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Cardiovascular Pathology > Myocardial and Pericardial Disease > Flashcards

Myocardial and Pericardial Disease Flashcards

1
Q

Myocarditis

A

inflammatory reaction within the myocardium

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2
Q

Clinical, functional and pathologic patterns of Myocardial disease

A

dilated (90%)
hypertrophic
restrictive (least common)

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3
Q

Diagnosis of myocardial disease depends on

A

endomyocardial biopsy; small pieces of tissue removed from right ventricular septum

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4
Q

Dilated cardiomyopathy

A

gradual development of cardiac failure with 4-chamber hypertrophy and dilatation of heart of unknown etiology

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5
Q

Suspected etiologies of dilated cardiomyopathy

A

alcohol or other toxicities; previousmyocarditis; pregnancy assocaited with nutritional deficiency or immunologic

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6
Q

Clinical picture of dilated cardiomyopathy

A

slowly developing CHF which is progressive and unremitting; may have precipitous decompensation; 50% die within 2 years

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7
Q

treatment for dilated cardiomyopathy

A

transplant

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8
Q

Gross morphology of dilated cardiomyopathy

A

large, dilated hearts 2-3X normal size; all chambers involved; wall thickness may be normal; mural thrombi common; functional mitral regurgitation

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9
Q

Histology of dilated cardiomyopathy

A

most myofibers hypertrophied stretched; interstitial and endocardial fibrosis; replacement fibrosis

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10
Q

Two kinds of hypertrophic cardiomyopathy

A

idiopathic hypertrophic subaortic stenosis (IHSS)

hypertrophic obstructive cardiomyopathy

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11
Q

Clinical associations of hypertrophic cardiomyopathy

A

heaving muscular hypercontracting heart

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12
Q

Heart failure with hypertrophic cardiomyopathy is due to

A

decrease in chamber size, poor compliance with decreased stroke volume (diastolic failure)

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13
Q

What must hypertrophic cardiomyopathy be differentiated from

A

amyloidosis and hypertensive heart disease

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14
Q

Hypertrophic cardiomyopathy is what percent genetic

A

100% genertic causes

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15
Q

genetic causes of hypertrophic cardiomyopathy

A

sarcomere proteins with direct sarcomeric dysfunction; defect in energy transfer from mitochondria

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16
Q

Problems resulting from hypertrophic cardiomyopathy

A

atrial fibrillation with mural thrombus formation; infective endocarditis on mitral valve; intractable CF; sudden death

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17
Q

Morphology of IHSS

A

disproportionate thickening of ventricular septum compared to free wall

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18
Q

Morphology of hypertrophic cardiomyopathy

A

endocardial thickening or mural plaque formation of left ventricular outflow tract; thickening of anterior mitral leaflet secondary to contact of anterior mitral leaflets with septum during ventricular systole

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19
Q

Histology of hypertrophic cardiomyopathy

A

extensive myocyte hypertrophy; myofiber disarray; interstitial and replacement fibrosis

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20
Q

Restrictive cardiomyopathy

A

diastolic disorder; diastolic relaxation and left ventricular filling impeded by inability of myocardium to expand; contractile (systolic) function of ventricle usually unaffected

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21
Q

Restrictive cardiomyopathy results from

A

infiltrative diseases such as amyloidosis, hemochromatosis, leukemia, or storage disease; also radiation fibrosis, constrictive pericarditis

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22
Q

endocardial fibrosis

A

child, young adults in Africa and tropical countries; fibrosis or ventricular endocardium and subendocardium; extends from apex to inflow tract of rt/lt ventricles; may involve mitral, tricuspid valves; ventricular mural thrombi

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23
Q

Loeffler’s endomyocarditis

A

similar to endocardial fibrosis but unrestricted to specific geographic area; eosinophils, leukocytosis; involvement of other organs; eosinophils appear to be functionally abnormal

