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Cardiovascular 2018 > Non-Ischaemic Myocardial Disease > Flashcards

Non-Ischaemic Myocardial Disease Flashcards

1
Q

What is a cardiomyopathy

A

Any disease of the cardiac muscle that is not ischaemic, hypertensive

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2
Q

What changes may cardiomyopathy cause?

A

Changes in size of chamber walls

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3
Q

What are the four classifications of cardiomyopathy?

A

Dilated
Hypertrophic
Restrictive
Arrhythmogenic right ventricular dysplasia

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4
Q

Describe dilated cardiomyopathy?

A

Weak and flabby heart

Bigger than it should be may only be by 50g though

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5
Q

What are the histological features of dilated cardiomyopathy?

A

none

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6
Q

What are the causes of dilated cardiomyopathy?

A 
50% genetic
toxins
-alcohol
-doxorubicin (chemo)
cardiac infection
pregnancy
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7
Q

What are the clinical features of DCM?

A

General heart failure

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8
Q

Describe hypertrophic cardiomyopathy?

A

Big solid heart
Strong contraction
Heart doesn’t relax as it should

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9
Q

What does hypertrophic cardiomyopathy cause?

A

Outflow obstruction

Sudden death

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10
Q

What are the causes of HCM?

A

Genetic
Actin or myosin mutated genes
beta myosin heavy chain

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11
Q

What is the appearance of HCM?

A

RV and RA look normal
LA may be dilated
LV will be extraordinarily thick- normally 15mm, may be 4cm
Coronary Arteies are not increased and therefore there must be areas of relative hypoxia or ischaemic- possibly angina

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12
Q

What is the histology of HCM?

A

Myofibres will be disorganised (swirls-myofibre disarray) as opposed to linear

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13
Q

Describe restrictive cardiomyopathy?

A

Lack of compliance
Stiff heart
Doesn’t fill well- diastolic dysfunction
Can’t generate a sufficient stroke volume to generate BP
Bi-atrial dilatation as a result of back pressure

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14
Q

What does RCM look like histologically?

A

Normal

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15
Q

What are the causes of RCM?

A 
>Deposition of something in the myocardium 
>metabolic by-products (iron)
>amyloidosis
>sarcoidosis
>tumour
>fibrosis
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16
Q

Describe amyloidosis

A

o abnormal deposition of an abnormal protein throughout the body
o lots of different types of protein- lots of types of amyloid
o tendency to form beta-pleated sheets
o body cannot get rid of them

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17
Q

What kind of amyloidosis is isolated to the heart?

A

Senile cardiac amyloidosis

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18
Q

What kind of amyloidosis may be isolated to the atrium?

A

Abnormal atrial natriuretic protein

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19
Q

What is the appearance of amyloidosis on histology?

A

o waxy pink material
o eosinophilic
o exhibits apple green birefringence
o stains positively for Congo red

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20
Q

What does amyloid generally resemble?

A

RCM

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21
Q

What is arrhythmogenic right ventricular dysplasia?

A

> Right ventricle becomes largely replaced by fat

>Big and floppy

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22
Q

What does ARVD look like histologically?

A

only a tiny bit of myocardium and muscle is replaced by adipocytes

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23
Q

What is the cause of ARVD?

A

Genetic

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24
Q

What is myocarditis?

A

Inflammation of the heart

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25
Q

What are the types of myocarditis?

A

Infectious vs non infectious

Bacterial, viral, fungal, protozoal and helminthic

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26
Q

What is the most common type of myocarditis?

A

Infectious

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27
Q

What are the causes of infectious myocarditis?

A
  • Coxsakie A and B
  • ECHO virus
  • chaga’s disease- trypanosomiasis in S. America
  • borrelia burgdorferi- Lyme’s disease
  • HIV
28
Q

What does the myocardium look like in infectious myocarditis?

A

Thick and beefy

29
Q

What might you see on biopsy of infectious myocarditis?

A

Inflammatory infiltrate

30
Q

What are the causes of non-infectious myocarditis?

A

> Immune mediated hypersensitivity disorders
hypersensitivity to infection
hypersensitivity to drugs
SLE

31
Q

Describe hypersensitivity to infection in myocarditis?

