Non Ischaemic Myocardial Disease Flashcards
What is cardiomyopathy?
Any disease of the cardiac muscle. Slide 4
What can cardiomyopathy be classified into?
Dilated
Hypertrophic
Restrictive
Slide 5
What is dilated cardiomyopathy?
A big heart, usually 2/3 times normal.
The heart is flabby and floppy. Slide 7
What causes dilated cardiomyopathy?
50% Genetics Toxins Excessive alcohol Chemotherapy agents. Cardiac infection (rare) Pregnancy (rare) Slide 9-11
What does dilated cardiomyopathy present clinically?
Usually the general picture of heart failure. SOB Poor exercise tolerance Low cardiac output. Slide 13
What is hypertrophic cardiomyopathy and what are the causes?
Big solid hearts with disorganised myofibers.
They are hypertrophic and contract fine.
However they have diastolic dysfunction as the heart cannot relax.
Genetic causes e.g. myosin binding protein C. Slide 13, 14+16
What is restrictive cardiomyopathy?
There is a lack of compliance due to the stiffness of the heart.
Diastolic dysfunction
Often looks normal. Slide 17
What are causes of restrictive cardiomyopathy?
Can need a biopsy. Deposition of something in the myocardium. Metabolic byproducts e.g. iron Amyloid Sarcoid Tumours Slide 17+19
What is amyloid?
Abnormal deposition of an abnormal protein in beta sheets where the body cannot get rid of them.
Slide 20
Histologically, what does amyloid look like and how can it be detected?
It is a waxy pink.
Stains positively for Congo Red stain and then put under polarised light and turns apple green. Slide 23
What is Arrhythmogenic Right Ventricular Dysplasia?
A genetic disease with syncope and arrhythmias and can result in sudden death.
It is when the right ventricle becomes replaced by fat and big and floppy. Slide 26+27
What does infectious myocarditis look like and what are causes of it?
Thickened ‘beefy’ myocardium
Most causes are viral:
Coxsackie A and B
ECHO virus
Lyme’s disease
HIV
Chaga’s disease from S. America. Slide 31+32
What are causes of non infectious myocarditis?
Hypersensitivity to infection - Rheumatic fever
Hypersensitivity to drugs - eosinophilic myocarditis.
SLE. Slide 34
What is a sign of rheumatic fever histology?
Aschoff bodies
Slide 36
What is pericarditis and what are causes?
Inflammation of pericardial layers. Causes: Infection Immune mediated (rheumatic fever) Idopathic Renal favour Slide 37
What are complications of pericarditis?
Pericardial effusions
Tamponade
Constrictive pericarditis. Slide 43
What organisms could cause endocarditis, where does it usually involve and how do the organisms aggregate?
It usually occurs on the valves.
THey aggregate in vegetations on the valves.
Haemophilus, actinobacillus, cardiobacteria, eikenella, kingella (HACEK)
For IV drug users:
Candida, staph aureus.
Prosthetic valves: S. epidermidis. Slide 46-48
What systemic manifestations can occur from endocarditis?
Oslers nodes Janeway lesions Roth spots Splinter Haemorrhages Septicaemia Septic emboli Mycotic aneurysms. Slide 54
What are causes of non infectious endocarditis?
Rheumatic fever
SLE
Non bacterial thrombotic endocarditis (marantic)
Slide 56
What is non-bacterial thrombotic endocarditis?
NBTE
Small and multiple vegetations that don’t destroy heart valves.
Can cause embolic disease and are associated with cancer. Slide 57
How can lupus cause endocarditis?
Libman sacks endocarditis
Small sterile emboli on undersurfaces of valves or on chords. Slide 59
What is carcinoid heart disease?
Carcinoid tumours are neoplasms of neuroendocrine cells.
Slide 61
What are signs and symptoms of carcinoid heart disease?
Excess serotonin, histamine, bradykinin produced by tumour.
Flushing
Nausea, D+V
Produces right sided cardiac valve disease. Slide 62
What is an example of a tumour of the heart?
Atrial myxoma
Most common but still very rare
Is benign and can cause obstruction of the valves. Slide 65