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24
Q

Endocardial fibroelastosis

A

focal or diffuse; cartilage-like fibroelastic thickening; first 2 years; often associated with congenital abnormalities (aortic valve obstruction)

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25
Toxic, metabolic, and other specific causes of myocardial disease
1. alcohol 2. adriamycin and other drugs 3. catecholamines 4. peripartum state 5. amyloidosis 6. iron overload 7. hyperthyroidism and hypothyroidism
26
Alcohol and myocardial disease
ETOH or its metabolites have direct toxic effect; may be complicated by thiamin deficiency (beriberi heart disease)
27
Adriamycin and other drugs and myocardial disease
anthracycline chemotherapeutic agents doxorubicin, daunorubicin, lithiu, phenothiazines, cocaine; attributed to lipid peroxidation of myofiber membranes; myofiber swelling and vacuolization; resolves with dissolution of the drug
28
Catecholamines and myocardial disease
pheochromocytoma - contraction band necrosis; dopamine, cocaine
29
Peripartum state and myocardial disease
globally dialted heart; due to hypertension, volume overload; nutritional deficiency
30
Amyloidosis
may be part of systemic amyloidosis or only affect heart, particiarly with senile isolated cardiac amyloidosis; two forms: ventricular (transthyretin) and atrial
31
Iron overload (hemochromatosis, hemosiderosis) and myocardial disease
more prominent in ventricles than atria; interferes with metal-dependent enzyme systems; accumulation of hemosiderin within cardiac myocytes
32
Hyperthyroidism and myocardial disease
tachycardia, palpitations, cardiomegaly, supraventricular arrhythmias; direct and indirect effect of thyroid hormones on the cells of the heart; alter plasma membrane function, responsiveness to sympathetic stimulation
33
Hypothyroidism and myocardial disease
decreased cardiac output with reduced stroke volume and rate; increased peripheral resistance (cold sensations); myxedema; heart is flabby, enlarged, dilated; myofiber swelling with loss of striation and basophilic degeneration, interstitial mucopolysaccharide-rich edema fluid
34
Myocarditis
inflammatory involvement of the heart muscle characterized by leukocytic infiltrate and resultant non-ischemic necrosis or degeneration of myocytes
35
Most cases of myocarditis are
viral in origin
36
Patients most vulnerable to myocarditis
infants, immunosuppressed, pregnant women
37
Viruses that cause myocarditis
Coxsackievirus A and B; ECHO virus; poliovirus; influenza A and B
38
Nonviral causes of myocarditis
1. Chaga's disease 2. trinosis 3. Corynebacterium diphtheriae 4. Lyme disease 5. AIDS
39
Chaga's disease
Trypanosoma cruzi; endemic in South America; myocardial involvement found in 80%
40
Corynebacterium diphtheriae
patchy myocyte necrosis with only sparse lymphocytic infiltrate
41
AIDS patients and myocarditis
a. inflammation and myocyte damage without a clear etiologic agent b. myocarditis caused directly by HIV or by opportunitistic pathogen
42
Non-infectious causes of myocarditis
hypersensitivities (drugs); rheumatic fever, SLE; sarcoidosis
43
Morphology of myocarditis
interstitial mononuclear, predominantly lymphocytic inflammatory infiltrate; focal necrosis
44
Giant cell myocarditis
widespread inflammatory cellular infiltrate containing multinucleate giant cells, interspersed with lymphocytes, eosinophils, plasma cells, and macrophages with necrosis
45
Pericardial disease almost always associated with
disease in othe rportions of the heart or surrounding structures
46
Normal fluid in pericardium
normal 30-50 ml of thin, clear, straw-colored translucent fluid
47
How do pericardial effusions usually accumulate
slowly and rarely exceed 500 ml
48
Hemopericardium
due to rupture of heart wall secondary to MI, traumatic performation, or rupture of intrapericardial aorta; leads to cardiac tamponade
