Cardiovascular Pathology Flashcards by Charis Gibson

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

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Classification of myopathy?

Dilated
Hypertrophic
Restrictive

Arrhythmogenic right ventricular dysplasia

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What is a simple description of hypertrophic cardiomyopathy?

Muscle bound

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What is a simple description of restrictive cardiomyopathy?

Stiff

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What is a simple description of dilated cardiomyopathy?

Weak/flabby

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Features of dilated cardiomyopathy?

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

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Main cause of DCM (dilated cardiomyopathy)?

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

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Causes of DCM?

Genetics
Alcohol
Drugs- chemotherapy drugs

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Rare causes of DCM?

Pregnancy

Cardiac Infection

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Clinical features of DCM?

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

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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)

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Causes of hypertrophic cardiomyopathy?

Genetics - lots of different genes

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

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Examples of genes that cause hypertrophic cardiomyopathy?

Beta myosin heavy chain
Myosin binding protein C
Alpha tropomyosin

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Pathophysiology of hypertrophic cardiomyopathy?

Bulging interventricular septum
Outflow tract obstruction
LV luminal reduction

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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

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

Walls become stiff but not necessarily thickened

Heart may appear grossly normal

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Causes of restrictive cardiomyopathy?

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

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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

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2 Main types of amyloids?

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

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Features of amyloid?

Generally resembles restrictive cardiomyopathy

Arrhythmogenic death

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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 ```