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SPR2015_Week2 > Myocardial pathology > Flashcards

Myocardial pathology Flashcards

1
Q

layers of heart

A

Deep to outer
1) endothelium

2) myocardium
3) visceral pericardium

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2
Q

anterior layer of heart

A

LAD artery visible in pericardium

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3
Q

characteristics of normal cardiac muscle

A

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

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4
Q

Parts of sarcomere

A

1) light chain - attach to z disk

2) heavy chain - btwn light chains

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5
Q

Z-disk proteins

A

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

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6
Q

Parts of heavy chain in sarcomere

A

1) myosin

2 isoforms = fast and slow twitch

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7
Q

parts of light chain in sarcomere

A

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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8
Q

define cardiac myxoma

A

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

2) frequency= rare
3) location = MAINLY LA

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9
Q

patient population with cardiac myxoma

A

teen

adult

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10
Q

structure of cardiac myxoma

A

1) pedunculated or sessile mass

2) ball-valve obstruction and damage

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11
Q

most common valve involved in cardiac myxoma

A

mitral valve

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12
Q

dangers of cardiac myxoma

A

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

–> syncope/sudden death

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13
Q

Other primary neoplasms in heart

A

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

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14
Q

define rhabdomyoma

A

benign neoplasm

made of skeletal muscle cells

MOST COMMON PRIMARY CARDIAC TUMOR OF INFANCY/CHILDHOOD

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15
Q

define angiosarcoma

A

malignant

tumor of blood vessels

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16
Q

define thrombus

A

blood clot

mass in heart

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17
Q

possible cardiac metastases of breast cancer

A

metastasis of leukemias and lymphomas

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

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18
Q

causes of infectious myocarditis

A

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

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19
Q

define viral myocarditis

A

inflammation (lymphocytes) injury to myocardium

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20
Q

common viral causes of viral myocarditis

A

coxsackie A or B

enteroviruses

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21
Q

types of parasitic myocarditis

A

tricinosis (trichinella)

chagas disease (trypanosoma cruzi)

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22
Q

define trichinosis

A

caused by raw pork, game animal

most common in skeletal muscle

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23
Q

define chagas disease

A

trypanosoma cruzi (biting fly)

over time, immune system attacks

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24
Q

fungal myocarditis

most common in which type of patients

A

mostly immunocompromised

such as with chemo and steroids

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25
Q

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

A

systemic autoimmune disease affect many organs

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26
Q

examples of systemic autoimmune disease

A

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

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27
Q

organ-specific autoimmune disease

lung and kidney

A

goodpasture

28
Q

organ-specific autoimmune disease

RBC

A

autoimmune hemolytic anemia

29
Q

organ-specific autoimmune disease

thyroid

A

graves disease

30
Q

if heart involved, then usually systemic autoimmune

A

involves pericardium, myocardium, endocardium

–> heart blood vessel attack = vasculitis –> small infarcts

31
Q

define vasculitis

A

heart blood vessel attack

32
Q

define toxic effects on heart

A

vary amongst patients

some sensitive/some not

33
Q

if patient not sensitive to toxic effect that means ____

A

idiosyncratic

34
Q

medications for toxic metabolic diseases

A

adriamycin = chemo drug for cumulative dose-dependent toxicity

35
Q

exogenous substances that can cause toxic disease

A

ethanol (or metabolite acetaldehyde)

cobalt from artificial joint prosthesies

36
Q

define hemochromatosis

A

inherited excess iron in muscle

37
Q

hemochromatosis on stain

A

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

38
Q

define amyloidosis

A

protein deposit as “beta pleated sheats”

or immunoglobulin light chain

39
Q

example of amyloidosis involving laying down beta pleated sheet proteins

A

multiple myeloma = plasma cell neoplasm/dyscrasia

40
Q

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

A

amyloid P

trasthyretin/prealbumin

41
Q

genetics of amyloidosis

A

MOST CASES SPORADIC

42
Q

symptomatic effects of amyloidosis on organs

A

wax-like

heart
kidney
nerves
liver
spleen
43
Q

amyloidosis on stain

A

cardiomyocytes separated by fibrosis + AMORPHOUS (AMYLOID) material

44
Q

special stains for amyloidosis

A

1) congo red
2) congo red stain polarized

LOOK FOR AMYLOIDOSIS NOT SPECIFIC FOR PROTEIN

45
Q

what does congo red stain visualize as?

A

salmon orange color of amyloid

46
Q

what does congo red stain polarized visualize as

A

amyloid = “granny apple green”

birefringence

47
Q

define= systemic metabolic disease

A

disease affect muscle (glycogen storage + muscular dystrophy)

include cardiac

48
Q

define cardiomyopathy

A

primary abnormality in myocardium (myofiber)

EXCLUDE SECONDARY CAUSES

49
Q

examples of secondary cardiomyopathy

EXCLUDED FROM CARDIOMYOPATHY

A

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

50
Q

clinical effects of cardiomyopathy

A

electrical and mech dysfunction

51
Q

mechanism of dilated cardiomyopathy

A

impaired contractility (systolic dysfunction)

because heart is so thick –> can cause stasis of blood

52
Q

mechanism of hypertrophic cardiomyopathy

A

impaired compliance and diastolic relax (diastolic dysfunction)

53
Q

mechanism of restrictive cardiomyopathy

A

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

normal systolic fxn

54
Q

Mechanism of myocyte hyperrophy causing cardiac dysfunction

A

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

55
Q

reason why HTN causes myocyte hypertrophy

A

pressure overload

56
Q

reason why valvular disease causes myocyte hypertrophy

A

pressure +/- volume overload

57
Q

reason why MI causes myocyte hypertrophy

A

regional dysfunction + volume overload

58
Q

microscopic appearance of dilated cardiomyopathy

A

nonspecifc changes

59
Q

complications of dilatedd cardiomyopathy

A

mural thrombus form

systemic emboli

dysarrhythmia

big/dilated heart (thick walls)

60
Q

causes of DCM

A

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

61
Q

causes of HCM and murmur

A

100% genetic

systolic murmur loudest at left sternal border + mitral regurg

62
Q

effect of hypertrophic cardiomyopathy on heart strxr

A

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

63
Q

type of murmur in HCM

A

ejection murmur

64
Q

complications of HCM

A

sudden death

65
Q

pathologic change in HCM

A

hypertrophy + disarray of fibers

66
Q

restrictive cardiomyopathy inheritance

A

ACQUIRED NOT GENTIC

67
Q

causes of restrictive cardiomyoapthy

A

1) amyloid deposition

radiation induced fibrosis

scleroderma

hemochromatosis

SPR2015_Week2 (19 decks)

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