Non Ischaemic Heart Disease Flashcards
Define Cardiomyopathy
any disease of the cardiac muscle that often results in changes in the size of the heart chambers
What are the three classifications of cardiomyopathy?
dilated, hypertrophic, restrictive
What are the characteristics of hypertrophic cardiomyopathy?
thickened left ventricle, big solid heart
diastolic dysfunction, heart can contract but cannot relax as well as it should so eventually causes outflow obstruction
What is a cause of sudden death in young athletes?
hypertropic cardiomyopathy
What does hypertrophic cardiomyopathy cause?
arrhythmias because the hearts normal function is altered
What is the histological appearance of hypertrophic cardiomyopathy?
disorganised myofibrils
What are the causes of hypertrophic cardiomyopathy?
genetic – myosin binding to protein C, beta myosin heavy chain, alpha tropomyosin
What are the characteristics of dilated cardiomyopathy?
weak, floppy and flabby heart
2-3 times normal weight
What are the causes of dilated cardiomyopathy?
genetic cause - genes that encode heart muscle proteins alcohol – toxic effect of ethanol on the myocardium, people who have undergone toxic chemotherapy.
Rare causes – cardiac infection and pregnancy
What are the clinical features of dilated cardiomyopathy?
- general picture of heart failure
What are the characteristics of restrictive cardiomyopathy?
- lack of compliance (relaxation of the heart during diastole)
- rigid, stiff heart so it doesn’t fill with blood well so creates a diastolic dysfunction
What are the causes of restrictive cardiomyopathy?
- deposition of something in the myocardium
- metabolic byproducts (iron)
- amyloidosis
- sarcoidosis
- tumours
- fibrosis
What do you see in restrictive cardiomyopathy and why?
bilateral dilatation as a result of pressure
What is the histological appearance of restrictive cardiomyopathy?
waxy pink material – green apple birefringence, stains positively for congo red
abnormal deposition of an abnormal protein (amyloid)
AMYLOID IS PANSYSTEMIC
What is Arrythmogenic right ventricular dysplasia?
abnormality of the right ventricle and atrium due to accumulation of abnormal adipose tissue within the myocardium
What is myocarditis?
Inflammation of the heart
What is infectious myocarditis due to?
viral, bacterial, fungal, protozoal and helminthic
– echo virus and caxackie A and B
MOST COMMONLY INFECTIOUS
What is non infectious myocarditis due to?
immune mediated hypersensitivity disorders (rheumatic fever)
What is Rheumatic fever and what is is histological appearance?
mitral stenosis, with thickening and fusion to heart valve leaflets (short thick chordae tendonae).
Histoloicaly – aschoff bodies
What is pericarditis?
Inflammation of pericardial layers
What causes pericarditis?
infection immune mediated (rheumatic fever) idiopathic uraemic (renal failure) post M.I (dressler’s syndrome) connective tissue disease
What causes infectious endocarditis? And where is it caused?
occurs on normal valves but normally abnormal
- requires a very virulent organism, bacterial or fungal – IV drugs abuse and septicaemia
What causes infectious pericarditis?
Esp ECHO virus bacterial (extend from elsewhere – pneumonia, purulent effusions) fungi (immunosuppressed pts post transplant produce purulent effusions tuberculosis (caseous material in sac)
What are the complications of pericarditis?
pericardial effusions tamponade constrictive pericarditis cardiac failure death
What is endocarditis?
Inflammation of the inside of the heart (generally refers to inflammation of the valves)
What is the pathology of endocarditis?
Aggregates of organism on heart valves called vegetations
Appear to erode the heart valve
What are the causes of non infectious endocarditis?
non bacterial thrombotic endocarditis (don’t destroy the valves they just get smaller, associated with cancer)
Lupus – small sterile emboli, often asymptomatic
What are the cardiac complications of endocarditis?
acute valvular incompetence
high output cardiac failure
What are the characteristics of Carcinoid Heart disease?
neoplasms, high amounts of 5HIAA, secreted from the tumour, affects the right side of the heart
What is the most common cardiac tumour?
atrial myxoma - usually left atrium, will cause an obstruction and may cause endocarditis, systemic fever and malaise
