do carcinoid heart disease cause (effects and symptoms)
Flushing of skin Nausea, vomiting and diarrhea Produces right sided cardiac valve disease Tricuspid and Pulmonary insufficiency
62
how common are cardiac tumours and which is the most common
rare, artial myxoma, usually in left atria
63
what does a artial myxoma lead to
ball/valve obstruction, tumour emboli, maybe endocarditis, systemic fever and malaise

Cardiovascular (34 decks)

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