Cardiovascular Pathology 4

Question 1

“box car” shaped nuclei of myocytes is indicative of?

Answer 1

hypertrophied cardiac cells

Question 2

what is cor pulmonale?

Answer 2

disease of RIGHT SIDED cardiac chambers secondary to pulmonary parenchymal or pulmonary vascular diseases

pulmonary disease comes first THEN leads to heart problems

Question 3

the right ventricle is ___________ in acute cor pulmonale

Answer 3

dilated but NO HYPERTROPHY

Question 4

most common cause of chronic cor pulmonale is ______

Answer 4

COPD

Question 5

what are some causes of chronic cor pulmonale?

Answer 5

• COPD (main)
• obesity
• idiopathic pulmonary fibrosis
• cystic fibrosis

Question 6

what is the morphology of the heart in chronic cor pulmonale?

Answer 6

• right ventricle is hypertrophied and can be associated with right atrial hypertrophy +/- dilation

Question 7

what is the predominant types of cells you see on histology of viral myocarditis caused most commonly by coxsackie virus?

Answer 7

interstitial inflammation with mainly lymphocytes and a few plasma cells

Question 8

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?

Answer 8

the predominant cells seen on inflammation due to ischemia/necrosis is PMN’s but with viral myocarditis the predominant cells is lymphocytes

Question 9

myocarditis (caused most commonly by ______) can lead to _______ cardiomyopathy →

Answer 9

coxsackie;

dilated cardiomyopathy → chronic CHF

Question 10

what is the main cause of sudden cardiac death?

Answer 10

ventricular arrhythmias

Question 11

complications of viral myocarditis:

Answer 11

• dilated cardiomyopathy

- arrhythmia leading to SCD

Question 12

most common out come of viral myocarditis

Answer 12

most recover completely

Question 13

parasitic causes of myocarditis

Answer 13

• trichinella spirali (trichinosis) and is the most common helminth associated w/ myocarditis
• Trypanosoma Cruzi (chaga’s disease)
• toxoplasmosis (toxoplasma Gondi)

Question 14

mixed inflammatory infiltrate composed of neutrophils, lymphocytes and plasma cells are indicative of myocarditis caused by _____

Answer 14

fungal (and also seen with myocarditis caused by trypanosoma cruzi)

Question 15

which drugs can cause non infectious myocarditis?

Answer 15

• methydopa

- sulfonamides

Question 16

high proportion of ______ along with ____ and ____ would be seen on histology in myocarditis caused by drugs

Answer 16

high proportion of eosinophils, w/ macrophages and lymphocytes

Question 17

what is the cause of death in patients with giant cell myocarditis?

Answer 17

arrhythmia and CHF

Question 18

what conditions are giant cell myocarditis associated with?

Answer 18

SLE and thyrotoxicosis

idiopathic etiology

Question 19

what is the cause of primary cardiomyopathy?

Answer 19

unknown; must exclude myocardial diseases caused by: ischemia, HTN, valvular lesions, congenital anomalies and inflammatory disorders

Question 20

what are the types of cardiomyopathy

Answer 20

• dilated/congestive
• hypertrophic/ obstructive
• restrictive

Question 21

dilated cardiomyopathy is associated with systolic/diastolic dysfunction

Answer 21

systolic; will see eccentric hypertrophy

Question 22

thiamine deficiency and chronic anemia is associated with ______ cardiomyopathy

Answer 22

dilated

Question 23

peripartum cardiomyopathy is a form of _____ cardiomyopathy and is due to (3) :

Answer 23

dilated

pregnancy associated: volume overload, HTN, nutritional deficiencies

Question 24

what are some histological findings in DCM?

