Lecture 13+14 Flashcards

Question

Isolated Pulmonary right sided hypertensive heart disease

Answer 1

Right ventricular and right atrial hypertrophy

Answer 2

early stages: asymptomatic Angina pectoris Signs and symptoms of left heart failure with progression ``` Cerebrovascular accidents (stroke) or renal failure as a consequence of HTN ``` Sudden cardiac death

Answer 3

Disease of right sided cardiac chambers secondary to pulmonary parenchymal or pulmonary vascular diseases excluded: Pulmonary hypertension due to left heart failure Pulmonary hypertension due to congenital heart disease

Answer 4

concentric hypertrophy of LV | enlarged myocytes with large rectangular nuclei

Answer 5

Pulmonary embolism causing sudden increase in burden on the right heart Right ventricle is dilated but no hypertrophy

Answer 6

COPD – Most common cause Others – Idiopathic pulmonary fibrosis, cystic fibrosis or marked obesity

Answer 7

Direct viral cytotoxicity Cell mediated immune reactions against infected myocytes Cytokines released can aggravate myocardial dysfunction

Answer 8

Varies from asymptomatic to sudden acute heart failure or arrhythmias Flu-like symptoms Fatigue, dyspnea, palpitations, chest pain, fever May mimic acute MI investigations: PCR for virus serology

Answer 9

Interstitial inflammation mainly lymphocytes and a few plasma cells Focal necrosis of myocytes adjacent to inflammatory cells

Answer 10

* Acute heart failure * Viral myocarditis may lead to dilated cardiomyopathy→ Chronic CHF * Arrhythmias: ventricular arrhythmias are the most dangerous → SCD

Answer 11

• Most common helminth associated with myocarditis. • Histologically: eosinophils predominance

Answer 12

myocarditis (parasitic) Endemic in South America. Myocardium involved in majority of cases. Parasitization of scattered myofibers by trypanosomes accompanied by a mixed inflammatory infiltrate

Answer 13

parasitic Household cats are the most common vector Causes myocarditis in immunocompromised

Answer 14

Morphology is characterized by the presence of mixed inflammatory infiltrate composed of neutrophils, lymphocytes, and plasma cells

Answer 15

Methydopa and sulfonamides Mild and self limiting Composed of lymphocytes, macrophages and abundant eosinophils

Answer 16

idiopathic associated with SLE, thyrotoxicosis fatal disease in those 40-50 cause of death is CHF or arrhythmia

Answer 17

Granulomatous inflammation with many giant cells, lymphocytes, eosinophils and plasma cells Focal to extensive necrosis

Answer 18

Associated with mechanical and/or electrical dysfunction Usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilatation Primary cardiomyopathies: involve predominantly the heart → may be genetic or acquired (e.g., viral myocarditis, anthracycline cardiotoxic) Secondary cardiomyopathies: myocardial involvement as a component of a systemic or multiorgan disorder (e.g. hemochromatosis, amyloidosis

Answer 19

morphologically and functionally by progressive cardiac dilation and contractile (systolic) dysfunction, usually with concomitant hypertrophy leads to HF etiopath: cause is unknown ``` more common genetic (auto dom) less common (X linked due to dystrophin gene mutation) uncommon (mutation of mito proteins) ``` alcohol is direct cytotoxicity ``` viral (viral myocarditis) nutritional disturbances (thiamine and anemia) chemo (doxorubicin) stress peripartum ```

Answer 20

Affects mostly individuals between 20-50 year Fundamental defect is ineffective contraction Ejection fraction is < 25% (normal 50-65%) Progressive CHF refractory to therapy, usually end stage by the time of clinical discovery treatment: transplantation

Answer 21

* Interstitial and endocardial fibrosis * Small subendocardial scars may replace individual cells or groups of cells * Most muscle cells are hypertrophied with enlarged nuclei (Some are attenuated, stretched, and irregular)

