Myocardial pathology

Question 1

most common primary cardiac neoplasms in

(a) infants/children
(b) teens/adults

Answer 1

(a) infants/children: Rhabdomyoma (benign)

(b) teens/adults: Cardiac myxoma
- Most common primary tumor of heart in teens and adults

Question 2

Location of Cardiac Myxoma:

Answer 2

Mitral valve (LA»RA)

Question 3

types of virus that may infect the myocardium

Answer 3

Coxsackivirus
ECHO
Influenza
HIV
cytomegalo

Question 4

types of bacteria that may infect the myocardium

Answer 4

chlamydia

rickettsiae

Question 5

Viral myocarditis:

Answer 5

• Inflammation (mostly lymphocytes) with injury to the myocardium
  
  • Typical viral causes are coxsackievirus A or B or other enteroviruses

Question 6

Parasitic Myocarditis

Answer 6

• More common is Chagas Disease (Trypanosoma cruzi)

* Trichinosis (mostly in skeletal muscle, but possible in heart)

Question 7

autoimmune disease that may affect the heart

Answer 7

• Collagen vascular diseases (CVD or
Connective Tissue Disease (CTDs)
• Lupus, scleroderma, RA

Question 8

Name one medication associated with toxic cardiomyopathy and
one non-medication substance associated with toxic cardiomyopathy.

Answer 8

• Adriamycin (medication) - Chemotherapeutic drug
○ Cumulative dose-dependent toxicity
• Cobalt (non medication)- metal joints, get shed into systemic system

*note: Toxic metabolic disease: Toxic A. “Toxic” Effects: Some agents have toxic effects on muscle

Question 9

Hemochromatosis

Answer 9

Issues with excess iron
Typically have more organs involved

Final cause of death could be heart failure

Question 10

Amyloidosis Most common disease association

Answer 10

plasma cell neoplasm (multiple myeloma)

• Plasma cell leukemia pumping out Ab and light chains
  
  • -> Condense and deposit into cells –> restrictive cardiomyopathy

note: salmon stain + birefringence

Question 11

LV EJ %:

• Dilated
• Hypertrophic
• Restrictive

Answer 11

• Dilated: <40%
• Hypertrophic: 50-80%
• Restrictive: 45-90%

Question 12

• Dilated
• Hypertrophic
• Restrictive
  Mechanism of HF

Answer 12

• Dilated: impairment of contractility (systolic dys)
• Hypertrophic: impairment of compliance (diastolic dys)
• Restrictive: impairment of compliance (diastolic dys)

Question 13

Causes of these cardiomyopathy:

• Dilated
• Hypertrophic
• Restrictive

Answer 13

• Dilated: idiopathic, alcohol, peripartum, myocarditis, hemochromatosis, chronic anemia, sarcoidosis
• Hypertrophic: Freidreich ataxia, storage diseases, infants of diabetic mothers
• Restrictive: amyloidosis, radiation induced fibrosis

Question 14

Complications of dilated cardiomyopathy

Answer 14

Mural thrombus formation (in apex or LA appendage )!
○ Systemic embolization
○ Arrhythmia