Answer 24

• hypertrophied myocytes with enlarged nuclei
• interstitial and endocardial fibrosis
• subendocardial scars

Question 25

arrhythmogenic right ventricular cardiomyopathy is due to a defect in __________ leading to

Answer 25

desmosomal adhesion proteins | thin RV because the myocytes replaced with fat leading to right sided HF and arrhythmia → SCD

Question 26

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

Answer 26

COD: arrhythmogenic right ventricular cardiomyopathy associated with Naxos Syndrome

Question 27

the primary problem in hypertrophic cardiomyopathy is _______

Answer 27

diastolic filling; the LV is markedly hypertrophied but it is not able to dilate during diastole → ↓ SV

Question 28

what would you expect to se on a gross specimen of a heart of someone who had hypertrophic cardiomyopathy

Answer 28

small LV chamber

Question 29

intermittent left ventricular outflow obstruction due to _______ is sometimes seen in what type of cardiomyopathy

Answer 29

due to anterior leaflet of MV; seen in hypertrophic cardiomyopathy

Question 30

_______ mutations in the sarcomere proteins is associated with hypertrophic cardiomyopathy

Answer 30

missense (GAIN of function)

Question 31

what proteins are mutated in hypertrophic cardiomyopathy?

Answer 31

sarcomere proteins: - β myosin heavy chain (most common) - myosin binding protein C - cardiac troponin T

Question 32

person has a_______ of function mutation in the β myosin heavy chain, causing ________

Answer 32

gain of function; myocyte HYPERcontractility → fibroblast proliferation and hypertrophy

Question 33

what type of cardiomyopathy will you see marked fibrosis?

Answer 33

hypertrophic; will see pale areas on histology

Question 34

on a gross image, you see a "banana like" configuration of the ventricular cavity, what mutation is this type of cardiomyopathy associated with?

Answer 34

``` hypertrophic cardiomyopathy (shape is due to the asymmetric septal hypertrophy) mutations: β myosin heavy chain, myosin binding protein C, cardiac troponin T ```

Question 35

endocardial plaques or sclerosis in the left outflow tract is seen in ______

Answer 35

hypertrophic CM

Question 36

exertion dyspnea is a presenting symptom of ______ cardiomyopathy

Answer 36

dilated; due to the ↓ CO and the ↑ pressure of the LV causes ↑ pulmonary venous pressure

Question 37

harsh ejection systolic murmur is a clinical feature of ______ cardiomyopathy

Answer 37

hypertrophic

Question 38

restrictive cardiomyopathy is associated with ________ dysfunction

Answer 38

DIASTOLIC and systolic

Question 39

restrictive cardiomyopathy is characterized by _______ leading to diastolic dysfunction

Answer 39

↓ compliance of the ventricles due to STIFF WALLS

Question 40

______ fibrosis is a hallmark feature of hypertrophic cardiomyopathy

Answer 40

myocardial

Question 41

______ fibrosis is seen in restrictive cardiomyopathy

Answer 41

endomyocardial

Question 42

etiologies associated with restrictive cardiomyopathy

Answer 42

- endomyocardial fibrosis - Loffler's syndrome - radiation fibrosis - amyloidosis - metastatic tumors

Question 43

amyloidosis is associated with which cardiomyopathy

Answer 43

restrictive

Question 44

describe the size of the atria and ventricles seen in gross image of someone with restrictive CM

Answer 44

- atria are dilated | - ventricles are usually normal or slightly enlarged

Question 45

patchy variable interstitial fibrosis is seen in _____ CM

Answer 45

restrictive

Question 46

describe the endomyocardial fibrosis seen in RCM

Answer 46

- dense fibrosis of the endocardium and subendocardium from apex to AV valves

Question 47

______ endomyocarditis has endocardial fibrosis with large mural thrombi

Answer 47

Loeffler's endomyocarditis (type of RCM)

Question 48

which type of RCM is seen in children and young adults and in Africa and the tropics?

Answer 48

endomyocardial fibrosis

Question 49

what is a indicator of Loeffler's endomyocarditis?

Answer 49

- peripheral hypereosinophilia, abnormal degranulated eosinophils

Question 50

what is the cause of fibrosis in Loeffler's endomyocarditis?

Answer 50

MBP from eosinophils will cause endocardial damage, necrosis and fibrosis