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Cardiovascular Module > Myocarditis > Flashcards

Myocarditis Flashcards

1
Q

Myocarditis definition

A

Inflammatory condition of the heart

Inflammatory infiltrate of the myocardium with necrosis and degeneration of adjacent myocytes (not due to ischemia )

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2
Q

Classification of myocarditis

A

Acute
Resolving
Resolved

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3
Q

Acute myocarditis

A

Inflammatory infiltrate and necrosis of adjacent myocytes

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4
Q

Ongoing myocarditis

A

Degree of myocarditis unchanged from previous biopsy

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5
Q

Resolving myocarditis

A

Reduction or inflammatory cell infiltrate

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6
Q

Resolved myocarditis

A

Very little or no evidence of inflammation.

Fibrosis may be extensive

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7
Q

Myocarditis etiology

A

Infective
Idiopathic
Immune mediated
Miscellaneous

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8
Q

Infective myocarditis

A

Bacteria (diphtheria, neisseira)

Ricketssial

Viral (cockackie, echo…)

Protozoaires

Parasitic

Fungal

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9
Q

Most common cause of myocarditis

A

Infective myocarditis

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10
Q

Most common cause of infective myocarditis

A

Coxackie

Entero virus

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11
Q

Idiopathic myocarditis

A

Diffuse
Interstitial
Granulomatous

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12
Q

Immune mediated myocarditis

A 
Rheumatic fever 
Rheumatoid arthritis 
Lupus erythematosus
Polyarteritis nodosa 
Dermatomyositis
Drugs (sulfonamides , a methyldopa)
Transplant rejection
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13
Q

Miscellaneous myocarditis

A 
Trauma 
Irradiation 
Chemical agent 
Drugs 
Uraemia
Hypokalemia
Others
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14
Q

Viral myocarditis pathogenesis

A

Initial viral infection elsewhere
Few weeks later heart affected

First mechanism :
Direct viral cytotoxicity
Death of my sites with inflammation
Infrequent

2nd mechanism :
T cell dependence mechanism
Initial myocardial or extra cardiac infection
Clearance of infection by monocytes and humoral immune system
Immunologic phase with t lymphocytes against Antigens from the virus-myocardial interaction or cross reaction with viral antigen apart of heart

3rd mechanism:
Bacterial toxins leading to inflammation

4rth mechanism :
Immune mediated reaction dragons used or autoimmune disease causing inflammation

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15
Q

Primary myocarditis

A

When myocardium is the only site or major focus of viral infection

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16
Q

Majority of viral myocarditis due to what type of virus

A

Enterovirus group

especially Group B Coxsackie virus (more than half)

17
Q

How do you demonstrate that there is a viral infection leading to myocarditis

A

Evidence of viral infection based on rising or high serum antibody titres to the virus

18
Q

Viral myocarditis morphology

A

Interstitial edema
Mononuclear cell infiltration (lymphocytes)
Focal necrosis of myocytes adjacent to inflammatory cells

19
Q

When do you have suppurative myocarditis

A

Pyogenic bacteria

20
Q

Bacterial myocarditis morphology

A

Cardiac hypertrophy and dilatation
Pale flabby myocardium

Localised abscess I’m Steph aureus
Spreading infection with necrosis strep pyogenes

Granulomatous inflammation of myocardium in tuberculosis , tularaemia, brucellosis
Tuberculous myocarditis rare (nodular, miliary, diffuse infiltrative types)

21
Q

Fungal myocarditis occurs in

A

Immunosuppresseur individuals

22
Q

Main fungus involved in fungal myocarditis

A

Candida

Aspergillus

23
Q

Fungal myocarditis morphology please

A

White to yellow nodules up to 15mm in diameter
Microcolonies of radially arranged pseudohyphae
Microabscesses
Chronic inflammatory cells

24
Q

Aspergillus myocarditis

A

Fibrinopurulent infiltrate in the endocardium with necrosis and inflammation in myocardium

25
Q

Protozoal myocarditis population at risk

A

Toxoplasmosis in immunocompromised

26
Q

Organs damaged in protozoal myocarditis

A

Brain and heart

27
Q

Findings in protozoal myocarditis il

A

Paeudocysts with Bradyzoites/ macrophages

Tachyzoites

28
Q

Metazoal myocarditis

A

Patchy interstitial myocarditis
Many neutrophils
Many giant cells

Eosinophilic myocarditis in onchocerca volvulus

29
Q

Toxic myocarditis morphology

A

Numerous small foci of coagulative necrosis surrounded by macrophages, lymphocytes, neutrophils

Necrotic fibres replaced by small fibrous scars

30
Q

Adriamycin cardiotoxicity characteristics

A

Myofibre swelling & vacuolisation

Fatty change

Myocytolysis

31
Q

Cyclophosphamide cardiotoxicity

A

Large areas of necrosis
Capillary thombosis
Considerable fibrosis

32
Q

Where do you find Granulomatous myocarditis

A

In patients with active sarcoidosis

33
Q

Idiopathic granulomatous myocarditis characteristics

A

Small and large granulomas without caseation

Macrophages 
Giant cells 
Foreign body 
Langhans 
Leucocytes
34
Q

Giant cell myocarditis second name

A

Fiedlers giant cell myocarditis

35
Q

Giant cell myocarditis morphology

A

Focal
Frequently extensive myocaradial necrosis
Multinucleate giant cells of myope if
Macrophages origin
Mixed infiltrate of eosinophils, lymphocytes, plasma cells, macrophages

36
Q

Allergic/hypersensitivity myocarditis morphology

A

Interstitial inflammatory infiltrate
Eosinophils
Mononuclear cells

Cardiovascular Module (21 decks)

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