Cardiovascular Pathology Flashcards
What is cardiomyopathy?
Any disease of the cardiac muscle
-Often results in changes in the size of the heart chambers and thickness of the heart
Classification of myopathy?
Dilated
Hypertrophic
Restrictive
Arrhythmogenic right ventricular dysplasia
What is a simple description of hypertrophic cardiomyopathy?
Muscle bound
What is a simple description of restrictive cardiomyopathy?
Stiff
What is a simple description of dilated cardiomyopathy?
Weak/flabby
Features of dilated cardiomyopathy?
Flabby/floppy heart
Big heart= 2-3 times normal size
Histological features are non-specific
Main cause of DCM (dilated cardiomyopathy)?
Genetics- AD,AR, X-linked and mitochondrial
Genes that encode heart muscle proteins eg
Desmin and dystrophin
Causes of DCM?
Genetics
Alcohol
Drugs- chemotherapy drugs
Rare causes of DCM?
Pregnancy
Cardiac Infection
Clinical features of DCM?
General picture of heart failure
Shortness of breath, poor exercise tolerance
Low ejection fraction (low cardiac output)
Features of hypertrophic cardiomyopathy?
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)
Causes of hypertrophic cardiomyopathy?
Genetics - lots of different genes
-Beta myosin heavy chain, Myosin binding protein C, alpha tropomyosin
Examples of genes that cause hypertrophic cardiomyopathy?
- Beta myosin heavy chain
- Myosin binding protein C
- Alpha tropomyosin
Pathophysiology of hypertrophic cardiomyopathy?
Bulging interventricular septum
Outflow tract obstruction
LV luminal reduction
Features of restrictive cardiomyopathy?
Lack of heart compliance
Stiff heart
Doesn’t fill well so diastolic dysfunction
Can look normal
Biatrial dilatation as a result of back pressure
What happens to the walls of the ventricles in restrictive cardiomyopathy?
Walls become stiff but not necessarily thickened
Heart may appear grossly normal
Causes of restrictive cardiomyopathy?
Deposition of something in myocardium Metabolic byproducts - Iron Amyloid Sarcoid- multi system granulomatous disorder Tumours Fibrosis - following radiation
What is amyloid?
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
2 Main types of amyloids?
AA- most main- related to chronic diseases like rheumatoid AL Haemodialysis associated Familial forms Diabetes Alzheimers
Features of amyloid?
Generally resembles restrictive cardiomyopathy
Arrhythmogenic death
What is arrhythmogenic right ventricular dysplasia?
Genetic Disease - autosomal dominant with low penetrance
Causes- syncope and funny turns
Arrhythmia
Non specific features- difficult diagnosis
What are the features of ARVD?
Right ventricle becomes largely replaced by fat
Big and floppy
Problem== RV always looks a bit fatty
What is myocarditis?
Inflammation of the heart
Types of myocarditis?
Infectious
Non-infectious (Most common)
Types of infectious myocarditis?
Viral Bacterial Fungal Protozoal Helminthic
Most common cause of infectious myocarditis?
Viral
Viruses which cause infectious myocarditis?
ECHO virus
Chaga’s disease
Borrelia burgdorferi- Lyme’s disease
HIV
Pathophysiology of infectious myocarditis?
Thickened beefy myocardium
Causes of non-infectious myocarditis?
Immune mediated hypersensitivity reactions
Hypersensitivity to infection- Rheumatic fever after strep throat
Hypersensitivity to drugs- eosinophillic myocarditis
Systemic lupus erythematosus (SLE)
Pathophysiology of rheumatic fever?
Classic mitral stenosis with thickening and fusion of valve leaflets
Short thick chordae tendinae
Myocardium also patchily inflammed
What is pericarditis?
Inflammation of pericardial layers
Causes of pericarditis?
Infection Immune mediated (rheumatic fever) Idiopathic Uraemic (renal failure) Post MI (Dresslers syndrome) Connective tissue dse eg SLE
Types of infection which cause infectious pericarditis?
Viruses (ECHO) virus- cause serous effusions
Bacterial - pneumonia produce perulent effusions
Fungi- Post transplant produce perulent effusions
Tuberculosis- caseous material in sac
What does tuberculosis pericarditis produce?
Constrictive pericarditis
Features of pericarditis that occurs post MI?
Many weeks post MI
Assumed to be immune mediated
Damaged heart muscle release previously un-encountered material that stimulates an immune response
What is Dressler’s syndrome?
Pericarditis post MI
Complications of pericarditis?
Pericardial effusion Tamponade Constrictive pericarditis Cardiac failure Death It effectively strangles the heart
What is endocarditis?
Affects heart lining but generally refers to inflammation of the valves
May or may not be infectious
Features of infectious endocarditis?
Can occur on normal valves
Usually requires v. virulent organism
May be bacterial or fungal
Common in IV drug users and people with septicaemia
Microbiology of Endocarditis?
H= Haemophilus A= Actinobacillus C= Cardiobacteria E= Eikenella K= Kingella
IV drug users= Candida, Staph aureus
Prosthetic valves= S. epidermidis
Pathology of infectious endocarditis?
Vegetations on heart valves
Bacteria excite acute inflammation and bacterial and inflammatory cell products digest the valve leaflets
Vegetations can cause emboli
Examples of cardiac complications?
Acute valvular incompetence
High output cardiac failure
Abscess, fistula, pericarditis
Systemic manifestations of cardiac complications?
Oslers nodes Janeway lesions Roth spots Splinter haemorrhages Septicaemia Systemic septic emboli Mycotic aneurysms
Features of non- bacterial thrombotic endocarditis?
Non-invasive and don't destroy valves Small and multiple vegetations Can cause embolic disease Associated with cancer Frequently associated with mucinous adenocarinomas
Where are carcinoid tumors common?
GI tract and lungs
What do carcinoid tumors do?
Release Hormones
What are carcinoid tumors and what disease is it associated with?
Neoplasms of neuroendocrine cells
Carcinoid heart disease
Clinical features of carcinoid heart disease?
Flushing of skin
Nausea
Vomiting
Diarrhea
Pathophysiology of carcinoid syndrome?
XS 5HIAA, serotonin, histamine, bradykinin, production by tumour
Produces right sided cardiac valve disease
Tricuspid and pulmonary insufficiency
Most common tumour of the heart?
Atrial myxoma
What type of tumours are rare in heart and why?
Primary Tumours
Cardiac muscle cells are end differentiated
Features of atrial myxoma?
90% in atria and usually left Can cause ball/valve obstruction May cause tumour emboli May develop endocarditis Associated with systemic fever and malaise
