Myocardial pathology Flashcards
Name (a) the most common primary cardiac neoplasm, (b) the cell type of origin, (c) the most common location, and (d) possible complications
Myxoma is benign neoplasm of mesodermal tissue. Most common in left atrium and complications include embolization (fragments of neoplasm or thrombus associated with mass), or mitral valve obstruction. Most common primary tumor of heart in teens and adults
List the possible primary neoplasms in heart and the cell of origin
Myxoma (mesoderm), lipoma (adipose), rhabdomyoma (cardiomyocyte), Angiosarcoma (endothelial cell)
lipoma
benign neoplasm of adipose. Most common in LV, right atrium, atrial septum, subendocardial, subepicardial, myocardium. Symptoms include arrhythmias, valve obstruction
Rhabdomyoma
Benign neoplasm of muscle fibers. Most common primary tumor in infancy/childhood. Most common in ventricle. Symptoms may include valvular obstruction
Angiosarcoma
Malignant endothelial neoplasm located anywhere in heart
Name at least one example of (a) a carcinoma and (b) a hematopoietic disease that can affect the heart
carcinomas: breast, lung. Hematopoietic: lymphoma and leukemia. Can affect the heart in the myocardium or pericardial space. Symptoms can include arrhythmias and restrictive cardiomyopathy. Chemo causes dilated cardiomyopathy and radiation causes restrictive cardiomyopathy.
Can melanoma metastasize to the heart
yep
Myocarditis definition
inflammation of myocardium and myofiber necrosis
Name the most common form of viral disease which affects the heart- infiltrative cell types
Enterovirus such as coxsackie A+B, Echo virus. Cuase direct myocardial injury. Lymphocyte infiltrate with macrophages. Often present later as dilated cardiomyopathies
Name at least one parasitic disease that affects the heart
Trypansoma cruzi (chagas kissing bug), trichinosis (trichinella spiralis). Mainly eosinophil infiltrate
Name at least one fungal entity that affects the heart
Candida, aspergillus, cryptococcus- neutrophils early, mononuclear cells later
Name bacteria that affect the heart
Corynebacterium diphtheria (toxin), Neisseria meningitis, lyme disease. Mainlly neutrophil infiltrates
Name the bacteria associated with Rheumatic Fever / Rheumatic heart disease
Group A strep (pyogenes)
Name the process by which the heart / other organ systems are injured in rheumatic disease
Antibodies against M protein cross-react with glycoproteins of heart
What components of heart are affected by rheumatic disease
All three (pan-carditis)- endocarditis causes valve damage/necrosis and fibrosis, myocarditis shows Aschoff bodies (mononuclear cell collections), pericarditis results in fibrosis and adhesions
What is an Anitschkow cell
foamy macrophages with central aggregated chromatin. AKA caterpillar cells. Found within an Aschoff body
Jones criteria for acute rheumatic fever
evidence of group A strep + 2 major or 1 major and 2minor criteria. Major: Pancarditis, polyarthritis, skin and CNS problems. Minor: fever, joint pain, elevated CRP, prolonged PR interval)
Symtpoms of rheumatic fever
arrhythmia, tachycardia, pericardial friction rub,
Name (a) at least one example of an autoimmune disease that affects the heart and (b) the component of the heart affected
Systemic autoimmune diseases can involve the heart. Lupus causes fibrinous pericarditis, endocarditis and myocarditis. Scleroderma/systemic sclerosis causes small artery inflammation leading to infarcts and subsequent fibrosis/sclerosis (repair). Rheumatoid arthritis causes granulomatous inflammation that is centrally necrotic. Polyarteritis nodosa cuases necrotizing arteritis leading to myocardial ischemia and arrhythmias.
