Cardiovascular pathology

Question 1

What is meant by cardiomyopathy?

Answer 1

Any disease of the cardiac muscle

Question 2

What are the 5 main types of cardiomyopathy?

Answer 2

Dilated cardiomyopathy
Restrictive cardiomyopathy
Hypertrophic cardiomyopathy
Arrhythmogenic right ventricular dysplasia
Cardiac amyloidosis

Question 3

What occurs pathologically in dilated cardiomyopathy?

Answer 3

The heart becomes around 2-3 times larger than the normal heart and has floppy walls

Question 4

What are some causes of dilated cardiomyopathy?

Answer 4

Genetics (50%)
Toxins
Alcoholism
Doxorubicin (Chemotherapy agent)
Myocarditis
Childbirth

Question 5

What are some clinical features of dilated cardiomyopathy?

Answer 5

Shortness of breath
Low ejection fraction

Question 6

What occurs pathologically in hypertrophic cardiomyopathy?

Answer 6

The heart becomes large and solid
The heart walls become hypertrophic with strong contraction, however, it causes narrowing of the chambers, leading to decreased filling in diastole

Question 7

What is the main cause of hypertrophic cardiomyopathy?

Answer 7

Genetics - Most commonly ß-myosin heavy chain, myosin binding protein C or alpha tropomyosin genes mutated

Question 8

What occurs in restrictive cardiomyopathy?

Answer 8

A lack of compliance of the heart walls leads to a stiff wall that won’t contract, causing diastolic dysfunction

Question 9

What are the main causes of restrictive cardiomyopathy?

Answer 9

Deposition (Iron, amyloid, sarcoid)
Tumours
Radiation fibrosis

Question 10

What is the main cause of arrhythmogenic right ventricular dysplasia?

Answer 10

Genetic - Autosomal dominant with low penetrance

Question 11

What occurs pathologically in arrhythmogenic right ventricular dysplasia?

Answer 11

The right ventricle becomes largely replaced by fat and becomes large and floppy

Question 12

What is amyloid?

Answer 12

An abnormal deposition of any protein

Question 13

What structure do proteins take in amyloid?

Answer 13

ß-Pleated sheets

Question 14

What are the 2 main classes of amyloid?

Answer 14

AA amyloid - Associated with chronic diseases
AL (light chain) - Associated with abnormal immunoglobulin in haematological cancers

Question 15

What are some common diseases that involve amyloid?

Answer 15

Amyloid deposition in the Islets of Langerhan’s in type I diabetes
Amyloid deposition in the brain in Alzheimers

Question 16

What are some examples of amyloidosis affecting the cardiovascular system?

Answer 16

Abnormal atrial natriuretic peptide
Senile cardiac amyloidosis (Transthyretin build up)
Haemodialysis associated amyloidosis (ß2 microglobulin build up)

Question 17

What does amyloid look like under a microscope?

Answer 17

It looks like a pink, waxy material
It stains positive for congo red stain
It exhibits apple green birefringence

Question 18

What are the main viral causes of myocarditis?

Answer 18

Coxsackie A and B
ECHO virus

Question 19

What are some atypical viruses that can cause myocarditis?

Answer 19

Chagas disease - trypanosomiasis
Borellia burgdorferi - Lyme’s disease
HIV

Question 20

What virus causes Lyme’s disease?

Answer 20

Borellia burgdorferi

Question 21

What are some non-infectious causes of myocarditis?

Answer 21

Hypersensitivity such as in rheumatic fever
SLE

Question 22

What are aschoff bodies?

Answer 22

Rheumatic granulomas formed by macrophages such as Aschoff cells and Anitchkov cells that surround collagen fibres and collagen necrosis

Question 23

What is formed by rheumatic myocarditis?

Answer 23

Aschoff bodies

Question 24

What is the most common cause of pericarditis?

Answer 24

ECHO virus

Question 25

What is usually seen pathologically in pericarditis?

Answer 25

A discoloured, clear liquid in the pericardium

Question 26

What would be seen in pericarditis caused by Mycobacterium tuberculosis?

Answer 26

A suppurative (Cheesy) inflammation

Question 27

What is Dressler’s syndrome?

Answer 27

Pericarditis post Myocardial Infarction due to immune reaction to damaged heart muscle