Cardiomyopathy and myocardial disease Flashcards
gross morphology Restrictive CM
normal vent
bi-atrial dilation
fibrous myocardium
interstitial fibrosis
stain for amyloidosis
congo red > apple green birefringence under polarizd
heart impacts of thyroid disease - hyperthyroidism
tachycardia
palpitations
cardiomegaly
Loeffler endomyocarditis
endomyocardial fibrosis
large mural thrombi
peripheral eosinophilia + eosinophilic infiltrates in organs
(damage via maj. basic protein
cardiac impact of hypothyroidism
output decreased
advanced hypothyroidism
myxedema - flabbly, enlarged, dilated
fluid in accumulation
myofiberr swelling w/loss of striation, basophil degen
___ fxn in hypertrophic CM is disturbed, ____ fxn in largely preserved
dystolic dysfunction
normal systole
main lethal even for many with Hypertrophic CM
sustained Vtach/Vfib
mutations of hypertrophic CM
myosin heavy chain B-MHC
myosin binding protein MYBP-C
cardiac cnc
sarccomere fucntion - defect of energy transfer
clinical presentation arrhythmogenic right ventricular cardi myapthy / dysplasia
young adults
Vtac
sudden death
RV failure
mechanisms of myocardial ischemia in hypertrophic CM
supply/demand mismatch due to mass increase
icreased wall tension due to decreased relaxation
abnormal intramyocardial arteries
Arrhythomgenic right ventricular cardiomyopathy, morphology
inherited
RV failure and various rythm disturbance (Vtac or Vfib)
RV wall thinned due to loss of myocytes w/extensive fatty inflitration and fibrosis
defective desmosomes?
restrictive hemodynamics of amyloidosis
asymptomatic
pressure atrophy of fibers
depostion in regions of conduction system > arrhythmias
clinical presentation dilated CM
Heart failure
angina
syncope
sudden cardiac death
dilated cm gross morphology
four chamber dilation
variable wall thickness (hyper, normal, flabby)
**normal **valves
mitral or tricus regurg 2ndry two dilation
heart morphology cardiomyopathy
progressive cardiac dilation
hypertrophy
enlarged, heavy, flabby heart
regurgitation (functional)
pathovisiology hypertrophic CM (5 processes)
LV outflow tract obstruction
Mitral regurg
diastolic dsfxn
myocariial asichemia
cardiac arrhythmias
histology restrictive CM
patch or diffuse interstitial fibrosis and diseases specific changes
amyloid fibers
cardiotoxic drugs
lithium
pehnothiazines
chloroquine
cocaine
histology hypertrophic CM
fibrosis, irregular organization
gross morphology hypertrophic CM
banana ventricle
enlarged atrium
endocardial thickening
mural plaques in outflow tract
Dilated cardiomyopathy genetics
genetic encoding cytoskeleton proteins
X-linked (often dystrophin)
also mitochondrial mutations (ox phos and FA B-ox)
SAM of hypertropohic CM
anterior dispalcement of mital leaflets during systole
SAM - systolic anterior motion of mitral valve
sarcoidosis
restriction
conduction system disease = arrhythmias
sudden cardiac death
Acute viral myocarditis (dilated cardiomyopathy) infection and impact
Coxasacie B or echovirus
myocyte cell death and fibrosis
immune mediated injury
Alcohol cardiomyopathy =
dilated (leads to beriberi heart disease)
restrictive CM =
primary decrease in ventricular compliance resulting in impaired v filling during diastole
increased risk for idiopathic dilated cardiomyopathy
male
African American
HTN
chronic beta-agonist use
heart wall of hypertrophic CM
thick, heavy, hypercontracting
doxorubicin causes
dilated cardiomyopathy (dose-dependent)
Restrictive CM clinical presentation
Right and left congestive HF (pulmonary congestion, hepatic congestion)
pericardial+epicardial inflammation compressing the heart
(dx with endomyocardial biopsy)
non-pharm tx hypertrophic CM
surgical septal myectomy
alcohol induced septal ablation
dual chamber pacemaker
cardiac effects of catecholamines (seen in pts of pheochromocytoma)
sudden intense emotional or physical stress leading to acute ventricular dysfxn
takotsubo cardiomyopathy
Hypertrophic CM pathogenesis
mutatio in sarcomeric proteins increase myofilament activation resulting in hypercontractility
Senile cardiac amyloidosis
Transthyretin depostis in ventrilces and atria
__ dysfunction in dilated cardiomyopathy
systolic
morphology of amyloiddosis
normal heart or firm and rubbery
eosinophilic amyliodi depsits
treatment hypertrophic CM
beta blockers (for negative ionotrope)
Ca channel blockers
Dispyramide (pts with resting gradient)
dilated CM histology
myocyte hypertrophy
deranged nuclei
fibrosis between myocytes (interstitial and endocardial)
morphology arrhythmogenic right ventricular cardiomyopathy
thin and dilated RV with **fatty infiltration **and interstitial fibrosis
clinical presentation hypertrophic CM
post puberty
exertional dyspnea
syncopes (LV outflow obstruction)
Afib with mural thrombus
Sudden death in young atheletes
endocardio fibroelastosis =
focal or diffuse fibroelastic thiecnking usually involving mural of LV endocardium
peripartum cardiomyopathy =
dilated
hypertrophic cardiomyopathy may lead to ____ outflow obstruction
left ventricular
iron overload from transfusion or hemochromatosis causes what type of cardiomyopathy
dilated