49
Serous pericarditis
non-infectious inflammation (RF, SLE, scleroderma, tumors, uremia)
50
Most frequent type of pericarditis
Fibrinous and serofibrinous pericarditis
51
Fibrinous and serofibrinous pericarditis
serous fluid mixed with fibrinous exudate; MI, Dressler's syndrome; uremia, chest irradiation, rheumatic fever, trauma
52
Dressler's syndrome
autoimmune conditions which appear several weeks after MI
53
Most striking characteristic of fibrinous and serofibrinous pericarditis
loud pericardial friction rub
54
Purulent or suppurative pericarditis
invasion of organisms into pericardial space; organization may lead to restrictive pericarditis
55
Hemorrhagic pericarditis
exudate composed of blood mixed with a fibrinous or suppurative effusion; tuberculosis, direct malignant neoplastic involvement of the pericardial space
56
Types of pericarditis
1. Serous pericarditis 2. Fibrinous and serofibrinous pericarditis 3. Purulent or suppurative pericarditis 4. Hemorrhagic pericarditis 5. Caseous pericarditis 6. Chronic pericarditis
57
Chronic pericarditis
often denotes healed or organized effusions which may lead to fibrosis, adhesive percarditis; restrictive pericarditis
58
Myxoma
most common primary tumor of the heart in adults; 90% are located in the atria
59
Lipoma
may occur in subendocardium, subepicardium or within myocardium
60
Fibroelastoma
generally located on valves as Lambl's excrescences; incidental lesions
61
Rhabdomyosarcoma
most frequent primary tumor of the heart in children; discovered in first years of life because of obstruction of the outflow tract or cardiac chamber
62
Noncardiac Neoplasms
1. carcinoid, pheochromocytoma, myeloma-associated amyloidosis 2. metastatic diseae
63
Morphology of dilated cardiomyopathy
four-chamber hypertrophy; associated with mural thrombi; patchy myocardial scars
64
Morphology of idiopathic hypertrophic subaortic stenosis
asymmetric septal hypertrophy; myofiber disarray; subaortic hypertrophy leads to outflow obstruction
65
Adhesive mediastinopericarditis
results when the pericardial sac is obliterated and the cardiac structures are adhered to surrounding structures, greatly increasing the workload of the heart; heart is free to contract but pulls on adjacent structures leading to hypertrophy and dilatation
66
Morphology of viral myocarditis caused by Coxsackie A and B
interstitial mononuclear lymphocytic infiltrate
67
Morphology of viral myocarditis caused by HIV
focal necrosis of myocytes
68
Morphology of viral myocarditis caused by ECHO, polio, and influenza virus
post-infectious fibrosis
69
Morphology of Chaga's disease myocarditis
parasitism of myocytes with scattered inflammatory infiltrate
70
Morphology of Trinchinella myocarditis
encysted trinchinella with inflammatory infiltrate, eosinophils
71
Morphology of Corynebacterium diptheriae myocarditis
patchy myocyte necrosis with sparse lymphocyte infiltrate
72
Morphology of alcohol related myocardial disease
dilated myocardial disease
73
Morphology of Adriamycin (Doxorubicin, daunorubicin) related myocardial disease
myofiber swelling and vacuolization, fatty change, myocytolysis
74
Morphology of catecholamine-related myocardial disease
foci of myocardial necrosis with contraction bands; monocytic infiltrate; similar to reperfusion injury
75
Morphology of peripartum state myocardial disease
globally dilated heart
76
Morphology of iron overload associated myocardial disease
hemosiderin within cardiac myocytes; cellular degeneration and replacement fibrosis; dilated myocardial disease
77
Morphology of hyperthyroidism related myocardial disease
nonspecific hypertrophy
78
Morphology of hypothyroidism related myocardial disease
dilated myocardial disease with myxedema; deposition of mucopolysaccharide-rich edema fluid; myofiber swelling

Cardiovascular Pathology (8 decks)

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