Answer 22

``` inherited right ventricular cardiomyopathy that classically manifests with right-sided heart failure and rhythm disturbances, which can cause sudden cardiac death (auto dom) ``` etio: Mutations in genes coding for Desmosomal junctional proteins at intercalated disk → plakoglobin Proteins that interact with desmosome→ intermediate filaments like desmin

Answer 23

Arrhythmogenic right ventricular cardiomyopathy Hyperkeratosis of plantar and palmar skin surfaces Associated with plakoglobin mutations

Answer 24

the RV is major dilated histo: the myocardium is replaced by FCT and fat

Answer 25

genetic disorder, auto dom, that leads to myocardial hypertrophy Leading cause of left ventricular hypertrophy unexplained by other clinical or pathologic causes Heart is thick-walled, heavy, and hypercontracting (Primarily diastolic dysfunction) ``` etiology: Missense point mutations in any one of several genes that encode sarcomeric proteins • β-myosin heavy chain – most common • Myosin-binding protein C • Cardiac troponin T ```

Answer 26

Gain of function mutation of the sarcomeric proteins → Myocyte hypercontractility → Increase energy use → Intense compensatory hypertrophy (myofiber disarray) and fibroblast proliferation

Answer 27

Massively hypertrophied LV that paradoxically provides markedly reduced stroke volume → Congestive heart failure Increased demand for oxygen and metabolites by hypertrophied muscle, high left ventricular pressure and compromised intramural coronary arteries leads to ischemia → Angina Decreased cardiac output and a secondary increase in pulmonary venous pressure → Exertional dyspnea Harsh ejection systolic murmur Sudden death – due to arrhythmias One of the most common causes of sudden, otherwise unexplained death in young athletes

Answer 28

gross: asymmetric septal hypertrophy massive myocardial hypertrophy histo: Marked myocyte hypertrophy – transverse myocyte diameter is >40 µm (normal 15 µm) Myofiber disarray - haphazard arrangement of hypertrophied, abnormally branching myocytes Interstitial fibrosis

Answer 29

Primary decrease in ventricular compliance, resulting in impaired ventricular diastolic filling ``` etiology: amyloidosis sarcoidosis radiation induced tumor metabolism disorder fibrosis ```

Answer 30

* Exertional dyspnea * Fatigue * Chest pain * Complications include arrhythmias and congestive heart failure morph: • Bi-atrial dilation due to restricted ventricular filling and pressure overloads • Ventricles approximately normal size (or slightly enlarged) • Cavities are not dilated • Myocardium is largely unremarkable

Answer 31

* A type of restrictive cardiomyopathy * Children and young adults * Africa and the tropics * Dense fibrosis of endocardium and subendocardium from apex to AV valves * Reduced volume and compliance of affected chambers

Answer 32

* Clinically a restrictive cardiomyopathy * Endocardial fibrosis with large mural thrombi * Peripheral hypereosinophilia * Abnormal degranulated eosinophils * Major basic protein (MBP) from granules of eosinophils → endocardial damage, necrosis and fibrosis

Answer 33

uncommon and infection origin

Answer 34

``` • MI, cardiac surgery • Uremia – most common systemic disorder associated with pericarditis. • Radiation induced • Rheumatic fever, SLE • Malignancies ```

Answer 35

* Bread and butter- irregular shaggy | * Seen in RHD, uremia, post-MI, post viral

Answer 36

seen in malignancy

Answer 37

seen in pericarditis due to bacteria

Answer 38

tuberculosis

Answer 39

Produces a combination of right sided venous distention and low cardiac output. Similar to restrictive cardiomyopathy progresses to chronic: Usually following caseous and suppurative pericarditis but can be idiopathic Chronic constrictive pericarditis morphology: Delicate adhesions to dense, fibrotic scars that obliterate the pericardial space Extreme cases – heart is completely encased with dense scar tissue; can not expand – “constrictive” pericarditis