Cardiovascular Pathology 4 Flashcards
“box car” shaped nuclei of myocytes is indicative of?
hypertrophied cardiac cells
what is cor pulmonale?
disease of RIGHT SIDED cardiac chambers secondary to pulmonary parenchymal or pulmonary vascular diseases
pulmonary disease comes first THEN leads to heart problems
the right ventricle is ___________ in acute cor pulmonale
dilated but NO HYPERTROPHY
most common cause of chronic cor pulmonale is ______
COPD
what are some causes of chronic cor pulmonale?
- COPD (main)
- obesity
- idiopathic pulmonary fibrosis
- cystic fibrosis
what is the morphology of the heart in chronic cor pulmonale?
- right ventricle is hypertrophied and can be associated with right atrial hypertrophy +/- dilation
what is the predominant types of cells you see on histology of viral myocarditis caused most commonly by coxsackie virus?
interstitial inflammation with mainly lymphocytes and a few plasma cells
inflammation of the myocardium can also be secondary to necrosis (ischemia), how can you tell on histology the inflammation of the heart is due to that or from a virus like coxsackie?
the predominant cells seen on inflammation due to ischemia/necrosis is PMN’s but with viral myocarditis the predominant cells is lymphocytes
myocarditis (caused most commonly by ______) can lead to _______ cardiomyopathy →
coxsackie;
dilated cardiomyopathy → chronic CHF
what is the main cause of sudden cardiac death?
ventricular arrhythmias
complications of viral myocarditis:
- dilated cardiomyopathy
- arrhythmia leading to SCD
most common out come of viral myocarditis
most recover completely
parasitic causes of myocarditis
- trichinella spirali (trichinosis) and is the most common helminth associated w/ myocarditis
- Trypanosoma Cruzi (chaga’s disease)
- toxoplasmosis (toxoplasma Gondi)
mixed inflammatory infiltrate composed of neutrophils, lymphocytes and plasma cells are indicative of myocarditis caused by _____
fungal (and also seen with myocarditis caused by trypanosoma cruzi)
which drugs can cause non infectious myocarditis?
- methydopa
- sulfonamides
high proportion of ______ along with ____ and ____ would be seen on histology in myocarditis caused by drugs
high proportion of eosinophils, w/ macrophages and lymphocytes
what is the cause of death in patients with giant cell myocarditis?
arrhythmia and CHF
what conditions are giant cell myocarditis associated with?
SLE and thyrotoxicosis
idiopathic etiology
what is the cause of primary cardiomyopathy?
unknown; must exclude myocardial diseases caused by: ischemia, HTN, valvular lesions, congenital anomalies and inflammatory disorders
what are the types of cardiomyopathy
- dilated/congestive
- hypertrophic/ obstructive
- restrictive
dilated cardiomyopathy is associated with systolic/diastolic dysfunction
systolic; will see eccentric hypertrophy
thiamine deficiency and chronic anemia is associated with ______ cardiomyopathy
dilated
peripartum cardiomyopathy is a form of _____ cardiomyopathy and is due to (3) :
dilated
pregnancy associated: volume overload, HTN, nutritional deficiencies
what are some histological findings in DCM?
- hypertrophied myocytes with enlarged nuclei
- interstitial and endocardial fibrosis
- subendocardial scars
arrhythmogenic right ventricular cardiomyopathy is due to a defect in __________ leading to
desmosomal adhesion proteins
thin RV because the myocytes replaced with fat leading to right sided HF and arrhythmia → SCD
a young patient dies suddenly and on autopsy you see that the RV is full of fat. What is an associated disease with this cause of death
COD: arrhythmogenic right ventricular cardiomyopathy
associated with Naxos Syndrome
the primary problem in hypertrophic cardiomyopathy is _______
diastolic filling; the LV is markedly hypertrophied but it is not able to dilate during diastole → ↓ SV
what would you expect to se on a gross specimen of a heart of someone who had hypertrophic cardiomyopathy
small LV chamber
intermittent left ventricular outflow obstruction due to _______ is sometimes seen in what type of cardiomyopathy
due to anterior leaflet of MV;
seen in hypertrophic cardiomyopathy
_______ mutations in the sarcomere proteins is associated with hypertrophic cardiomyopathy
missense (GAIN of function)
what proteins are mutated in hypertrophic cardiomyopathy?
sarcomere proteins:
- β myosin heavy chain (most common)
- myosin binding protein C
- cardiac troponin T
person has a_______ of function mutation in the β myosin heavy chain, causing ________
gain of function; myocyte HYPERcontractility → fibroblast proliferation and hypertrophy
what type of cardiomyopathy will you see marked fibrosis?
hypertrophic; will see pale areas on histology
on a gross image, you see a “banana like” configuration of the ventricular cavity, what mutation is this type of cardiomyopathy associated with?
hypertrophic cardiomyopathy (shape is due to the asymmetric septal hypertrophy) mutations: β myosin heavy chain, myosin binding protein C, cardiac troponin T
endocardial plaques or sclerosis in the left outflow tract is seen in ______
hypertrophic CM
exertion dyspnea is a presenting symptom of ______ cardiomyopathy
dilated; due to the ↓ CO and the ↑ pressure of the LV causes ↑ pulmonary venous pressure
harsh ejection systolic murmur is a clinical feature of ______ cardiomyopathy
hypertrophic
restrictive cardiomyopathy is associated with ________ dysfunction
DIASTOLIC and systolic
restrictive cardiomyopathy is characterized by _______ leading to diastolic dysfunction
↓ compliance of the ventricles due to STIFF WALLS
______ fibrosis is a hallmark feature of hypertrophic cardiomyopathy
myocardial
______ fibrosis is seen in restrictive cardiomyopathy
endomyocardial
etiologies associated with restrictive cardiomyopathy
- endomyocardial fibrosis
- Loffler’s syndrome
- radiation fibrosis
- amyloidosis
- metastatic tumors
amyloidosis is associated with which cardiomyopathy
restrictive
describe the size of the atria and ventricles seen in gross image of someone with restrictive CM
- atria are dilated
- ventricles are usually normal or slightly enlarged
patchy variable interstitial fibrosis is seen in _____ CM
restrictive
describe the endomyocardial fibrosis seen in RCM
- dense fibrosis of the endocardium and subendocardium from apex to AV valves
______ endomyocarditis has endocardial fibrosis with large mural thrombi
Loeffler’s endomyocarditis (type of RCM)
which type of RCM is seen in children and young adults and in Africa and the tropics?
endomyocardial fibrosis
what is a indicator of Loeffler’s endomyocarditis?
- peripheral hypereosinophilia, abnormal degranulated eosinophils
what is the cause of fibrosis in Loeffler’s endomyocarditis?
MBP from eosinophils will cause endocardial damage, necrosis and fibrosis
