Cardiovascular- pathology (2) Flashcards
Dilated cardiomyopathy
- etiology
Most common cardiomyopathy (90% of cases).
Often idiopathic or familial.
Other etiologies ABCCCD:
chronic Alcohol abuse, wet Beriberi, Coxsackie B viral myocarditis, chronic Cocaine use, Chagas disease, Doxorubicin toxicity, hemochromatosis, sarcoidosis,
thyrotoxicosis, peripartum cardiomyopathy.
Dilated cardiomyopathy
- Findings
- Treatment
HF, S3, systolic regurgitant murmur, dilated heart on echocardiogram, balloon appearance of heart on CXR.
Na+ restriction, ACE inhibitors, β-blockers, diuretics, digoxin, ICD, heart transplant.
Takotsubo cardiomyopathy:
broken heart syndrome—ventricular apical ballooning likely due to increased sympathetic stimulation (eg,
stressful situations).
Hypertrophic obstructive cardiomyopathy
- etiology
60–70% of cases are familial, autosomal dominant (most commonly due to mutations in genes encoding sarcomeric proteins, such as myosin binding protein C and β-myosin heavy chain).
Other causes of concentric LV hypertrophy: chronic HTN, Friedreich ataxia.
Marked ventricular concentric hypertrophy
Hypertrophic obstructive cardiomyopathy
- Findings
- Treatment
S4, systolic murmur. May see mitral regurgitation due to impaired mitral valve closure. Causes syncope during exercise and may lead to sudden death.
cessation of high-intensity athletics, use of β-blocker or non-dihydropyridine Ca2+ channel blockers (eg, verapamil). ICD if patient is high risk.
Restrictive/infiltrative cardiomyopathy
- Etiology
“Puppy LEASH”
Postradiation fibrosis, Löffler endocarditis, Endocardial fibroelastosis (thick fibroelastic tissue in endocardium of young children), Amyloidosis, Sarcoidosis, Hemochromatosis (although dilated cardiomyopathy is more common).
Löffler endocarditis
associated with hypereosinophilic syndrome; histology shows eosinophilic infiltrates in myocardiu
Heart failure
- Symptoms
dyspnea, orthopnea, fatigue; signs include S3 heart sound, rales, jugular venous distention (JVD), pitting edema.
Right HF most often results from left HF. Cor pulmonale refers to isolated right HF due to pulmonary cause.
Heart failure
- Diastolic dysfunction
- Systolic dysfunction
preserved EF, normal EDV; low compliance (high EDP) often 2° to myocardial hypertrophy.
reduced EF, high EDV; decrease contractility often 2° to ischemia/MI or dilated cardiomyopathy.
Heart failure
- Treatment
ACE inhibitors or angiotensin II receptor blockers, β blockers (except in acute decompensated HF), and spironolactone decrease mortality.
Thiazide or loop diuretics are used mainly for symptomatic relief.
Hydralazine with nitrate therapy improves both symptoms and mortality in select patients.
Left heart failure triad
right heart failure triad
Orthopnea, Paroxysmal nocturnal dyspnea, Pulmonary edema.
Hepatomegaly (nutmeg liver), Jugular venous distention, Peripheral edema
Shock
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Bacterial endocarditis
- Acute
- Subacute
S aureus (high virulence). Large vegetations on previously normal valves. Rapid onset
viridans streptococci (low virulence). Smaller vegetations on congenitally abnormal or diseased valves. Sequela of dental procedures. Gradual onset.
Bacterial endocarditis
- Signs and symptoms
Bacteria FROM JANE Fever Roth spots Osler nodes Murmur Janeway lesions Anemia Nail-bed hemorrhage Emboli
Bacterial endocarditis
- If culture ⊝
- Most frecuent valve affected
- Tricuspid valve endocarditis
- in colon cancer
- on prostetic valves
most likely Coxiella burnetti, Bartonella spp, HACEK (Haemophilus, Aggregatibacter [formerly Actinobacillus],
Cardiobacterium, Eikenella, Kingella)
Mitral
Is associated with IV drug abuse. Associated with S aureus, Pseudomonas, and Candida.
S bovis (gallolyticus)
S epidermidis
