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Cardio > Cardiovascular Pathology > Flashcards

Cardiovascular Pathology Flashcards

1
Q

What is cardiomyopathy?

A

Any disease of the cardiac muscle

-Often results in changes in the size of the heart chambers and thickness of the heart

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2
Q

Classification of myopathy?

A

Dilated
Hypertrophic
Restrictive

Arrhythmogenic right ventricular dysplasia

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3
Q

What is a simple description of hypertrophic cardiomyopathy?

A

Muscle bound

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4
Q

What is a simple description of restrictive cardiomyopathy?

A

Stiff

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5
Q

What is a simple description of dilated cardiomyopathy?

A

Weak/flabby

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6
Q

Features of dilated cardiomyopathy?

A

Flabby/floppy heart
Big heart= 2-3 times normal size
Histological features are non-specific

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7
Q

Main cause of DCM (dilated cardiomyopathy)?

A

Genetics- AD,AR, X-linked and mitochondrial
Genes that encode heart muscle proteins eg
Desmin and dystrophin

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8
Q

Causes of DCM?

A

Genetics
Alcohol
Drugs- chemotherapy drugs

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9
Q

Rare causes of DCM?

A

Pregnancy

Cardiac Infection

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10
Q

Clinical features of DCM?

A

General picture of heart failure
Shortness of breath, poor exercise tolerance
Low ejection fraction (low cardiac output)

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11
Q

Features of hypertrophic cardiomyopathy?

A

Big Solid hearts

  • Hypertrophic and strong contraction (differes from DCM)
  • Diastolic dysfunction- (not systolic as contraction is fine)
  • Heart can’t relax
  • Eventual outflow obstruction

(causes sudden death in athletes)

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12
Q

Causes of hypertrophic cardiomyopathy?

A

Genetics - lots of different genes

-Beta myosin heavy chain, Myosin binding protein C, alpha tropomyosin

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13
Q

Examples of genes that cause hypertrophic cardiomyopathy?

A
  • Beta myosin heavy chain
  • Myosin binding protein C
  • Alpha tropomyosin
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14
Q

Pathophysiology of hypertrophic cardiomyopathy?

A

Bulging interventricular septum
Outflow tract obstruction
LV luminal reduction

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15
Q

Features of restrictive cardiomyopathy?

A

Lack of heart compliance
Stiff heart
Doesn’t fill well so diastolic dysfunction
Can look normal
Biatrial dilatation as a result of back pressure

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16
Q

What happens to the walls of the ventricles in restrictive cardiomyopathy?

A

Walls become stiff but not necessarily thickened

Heart may appear grossly normal

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17
Q

Causes of restrictive cardiomyopathy?

A 
Deposition of something in myocardium 
Metabolic byproducts - Iron 
Amyloid 
Sarcoid- multi system granulomatous disorder 
Tumours 
Fibrosis - following radiation
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18
Q

What is amyloid?

A

Abnormal deposition of an abnormal protein
Lots of different types as lots of abnormal proteins
Tendency to form beta pleated sheets
Body can’t get rid of them

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19
Q

2 Main types of amyloids?

A 
AA- most main- related to chronic diseases like rheumatoid
AL
Haemodialysis associated 
Familial forms 
Diabetes 
Alzheimers
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20
Q

Features of amyloid?

A

Generally resembles restrictive cardiomyopathy

Arrhythmogenic death

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21
Q

What is arrhythmogenic right ventricular dysplasia?

A

Genetic Disease - autosomal dominant with low penetrance
Causes- syncope and funny turns
Arrhythmia
Non specific features- difficult diagnosis

22
Q

What are the features of ARVD?

A

Right ventricle becomes largely replaced by fat
Big and floppy

Problem== RV always looks a bit fatty

23
Q

What is myocarditis?

A

Inflammation of the heart

24
Q

Types of myocarditis?

A

Infectious

Non-infectious (Most common)

25
Q

Types of infectious myocarditis?

A 
Viral 
Bacterial 
Fungal 
Protozoal 
Helminthic
26
Q

Most common cause of infectious myocarditis?

A

Viral

27
Q

Viruses which cause infectious myocarditis?

