Myocardial pathology Flashcards by A B

layers of heart

Deep to outer
1) endothelium

2) myocardium
3) visceral pericardium

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anterior layer of heart

LAD artery visible in pericardium

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characteristics of normal cardiac muscle

1) rich vascularity
2) minimal supporting connective tissue
3) cytoplasmic branches
4) distinct sarcomeric pattern

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Parts of sarcomere

1) light chain - attach to z disk

2) heavy chain - btwn light chains

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Z-disk proteins

1) alpha actinin
2) myotillin
3) filamin C
4) ZASP
5) telethonin

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Parts of heavy chain in sarcomere

1) myosin

2 isoforms = fast and slow twitch

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parts of light chain in sarcomere

1) actin
2) troponin T = Troponin-linking
3) troponin I = inhib ATPase
4) troponin C = Ca2+ binding
5) nebulin
6) tropomyosin 2,3

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define cardiac myxoma

1) benign neoplasm
MOST COMMON PRIMARY TUMOR OF HEART IN TEEN + ADULT

2) frequency= rare
3) location = MAINLY LA

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patient population with cardiac myxoma

teen

adult

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structure of cardiac myxoma

1) pedunculated or sessile mass

2) ball-valve obstruction and damage

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most common valve involved in cardiac myxoma

mitral valve

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dangers of cardiac myxoma

frags can embolize into systemic circulation and lodge in brain/kidney

–> syncope/sudden death

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Other primary neoplasms in heart

1) lipoma (benign)
2) rhabdomyoma (benign)
3) angiosarcoma (malignant

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define rhabdomyoma

benign neoplasm

made of skeletal muscle cells

MOST COMMON PRIMARY CARDIAC TUMOR OF INFANCY/CHILDHOOD

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define angiosarcoma

malignant

tumor of blood vessels

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define thrombus

blood clot

mass in heart

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possible cardiac metastases of breast cancer

metastasis of leukemias and lymphomas

1) inside of heart (conduction prblems)
2) pericardium (restrictive pericarditis)

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causes of infectious myocarditis

1) viral
2) bacterial
3) fungal
4) parasitic

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define viral myocarditis

inflammation (lymphocytes) injury to myocardium

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common viral causes of viral myocarditis

coxsackie A or B

enteroviruses

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types of parasitic myocarditis

tricinosis (trichinella)

chagas disease (trypanosoma cruzi)

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define trichinosis

caused by raw pork, game animal

most common in skeletal muscle

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define chagas disease

trypanosoma cruzi (biting fly)

over time, immune system attacks

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fungal myocarditis

most common in which type of patients

mostly immunocompromised

such as with chemo and steroids

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define autoimmune diseases (collagen vascular disease/connective tissue disease)

systemic autoimmune disease affect many organs

examples of systemic autoimmune disease

1) SLE 2) scleroderma 3) systemic sclerosis 4) rheumatoid arthritis

organ-specific autoimmune disease lung and kidney

goodpasture

organ-specific autoimmune disease RBC

autoimmune hemolytic anemia

organ-specific autoimmune disease thyroid

graves disease

if heart involved, then usually systemic autoimmune

involves pericardium, myocardium, endocardium --> heart blood vessel attack = vasculitis --> small infarcts

define vasculitis

heart blood vessel attack

define toxic effects on heart

vary amongst patients some sensitive/some not

if patient not sensitive to toxic effect that means ____

idiosyncratic

medications for toxic metabolic diseases

adriamycin = chemo drug for cumulative dose-dependent toxicity

exogenous substances that can cause toxic disease

ethanol (or metabolite acetaldehyde) cobalt from artificial joint prosthesies

define hemochromatosis

inherited excess iron in muscle

hemochromatosis on stain

lipofuscin pigment (wear and tear) does not stain with iron

define amyloidosis

protein deposit as "beta pleated sheats" or immunoglobulin light chain

example of amyloidosis involving laying down beta pleated sheet proteins

multiple myeloma = plasma cell neoplasm/dyscrasia

example of amyloidosis involving immunoglobulin light chain (k, gamma)

amyloid P trasthyretin/prealbumin

genetics of amyloidosis

MOST CASES SPORADIC

symptomatic effects of amyloidosis on organs

wax-like ``` heart kidney nerves liver spleen ```

amyloidosis on stain

cardiomyocytes separated by fibrosis + AMORPHOUS (AMYLOID) material

special stains for amyloidosis

1) congo red 2) congo red stain polarized LOOK FOR AMYLOIDOSIS NOT SPECIFIC FOR PROTEIN

what does congo red stain visualize as?

salmon orange color of amyloid

what does congo red stain polarized visualize as

amyloid = "granny apple green" | birefringence

define= systemic metabolic disease

disease affect muscle (glycogen storage + muscular dystrophy) include cardiac

define cardiomyopathy

primary abnormality in myocardium (myofiber) EXCLUDE SECONDARY CAUSES

examples of secondary cardiomyopathy EXCLUDED FROM CARDIOMYOPATHY

1) ischemia 2) hypertensive disease 3) valve assoc abnormality

clinical effects of cardiomyopathy

electrical and mech dysfunction

mechanism of dilated cardiomyopathy

impaired contractility (systolic dysfunction) because heart is so thick --> can cause stasis of blood

mechanism of hypertrophic cardiomyopathy

impaired compliance and diastolic relax (diastolic dysfunction)

mechanism of restrictive cardiomyopathy

impaired complaince stiff LV with impaired diastolic relaxation (diastolic dysfunction) because so stiff normal systolic fxn

Mechanism of myocyte hyperrophy causing cardiac dysfunction

1) HTN, valvular disease, MI 2) incr cardiac work 3) incr wall stress 4) cell stretch 5) hypertrophy/dilation 6) cardiac dysfunction

reason why HTN causes myocyte hypertrophy

pressure overload

reason why valvular disease causes myocyte hypertrophy

pressure +/- volume overload

reason why MI causes myocyte hypertrophy

regional dysfunction + volume overload

microscopic appearance of dilated cardiomyopathy

nonspecifc changes

complications of dilatedd cardiomyopathy

mural thrombus form systemic emboli dysarrhythmia big/dilated heart (thick walls)

causes of DCM

1) genetic 2) infectious 3) alcoholic 4) peripartum

causes of HCM and murmur

100% genetic systolic murmur loudest at left sternal border + mitral regurg

effect of hypertrophic cardiomyopathy on heart strxr

THICK IV SEPTUM bulge in LV outflow tract during early systole outflow obstruction of aortic valve anterior leaflet of mitral valve impinge on septal wall during systole

type of murmur in HCM

ejection murmur

complications of HCM

sudden death

pathologic change in HCM

hypertrophy + disarray of fibers

restrictive cardiomyopathy inheritance

ACQUIRED NOT GENTIC

causes of restrictive cardiomyoapthy

1) amyloid deposition radiation induced fibrosis scleroderma hemochromatosis