A

rheumatic fever after strep sore throat
o classic mitral stenosis with thickening and fusion of valve leaflets
o short, thick chordae tendinae
o myocardium is also patchily inflamed
o fibrotic scarring will effect heart valves and give you mitral stenosis

32
Q

What will you see histologically in myocarditis caused by hypersensitivity to infection?

A

o histologically- aschoff bodies, central destructive region which peppers the heart valves

33
Q

What is pericarditis?

A

Inflammation of the pericardial layers

Outer layers of the heart become inflamed

34
Q

What are the causes of pericarditis?

A 
Infectin
Immune related
Idiopathic
Uraemic
Post MI
SLE
35
Q

What is post MI pericarditis?

A

Dressler’s syndrome

  • abnormal response to dead cells
  • many weeks post MI
36
Q

Which virus produces serious effusion in pericarditis?

A

ECHO

37
Q

What is the common cause of bacterial pericarditis?

A

extension from elsewhere, pneumonias, produce purulent effusions

38
Q

Who gets fungal pericarditis?

A

immunosuppressed pts, post-transplant (bone marrow for example), produce purulent effusions

39
Q

What are the complications of pericarditis?

A 
>pericardial effusion
>tamponade
>constrictive pericarditis
>cardiac failure
>death
40
Q

Describe constrictive pericarditis?

A
  • fibrotic response to inflammation on surface of the heart
  • wherever there is fibrosis there is collagen, which contracts and cause a contracture, strangling the heart from the inside
41
Q

What is endocarditis?

A

inflammation of the inside of the heart lining generally referring to the inflammation of the valves

42
Q

Where does infective endocarditis occur?

A

can occur at normal valves

43
Q

What does infective endocarditis usually require?

A

A very virulent organism

44
Q

What are the most common causes of infective endocarditis now?

A

prosthetic valves, congenital defects, bicuspid valves, MV prolapse, calcific disease in the elderly

45
Q

What are the HACEK organisms?

A

Organisms of endocarditis

  • haemophilus
  • aggregatibacter
  • cardiobacterium
  • eikenella corrodens
  • kingella king
46
Q

What is the pathology of IV drug users?

A

Right sided valves

47
Q

Which organism is common in prosthetic valves?

A

S. epidermidis

48
Q

What is a vegetation

A

aggregates of organisms on heart valves

49
Q

What are some common signs of endocarditis?

A
  • oslers nodes
  • janeway lesions
  • roth spots
  • splinter haemorrhages
  • septicaemia
50
Q

What is non-infectious endocarditis?

A

Marantic

51
Q

What is non-bacterial thrombotic endocarditis?

A

Smaller

52
Q

What is non-bacterial thrombotic endocarditis associated with?

A

cancers

o mucinous adenocarcinomas

53
Q

What is found on the valves in non-bacterial thrombotic endocarditis ?

A

Small and multiple vegetation

non-invasive and don’t destroy valves

54
Q

When is non-bacterial thrombotic endocarditis common?

A

In hyper-coagulable states

55
Q

What kind of endocarditis occurs in lupus?

A

Libman-sacks endocarditis

56
Q

What are the symptoms of Libman-sacks endocarditis?

A

Often asymptomatic

57
Q

What kind of emboli are found in Libman-sacks endocarditis?

A

Small sterile emboli

58
Q

What is carcinoid heart disease?

A

Neuroendocrine cancer

can see them in any mucosa- common in GI and lung

59
Q

Where do carcinoid tumours metastasise to?

A

The liver

60
Q

What kind of heart disease does carcinoid heart disease produce?

A

Right sided cardiac valve disease

Tricuspid and pulmonary insufficiency

61
Q

What is the commonest heart tumour?

A

Atrial myxoma is the commonest primary

62
Q

Where is atrial myxoma found?

A

sits just above the mitral valve

63
Q

Is atrial myxoma benign?

A

Yes but can produce clinical pathology that is just as bad as malignancy

64
Q

What is a side effect of atrial myxoma?

A

Myxoid tumour emboli
May develop endocarditis
Systemic fever and malaise, IL-6
Potential secondary

65
Q

Where are atrial myxoma found?

A

90% in atria, usually left

Cardiovascular 2018 (39 decks)

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