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Cardiovascular > Cardiomyopathy > Flashcards

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
Q

what is myocarditis

A

inflammation of the heart

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26
Q

what are the two forms of myocarditis

A

infectious (most common) and non infecttious

27
Q

what can cause an infectious myocarditis

A

viral (most), bacterial, fungal, protozoal and helminthic

28
Q

name organisms that can cause myocarditis

A

coxasckie A and B and ECHO viruses most common

29
Q

what are the pathological features of infectious myocarditis

A

thickened ‘beefy’ myocardium

30
Q

what are the histological features of infectious myocarditis

A

inflammatory infiltrate

31
Q

what causes non infectious myocarditis, give 3 examples

A

immune mediated hypersensitivity reactions;

-hypersensitivity to infection (rheumatic fever after strep throat), to drugs ro SLE (systemic lupus erythematosus)

32
Q

what are the pathological features of rheumatic fever

A

thickening and fusion of valve leaflets causing mitral stenosis

short thick chordae tendinae

myocardium patchily inflamed

33
Q

what are the histological feature of rheumatic fever

A

aschoff bodies

34
Q

what is pericarditis

A

inflammation of pericardial layers

35
Q

what are the causes of pericarditis

A
  • Infection
  • Immune mediated (rheumatic fever)
  • Idiopathic
  • Uraemic (renal failure)
  • Post M.I. (Dressler’s syndrome)
  • Connective tissue dse. eg. SLE
36
Q

what type of infectious pericarditis produces serous effusions

A

viruses, especially ECHO virus

37
Q

what type of infectious pericarditis produces purulent effusions

A

bacterial (pneumonias), fungi (Immunosuppressed pts, post transplant)

38
Q

what type of infectious pericarditis produces caseous material in sac

A

tuberculosis

39
Q

what type of pericarditis does tuberculous pericarditis cause

A

constrictive pericarditis

40
Q

what does uraemic pericarditis look like and what causes it

A

bread and butter, renal failure, accumulation of urea (nitrogen) inflames the pericardium

41
Q

what is dresslers syndrome

A

pericarditis post MI (many weeks post)

42
Q

what causes dressler’s syndrome

A

immune mediated, damages heart muscle release previously un-encountered material that stimulates an immune response

43
Q

what are 5 complications of pericarditis

A

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
Q

what is endocarditis

A

affects heart lining but generally refers to inflammation of the valves

45
Q

what are the two forms of endocarditis

A

infectious or non infectious

46
Q

what can cause infectious endocarditis

A

very virulent organism, bacteria or fungi- IV drug abuse and septicaemia

47
Q

when does infectious endocarditis affect the valves

A

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
Q

what microorganisms cause infectious endocarditis

A

HACEK haemophilus, actinbacillus, cardiobacteria, eikenella, kignella

PWIDs- candida, staph aureus

prosthetic valves- s. epidermis

49
Q

what are the vegetations associated with infectious endocarditis

A

aggregates of organisms on heart valves

50
Q

how do vegetations cause damage

A

Bacteria excite acute inflammation and bacterial and inflammatory cell products digest the valve leaflets

Vegetations are also friable and can cause emboli

51
Q

what are the cardiac complications of infectious endocarditis

A

Acute valvular incompetence

High output cardiac failure

Abscess, fistula, pericarditis

52
Q

what other manifestations are common in infectious endocarditis

A 
systemic;
clubbing
Oslers nodes
Janeway lesions
Roth spots
Splinter haemorrhages
Septicaemia
Systemic septic emboli – brain, kidney etc.
Mycotic aneurysms
53
Q

what can cause non infectious endocarditis

A

rheumatic fever, SLE, non infectious thrombotic endocarditis (hypercoaguable states- cancer), carcinoid heart disease

54
Q

describe non bacterial thrombotic endocarditis

A

non invasive, doesnt destroy valves, small multiple vegetations

55
Q

what can NBTE cause

A

embolic disease

56
Q

what is NBTE associated with

A

cancer, hypercoaguable states, mucinous adrenocarinomas

57
Q

describe the presentation of lupus

A

Small sterile emboli
Often undersurfaces of the valves or on chords
Range of changes – often small asymptomatic deposits or significant valvulitis

58
Q

what is LSE

A

lupus (libman-sacks endocarditis)

59
Q

what is carcinoid heart disease

A

carcinoid tumours, common in GI tract and lung, release hormones

carcinoid syndrome occurs when tumour had spread to the liver

60
Q

what hormones are secreted by the hormone

A

serotonin, histamine, bradykinin

61
Q

what do carcinoid heart disease cause (effects and symptoms)

A

Flushing of skin

Nausea, vomiting and diarrhea

Produces right sided cardiac valve disease
Tricuspid and Pulmonary insufficiency

62
Q

how common are cardiac tumours and which is the most common

A

rare, artial myxoma, usually in left atria

63
Q

what does a artial myxoma lead to

A

ball/valve obstruction, tumour emboli, maybe endocarditis, systemic fever and malaise

Cardiovascular (34 decks)

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