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Pathology dt2 > Chapter 11: Complete lecture > Flashcards

Chapter 11: Complete lecture Flashcards

1
Q

What is myocarditis?

A

Inflammation of the heart: infectious or non-infectious cause

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2
Q

What is (in 99% of the cases) the cause of myocarditis? (bacteria/virus/parasites)

A

Virus!

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3
Q

What can lymphocytic myocarditis cause?

A
  • arrhythmia
  • vasospasm (contraction of blood vessels -> myocardial infarction)
  • heart failure (because of interleukins)
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4
Q

Is the amount of lymphocyts increased or decreased in patients of myocarditis?

A

Mostly increased (but some have no difference)

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5
Q

What ages does myocarditis mostly occur?

A

All ages! (so also young ones)

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6
Q

How can young patients have a myocardial infarction?

A

Because of myocarditis (vasospasm)

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7
Q

Do interleukins have a positive or negative effect on the heart muscle?

A

Negative! The contractility is reduced

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8
Q

True/false: there is no extensive cell death of cardiomyocytes during myocarditis

A

True, except for fulminant myocarditis

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9
Q

Are there more lymphocytes or more macrophages after a couple of days (viral myocarditis)?

A

More lymphocytes, this can be found up to 14days after the infection (this is from his study with mice/unpublished results, p34)

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10
Q

Fungi or bacteria can also be the cause of myocarditis, then there are no lymphocytes (primarily) found, but other cells. Which?

A

Neutrophilic granulocytes

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11
Q

We saw earlier that an acute myocardial infarction also causes neutrophilic granulocytes. So how can a fungi/bacterial myocarditis be distinguished from an acute myocardial infarction?

A

(fungi/bacterial) Myocarditis shows an aggregation of neutrophilic granulocytes Acute myocardial infarction shows an diffuse increase of neutrophilic granulocytes (i watched this about a 100x but he doesn’t say more than this / i don’t understand sorry)

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12
Q

What is myocytolysis

A

Cell death of myocardicytes

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13
Q

If you see increased eosinophilic granulocytes without myocytolysis, what can be the underlying cause of this?

A

Parasites (infectious) or drug induced (so it can be infectious/non-infectious)

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14
Q

If you see increased eosinophilic granulocytes with myocytolysis, what can be the underlying cause of this?

A

Hypereosinophilic syndrome (increased eosinophils in the blood)

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15
Q

What is a granuloma?

A

Aggregation of macrophages and/or giant cells

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16
Q

Myocarditis can be because of granuloma’s. What are diseases associated with this? (3 answers)

A
  • Tuberculosis
  • Sarcoidosis (no necrosis of cardiomyocytes)
  • Giant cell myocarditis (limited granuloma’s; extensive necrosis of cardiomyocytes)
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17
Q

How is non-infectious myocarditis also called?

A

Stress-myocarditis

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18
Q

In stress-myocarditis/non-infectious myocarditis there is a diffuse increase of….

A

neutrophilic granulocytes, lymphocytes, macrophages

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19
Q

What types/part of the heart wall are damaged in stress-myocarditis/non-infectious myocarditis?

A

Both endo- and myocardium!!!

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20
Q

What can be the causes of stress-myocarditis/non-infectious myocarditis?

A
  • feochromocytoma (tumour adrenal glands)
  • brain injury
  • lungemboli
  • sepsis
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21
Q

A thrombus in the left ventricle causes a risk for…

A

Brain infarction

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22
Q

A thrombus in the right ventricle causes a risk for…

A

Lung emboli

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23
Q

So, to summarize, what can be causes of myocarditis?

A
  • Inflammation of the heart: infectious or non-infectious (lung emboli/ brain injury / sepsis)
  • In infectious myocarditis the predominant inflammatory cell points to the cause:
    • lymphocytes: virus
    • neutrophilic granulocytes: fungi or bacteria
    • eosinophilic granulocytes: parasites
    • aggregates of macrophages: tuberculosis
24
Q

In case granuloma’s with giant cells are found in the heart with an infectious myocarditis, this is caused by: a: a viral infection b: a bacterial infection c: an infection with parasites d: tuberculosis

A

d: tuberculosis

25
Q

What is cardiomyopathy?

A

Disease of the heart muscle

26
Q

What are the four ways cardiomyopathy can present?

A
  • Hypertrophic
  • Dilated
  • Restrictive
  • Arrhythmogenic right ventricular
27
Q

First we discuss hypertrophic cardiomyopathy. What changes on macroscopic level can be seen?

A

Increase and asymmetry of the heart wall

28
Q

What are microscopic changes that can be seen during hypertrophic cardiomyopathy

A

Disarray of myofibrils and disarray of cardiomyocytes (-> ‘whorls)

29
Q

How do whorls have a negative impact on the contractility?

A

Like the name suggests, they are whorls/not aligned, therefore if you would ask yourself in what direction a signal would go, you would not be able to answer it! (see p44/google, it will make sense)

30
Q

What is the cause of hypertrophic cardiomyopathy?