A

ECHO virus
Chaga’s disease
Borrelia burgdorferi- Lyme’s disease
HIV

28
Q

Pathophysiology of infectious myocarditis?

A

Thickened beefy myocardium

29
Q

Causes of non-infectious myocarditis?

A

Immune mediated hypersensitivity reactions
Hypersensitivity to infection- Rheumatic fever after strep throat
Hypersensitivity to drugs- eosinophillic myocarditis
Systemic lupus erythematosus (SLE)

30
Q

Pathophysiology of rheumatic fever?

A

Classic mitral stenosis with thickening and fusion of valve leaflets
Short thick chordae tendinae
Myocardium also patchily inflammed

31
Q

What is pericarditis?

A

Inflammation of pericardial layers

32
Q

Causes of pericarditis?

A 
Infection 
Immune mediated (rheumatic fever) 
Idiopathic 
Uraemic (renal failure) 
Post MI (Dresslers syndrome) 
Connective tissue dse eg SLE
33
Q

Types of infection which cause infectious pericarditis?

A

Viruses (ECHO) virus- cause serous effusions
Bacterial - pneumonia produce perulent effusions
Fungi- Post transplant produce perulent effusions
Tuberculosis- caseous material in sac

34
Q

What does tuberculosis pericarditis produce?

A

Constrictive pericarditis

35
Q

Features of pericarditis that occurs post MI?

A

Many weeks post MI
Assumed to be immune mediated
Damaged heart muscle release previously un-encountered material that stimulates an immune response

36
Q

What is Dressler’s syndrome?

A

Pericarditis post MI

37
Q

Complications of pericarditis?

A 
Pericardial effusion 
Tamponade
Constrictive pericarditis 
Cardiac failure 
Death 
It effectively strangles the heart
38
Q

What is endocarditis?

A

Affects heart lining but generally refers to inflammation of the valves
May or may not be infectious

39
Q

Features of infectious endocarditis?

A

Can occur on normal valves
Usually requires v. virulent organism
May be bacterial or fungal
Common in IV drug users and people with septicaemia

40
Q

Microbiology of Endocarditis?

A 
H= Haemophilus 
A= Actinobacillus
C= Cardiobacteria 
E= Eikenella
K= Kingella

IV drug users= Candida, Staph aureus

Prosthetic valves= S. epidermidis

41
Q

Pathology of infectious endocarditis?

A

Vegetations on heart valves
Bacteria excite acute inflammation and bacterial and inflammatory cell products digest the valve leaflets
Vegetations can cause emboli

42
Q

Examples of cardiac complications?

A

Acute valvular incompetence
High output cardiac failure
Abscess, fistula, pericarditis

43
Q

Systemic manifestations of cardiac complications?

A 
Oslers nodes 
Janeway lesions 
Roth spots 
Splinter haemorrhages 
Septicaemia 
Systemic septic emboli 
Mycotic aneurysms
44
Q

Features of non- bacterial thrombotic endocarditis?

A 
Non-invasive and don't destroy valves 
Small and multiple vegetations 
Can cause embolic disease 
Associated with cancer 
Frequently associated with mucinous adenocarinomas
45
Q

Where are carcinoid tumors common?

A

GI tract and lungs

46
Q

What do carcinoid tumors do?

A

Release Hormones

47
Q

What are carcinoid tumors and what disease is it associated with?

A

Neoplasms of neuroendocrine cells

Carcinoid heart disease

48
Q

Clinical features of carcinoid heart disease?

A

Flushing of skin
Nausea
Vomiting
Diarrhea

49
Q

Pathophysiology of carcinoid syndrome?

A

XS 5HIAA, serotonin, histamine, bradykinin, production by tumour
Produces right sided cardiac valve disease
Tricuspid and pulmonary insufficiency

50
Q

Most common tumour of the heart?

A

Atrial myxoma

51
Q

What type of tumours are rare in heart and why?

A

Primary Tumours

Cardiac muscle cells are end differentiated

52
Q

Features of atrial myxoma?

A 
90% in atria and usually left 
Can cause ball/valve obstruction 
May cause tumour emboli 
May develop endocarditis 
Associated with systemic fever and malaise

Cardio (36 decks)

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