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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
Q

Toxic, metabolic, and other specific causes of myocardial disease

A
  1. alcohol
  2. adriamycin and other drugs
  3. catecholamines
  4. peripartum state
  5. amyloidosis
  6. iron overload
  7. hyperthyroidism and hypothyroidism
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26
Q

Alcohol and myocardial disease

A

ETOH or its metabolites have direct toxic effect; may be complicated by thiamin deficiency (beriberi heart disease)

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27
Q

Adriamycin and other drugs and myocardial disease

A

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

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28
Q

Catecholamines and myocardial disease

A

pheochromocytoma - contraction band necrosis; dopamine, cocaine

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29
Q

Peripartum state and myocardial disease

A

globally dialted heart; due to hypertension, volume overload; nutritional deficiency

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30
Q

Amyloidosis

A

may be part of systemic amyloidosis or only affect heart, particiarly with senile isolated cardiac amyloidosis; two forms: ventricular (transthyretin) and atrial

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31
Q

Iron overload (hemochromatosis, hemosiderosis) and myocardial disease

A

more prominent in ventricles than atria; interferes with metal-dependent enzyme systems; accumulation of hemosiderin within cardiac myocytes

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32
Q

Hyperthyroidism and myocardial disease

A

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
Q

Hypothyroidism and myocardial disease

A

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
Q

Myocarditis

A

inflammatory involvement of the heart muscle characterized by leukocytic infiltrate and resultant non-ischemic necrosis or degeneration of myocytes

35
Q

Most cases of myocarditis are

A

viral in origin

36
Q

Patients most vulnerable to myocarditis

A

infants, immunosuppressed, pregnant women

37
Q

Viruses that cause myocarditis

A

Coxsackievirus A and B; ECHO virus; poliovirus; influenza A and B

38
Q

Nonviral causes of myocarditis

A
  1. Chaga’s disease
  2. trinosis
  3. Corynebacterium diphtheriae
  4. Lyme disease
  5. AIDS
39
Q

Chaga’s disease

A

Trypanosoma cruzi; endemic in South America; myocardial involvement found in 80%

40
Q

Corynebacterium diphtheriae

A

patchy myocyte necrosis with only sparse lymphocytic infiltrate

41
Q

AIDS patients and myocarditis

A

a. inflammation and myocyte damage without a clear etiologic agent
b. myocarditis caused directly by HIV or by opportunitistic pathogen

42
Q

Non-infectious causes of myocarditis

A

hypersensitivities (drugs); rheumatic fever, SLE; sarcoidosis

43
Q

Morphology of myocarditis

A

interstitial mononuclear, predominantly lymphocytic inflammatory infiltrate; focal necrosis

44
Q

Giant cell myocarditis

A

widespread inflammatory cellular infiltrate containing multinucleate giant cells, interspersed with lymphocytes, eosinophils, plasma cells, and macrophages with necrosis

45
Q

Pericardial disease almost always associated with

A

disease in othe rportions of the heart or surrounding structures

46
Q

Normal fluid in pericardium

A

normal 30-50 ml of thin, clear, straw-colored translucent fluid

47
Q

How do pericardial effusions usually accumulate

A

slowly and rarely exceed 500 ml

48
Q

Hemopericardium

A

due to rupture of heart wall secondary to MI, traumatic performation, or rupture of intrapericardial aorta; leads to cardiac tamponade

49
Q

Serous pericarditis

A

non-infectious inflammation (RF, SLE, scleroderma, tumors, uremia)

50
Q

Most frequent type of pericarditis

A

Fibrinous and serofibrinous pericarditis

51
Q

Fibrinous and serofibrinous pericarditis

A

serous fluid mixed with fibrinous exudate; MI, Dressler’s syndrome; uremia, chest irradiation, rheumatic fever, trauma

52
Q

Dressler’s syndrome

A

autoimmune conditions which appear several weeks after MI

53
Q

Most striking characteristic of fibrinous and serofibrinous pericarditis

A

loud pericardial friction rub

54
Q

Purulent or suppurative pericarditis

A

invasion of organisms into pericardial space; organization may lead to restrictive pericarditis

55
Q

Hemorrhagic pericarditis

A

exudate composed of blood mixed with a fibrinous or suppurative effusion; tuberculosis, direct malignant neoplastic involvement of the pericardial space

56
Q

Types of pericarditis

A
  1. Serous pericarditis
  2. Fibrinous and serofibrinous pericarditis
  3. Purulent or suppurative pericarditis
  4. Hemorrhagic pericarditis
  5. Caseous pericarditis
  6. Chronic pericarditis
57
Q

Chronic pericarditis

A

often denotes healed or organized effusions which may lead to fibrosis, adhesive percarditis; restrictive pericarditis

58
Q

Myxoma

A

most common primary tumor of the heart in adults; 90% are located in the atria

59
Q

Lipoma

A

may occur in subendocardium, subepicardium or within myocardium

60
Q

Fibroelastoma

A

generally located on valves as Lambl’s excrescences; incidental lesions

61
Q

Rhabdomyosarcoma

A

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
Q

Noncardiac Neoplasms

A
  1. carcinoid, pheochromocytoma, myeloma-associated amyloidosis
  2. metastatic diseae
63
Q

Morphology of dilated cardiomyopathy

A

four-chamber hypertrophy; associated with mural thrombi; patchy myocardial scars

64
Q

Morphology of idiopathic hypertrophic subaortic stenosis

A

asymmetric septal hypertrophy; myofiber disarray; subaortic hypertrophy leads to outflow obstruction

65
Q

Adhesive mediastinopericarditis

A

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
Q

Morphology of viral myocarditis caused by Coxsackie A and B

A

interstitial mononuclear lymphocytic infiltrate

67
Q

Morphology of viral myocarditis caused by HIV

A

focal necrosis of myocytes

68
Q

Morphology of viral myocarditis caused by ECHO, polio, and influenza virus

A

post-infectious fibrosis

69
Q

Morphology of Chaga’s disease myocarditis

A

parasitism of myocytes with scattered inflammatory infiltrate

70
Q

Morphology of Trinchinella myocarditis

A

encysted trinchinella with inflammatory infiltrate, eosinophils

71
Q

Morphology of Corynebacterium diptheriae myocarditis

A

patchy myocyte necrosis with sparse lymphocyte infiltrate

72
Q

Morphology of alcohol related myocardial disease

A

dilated myocardial disease

73
Q

Morphology of Adriamycin (Doxorubicin, daunorubicin) related myocardial disease

A

myofiber swelling and vacuolization, fatty change, myocytolysis

74
Q

Morphology of catecholamine-related myocardial disease

A

foci of myocardial necrosis with contraction bands; monocytic infiltrate; similar to reperfusion injury

75
Q

Morphology of peripartum state myocardial disease

A

globally dilated heart

76
Q

Morphology of iron overload associated myocardial disease

A

hemosiderin within cardiac myocytes; cellular degeneration and replacement fibrosis; dilated myocardial disease

77
Q

Morphology of hyperthyroidism related myocardial disease

A

nonspecific hypertrophy

78
Q

Morphology of hypothyroidism related myocardial disease

A

dilated myocardial disease with myxedema; deposition of mucopolysaccharide-rich edema fluid; myofiber swelling

Cardiovascular Pathology (8 decks)

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