A

Genetic: mutations in genes coding for sarcomeres (=contractility unit)

31
Q

Onto the next part, dilated cardiomyopathy: how can this be seen macroscopically?

A

There is dilation of both the left, and right ventricle

32
Q

How can dilated cardiomyopathy be seen microscopically?

A

Increase of fat tissue and fibrosis

33
Q

Fill in: Heart failure is related to a *decrease/increase/no difference* of cardiomyocytes in hypertrophic cardiomyopathy. Heart failure is related to a *decrease/increase/no difference* of cardiomyocytes in dilated cardiomyopathy.

A

no difference, and loss respectively

34
Q

What can also be a result of dilated cardiomyopathy (next to heart failure)?

A

Arrhythmia

35
Q

What are the causes of dilated cardiomyopathy?

A
  • Genetic: in case a CMP is related to a genetic cause: it is suggested that patients develop the fenotype of a CMP subsequent to an event (infarction or myocarditis: also for HCMP and ACMP)
  • Alcoholic Cardiomyopathy
  • Viral myocarditis
  • After pregnancy
  • Idiopathic= no clear cause
36
Q

Alcoholic (dilated) cardiomyopathy shows a distinct macroscopic and microscopic view. Explain

A

Macroscopic: dilated and fatty (!) changed (mostly) left ventricle (but also right ventricle) Microscopic: cardiomyocytes have decreased density of myofibrils (!) and more liquid (fat inclusion)`

37
Q

3rd cardiomyopathy was the restrictive cardiomyopathy. What is this, generally, caused by?

A

Increase of a ‘compound’ in the heart (such as glycogen, amyloid, iron)

38
Q

How does amyloid impact cardiomyocytes (in restrictive cardiomyopathy)?

A
  • Amyloid causes a decrease in cardiomyocytes
  • Amyloid can be within cardiomyocytes (causing loss of myofibrils)
  • Amyloid can be between cardiomyocytes
  • Amyloid can be in blood vessels (both small capillaries and larger ones!)
39
Q

What does amyloid within and/or in between cardiomyoctes cause?

A

Inhibition of heart function

40
Q

What does amyloid in blood vessels cause?

A

Myocardial infaction

41
Q

Glycogen can also cause restrictive cardiomyopathies, how?

A

They form vacuoles with glycogen, disrupting myofibrils

42
Q

Next to glycogen, and amyloid, what else can cause restrictive cardiomyopathies?

A

Hemosiderosis (iron)

43
Q

So, storage of glycogen and iron results in:

A

Less myofibrils and thus a decrease of heart function

44
Q

What does ARVC stand for?

A

Arrhythmogenic right ventricular cardiomyopathy (the fourth! of cardiomyopathies) (almost theree)

45
Q

What is seen in arrhythmogenic cardiomyopathy (macroscopically/microscopically)?

A

Macroscopically: Wall thinning of the right ventricle (fatty chagnes myocardium) Microscopically: fatty changes, with/without fibrosis

46
Q

Does ARVC have a genetic cause?

A

Not per definition

47
Q

So how can the difference be seen of alcoholic dilated and arrhythmogenic cardiomopathy be seen?

A

Alcoholic: left ventricle (mostly) Arrhythmogenic: right ventricle (mostly)

48
Q

Sooo, to summarize it all, what are the four types of cardiomyopathy and their characteristics?

A
  • Hypertrophic: asymmetric thickening of 1 wall of the heart (mostly septum)
  • Dilated: dilatation of the ventricles
  • Arrhythmogenic: thinning and fatty changes of the ventricle (mostly right) with fibrosis
  • Restrictive: storage of f.i. iron/glycogen/amyloid in the heart
49
Q

Fatty changes of only the right ventricle of the heart is found in: a) dilated cardiomyopathy b) hypertrophic cardiomyopathy c) restrictive cardiomyopathy d) arrhythmogenic cardiomyopathy

A

d) arrhythmogenic cardiomyopathy

50
Q

Is it common to find a tumor in the heart?

A

No, it’s rare

51
Q

What type of tumor is mostly seen in the heart?

A

Metastases

52
Q

Where are the metastases of the heart seen?

A

Can be everywhere! Ventricles, atria, blood vessels, even the valves

53
Q

What is more common benign or malignant tumors in the heart?

A

benign

54
Q

What is the most common benign tumor of the heart? what is seen microscopically?

A

Myxoma (cause unknown), there is vessel proliferation

55
Q

Where is the benign tumor often found?

A

Atria

56
Q

What is the malignant type of tumor in the heart, and where can it be found?

A

Angiosarcoma (malignant tumour of blood vessels), can be everywhere (very poor prognosis)

57
Q

What is NOT a complication of acute myocardial infarction? a. Death b. Rupture of the myocardial wall c. Lymphocytic myocarditis d. Arrhythmia

A

c. Lymphocytic myocarditis Myocardial infarction causes cardiac inflammation (including a diffuse increase of lymphocytes) Lymphocytic myocarditis shows mainly lymphocytes that form aggregates: this is caused by a viral infection and can be the CAUSE of an acute myocardial infarction

Pathology dt2 (39 decks)

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