lab testing for autoimmune diseases
antinuclear antibody and anti-neutrophil cytoplasmic antibody test for collagen vascular and connective tissue diseases
Name the key histologic finding in sarcoid involvement of the heart
Systemic non-caseating (non-necrotizing) granulomatous disease (idiopathic) with multinucleated giant cell macrophages and lymphocyte infiltration. Patients can have granuloma in heart (left ventricle), but few have symptoms of heart involvement. May have ACE elevation but ANA and RF are negative
Name a medication associated with toxic myopathy
Adriamycin (doxorubicin-anthracycline) is a chemo drug that has a cumulative dose dependent toxicity on muscle
List other non-medication associated toxins
Ethanol (metabolite acetaldehyde) if person gets most of their calories from ethanol. Also cobalt, exogenous or in some forms of artificial hips
Name a glycogen storage disease associated with heart disease
Pompe disease: An acid maltase deficiency results in glycogen accumulation within lysosomes of myocytes. Results in energy deficits.
Name an iron metabolism disease associated with heart and other organ system disease and the gene responsible
Hemochromatosis: Increased iron storage in cardiac myocytes most commonly from HFE gene which is mutated (inactivated) thus there is increased transferrin uptake. Also could be due to mutations in transferrin receptor 2, Hemojuvelin, Hepcidin genes. This disease causes dilated cardiomyopathy with impairment of contractility, and variable involvement of other organs (pituitary, liver, skin, pancreas)
Hemosiderosis
Secondary hemochromatosis: red cell break down results in iron deposition or excess iron intake results in iron deposition, eventually in the heart
Name the disease process where proteins deposit as beta-pleated sheets around blood vessels and in the parenchyma of heart and other organs
Amyloidosis: involves heart, kidneys, nerves, liver, spleen, bone marrow. Can be systemic or local. Systemic includes MGUS (primary amyloidosis with Ig LC deposited in tissues), Rheumatoid arthritis (secondary, acute phase protein)
Name at least one dystrophy process that involves the heart
Duchenne and Becker muscular dystrophy: Duchenne has NO dystrophin expression. Becker has reduced dystrophin expression. Long term there is loss of cardiomyocytes
Name the form of “Cardiomyopathy” (dilated / restrictive / hypertrophic) associated with a. Dystrophin mutations
b. Myosin heavy chain mutationsName the form of “Cardiomyopathy” (dilated / restrictive / hypertrophic) associated with a. Dystrophin mutations
b. Myosin heavy chain mutations
Dystrophin mutations: dilated cardiomyopathy. Myosin HC mutations: hypertrophic cardiomyopathy
Name possible incidents resulting in traumatic injury to the heart
Blunt trauma(resulting in myocardial damage, arrhythmias, conduction defects, cardiogenic shock and hemopericardium -cardiac tamponade), radiation trauma (resulting in fibrosis and restrictive cardiomyopathy), commotio cordis (blow to chest resulting in cardiac arrest)
Name possible sequela of trauma to the heart resulting in: a. Contusion
b. Coronary artery tear or thrombosis
c. Ventricular rupture
d. Aortic rupture
Contusion(bruise): Focal injury to heart. Can also lacerate the heart depending on whether heart is in systole or diastole. Coronary artery tear or thrombosis: Can cause MI. Ventricular rupture: from focal injury during diastole. Aortic rupture: Causes hemopericardium with potential for tamponade.
Describe arrhythmogenic right ventricular cariomyopathy
Right ventricle is composed mainly of adipose and connective tissue, with minimal muscle. Results in right ventricular failure, rhythm alterations (Vtach and Vfib)
Myxoma: name (a) the most common location and (b) complications
Myxoma is neoplasm of mesodermal tissue. Most common in left atrium and complications include embolization (fragments of neoplasm or thrombus associated with mass), mitral valve obstruction
Trauma: what is the name applied when a baseball / hockey puck / punch to the chest results in cardiac arrest and (usually death) (causing a commotion!)
Commotio cordis: Occurs at a vulnerable palce in ventricular rhythm resulting in cardiac arrest.
