Non-ischaemic Heart disease Flashcards
what is cardiomyopathy?
any disease of the cardiac muscle
what does cardiomyopathy odten result in?
changes in SIZE of heart chambers and THICKNESS of heart
what are the 3 types of cardiomyopathy?
1) dilated
2) hypertrophic
3) restrictive
what is dilate cardiomyopathy?
= heart is expanded and therefore cannot pump blood effectively as it becomes weaker
- big heart = 2 or 3 times normal
- heart is flabby & floppy
what are the causes of dilated cardiomyopathy?
1) genetics
2) toxins
3) alcohol
4) chemotherapy agents
e. g. doxorubicin
Rarer;
5) cardiac infection
6) pregnancy
what are 4 features of dilated cardiomyopathy?
1) general picture of heart failure
2) shortness of breath
3) poor exercise tolerance
4) low ejection fraction ( low CO)
what is hypertrophic cardiomyopathy?
= big solid hearts.
= portion of the heart becomes thickened
= hypertrophic and strong contractions (doesn’t dilate, it gets bigger - very thick left ventricle)
what can hypertrophic cardiomyopathy result in?
diastolic dysfunction
= as the heart cannot relax
= eventually causing outflow obstruction
= sudden death in athletes
Yes or No.
In hypertrophic cardiomyopathy, is systolic contraction affected?
no - systolic contraction is fine, it is only diastolic dysfunction
what causes hypertrophic myopathy?
- majority is genetic
e.g. genes that create actin and myosin
= beta myosin heavy chain
= myosin binding protein C
= alpha tropomyosin
what are 3 features of hypertrophic cardiomyopathy?
1) building inter ventricular septum
2) LV luminal reduction
3) outflow tract obstruction
in hypertrophic cardiomyopahty, what would you see on a microscope of the myofibrils?
disorganised myo-fibres
what does restrictive cardiomyopathy cause?
- a LACK OF COMPLIANCE causes a STIFF HEART so the heart doesn’t relax during systole
- therefore, heart doesn’t fit well so diastolic dysfunction
Yes or No.
Can the heart appear normal in restrictive cardiomyopathy?
yes.
what causes restrictive cardiomyopathy?
= deposition of something in myocardium Examples; - metabolic byproducts, iron. - amyloid. - sarcoid = multi system granulomatous disorder. - tumours. - fibrosis
what is amyloidosis?
abnormal deposition of an abnormal protein
in amyloid, what is the tendency of the abnormal depositions to form?
tendency to form beta pleated sheets
what are the 6 classifications of amyloid?
1) AA
- relates to chronic diseases e.g. rheumatoid
2) AL
- light chains, abnormal immunoglobulin
3) haemo-dialysis associated beta 2 micro globulin
4) familial forms
5) diabetes
6) Alzheimer’s
under a microscope, what would an amyloid look like?
- waxy pink material
- stains positively for Congo red
- exhibits apple green birefringence
what does amyloid resemble?
restrictive cardiomyopathy
what is arrhythmogenic right ventricular dysplasia?
= genetic disease
- when fat replaces the right ventricle - prone to arrhythmias and therefore sudden death.
what is myocarditis?
inflammation of heart that can be infectious or non-infectious
what is infectious myocarditis most commonly caused by?
- viruses
e
= coxsackie A&B
= ECHO virus - bacterial
- fungal
- protozoal
- helminntthic
in infectious myocarditis, what happens to the myocardium?
it is thickened
what is non-infectious myocarditis caused by?
= immune mediated hypersensitivity reactions
e. g. hypersensitivity to infection, rheumatoid fever after strep sore throat
e. g. hypersensitivity to drugs, eosinophils myocarditis
e. g. systemic lupus erythematosus (SLE)
what is rheumatoid fever classically indicated by?
- mitral stenos with thickening and fusion of valve leaflets
- short thick chordae tensile
- myocardium is patchily inflamed
what is pericarditis?
= inflammation of pericardial layers
what causes pericarditis?
What does tuberculous pericarditis produce?
- infection
- immune mediated (rheumatoid fever)
- idiopathic
- uraemia (renal failure)
- post MI
- connective tissue disease
= produces constrictive pericarditis
what are 5 possible complications of pericarditis?
1) pericardial effusion
2) tamponade
3) constrictive pericarditis
4) cardiac failure
5) death
what is endocarditis?
= affects heart lining but refers to INFLAMMATION OF VALVES
who is at risk of getting infectious endocarditis?
- IV drug abusers
- individuals with septicaemia
what 5 organisms can be the cause of endocarditis?
and
what 2 organisms can be the cause of endocarditis in IV drugs users?
HACEK
- haemophilia
- actinobacillus
- cardiobacteria
- eikenella
- kingella
IV drug users;
- candida
- staph aureus
what are 5 cardiac complications?
1) acute valvular incompetence
2) high output cardiac failure
3) abscess
4) fistula
5) pericarditis
what is non-bacterial thrombotic endocarditis?
- non- invasive
- doesn’t destroy valves
- Can cause embolic disease
- Assoc with cancer
- associated with mucinous adenocarinomas
what is lupus?
= long-term autoimmune disease in which the body’s immune system becomes hyperactive and attacks normal, healthy tissue.
what is carcinomas heart disease?
= carcinoid tumours, neoplasms of neuroendocrine cells found in any mucosa
when does carcinoid syndrome occurs?
occurs when tumour has spread to liver, metastases
what does carcinoid heart disease & carcinoid syndrome produce as a result of the tumour?
what are the symptoms of carcinoid heart disease & carcinoid syndrome?
- 5HIAA
- serotonin
- histamine
- bradykinin
- flushing of skin
- nausea
- vomiting
- diarrhoea
- systemic fever
- malaise
what does carcinoid heart disease produce?
= right sided cardiac valve disease affecting tricuspid and pulmonary valves.
are primary tumour in heart common?
NO - very rare
what type of differentiation are cardiac muscle cells?
end differentiated
what is atrial myxoma?
cancer in the atria
what can atrial myxoma cause?
= ball/valve obstruction
= tumour emboli
= develop endocarditis
