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CVS Pathology > Pathology 3 - Myocardial Diseases > Flashcards

Pathology 3 - Myocardial Diseases Flashcards

1
Q

What is meant by cardiomyopathies

A

A diverse group of disorders with a primary myocardial dysfunction

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2
Q

What are the secondary myocardial changes

A

ischemic, hypertensive. valvular defects

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3
Q

what can secondary myocardial changes lead to?

A

Extrinsic cardiomyopathy
primary pathology outside myocardium

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4
Q

What are the 3 types of cardiomyopathies

A
  1. Dilated Cardiomyopathy
  2. Hypertrophic Cardiomyopathy
  3. Restrictive Cardiomyopathy
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5
Q

What is dilated cardiomyopathy

A

Extensive dilation of the 4 chambers
Most common (90% of cases)

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6
Q

What is hypertrophic cardiomyopathy

A

Hypertrophy of the ventricle

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7
Q

What is restrictive cardiomyopathy

A

The shape of the heart is more or less normal
There is interference with the relaxation the ventricles during diastole

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8
Q

What is seen in this gross specimen

A

Dilated Cardiomyopathy
Heart is doubled/tripled in size

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9
Q

What is seen in this gross specimen

A

Dilated cardiomyopathy with left ventricular mural thrombosis

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10
Q

How does dilated cardiomyopathy cause thrombosis

A

Dilation of the chambers cause slowing of blood flow
Stasis of blood can cause thrombus to form on the wall

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11
Q

what are the complications of mural thrombi ?

A

During contraction the thrombus can easily detach and travel to the systemic circulation and cause:
- Cerebral infarction
- Renal / Intestinal infarction
- severe impairment in the lower limbs (DVT) -> amputation

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12
Q

What is the etiology DCM

A
  • Genetic (20-50 %)
  • Myocarditis ( Coxsackie B , sometimes A)
  • Peripartum CM
  • Toxic CM (Alcoholic, Cocaine, Cytotoxic- drugs/chemotherapy, Cobalt-isotopic substances)
  • Iron overload (hemochromatosis)
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13
Q

What is seen in the gross picture of DCM

A
  • Dilation of all 4 chambers
  • 2-3 times the normal size
  • Systolic dysfunction (impaired contractility)
  • Mural thrombi
  • Functional Mitral or Tricuspid Regurgitation
  • Aortic incompetence
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14
Q

How does DCM cause Functional Mitral or Tricuspid Regurgitation/Aortic incompetence

A

Severe dilation will cause pulling/ traction on the valve ring = open valve
so although the valves are structurally normal they are functionally impaired

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15
Q

What is the microscopic picture of DCM

A

Non-specific
- hypertrophied myocytes with enlarged nuclei, loss of striction
- some atrophied myocyte
- interstitial fibrosis

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16
Q

Compare the two images

A

Top: normal cardiac muscle fibers
Bottom: DCM - Hypertrophied myocytes with enlarged nuclei

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17
Q

what is seen in this image

A

Hypertrophic Cardiomyopathy
Particularly the left ventricle and septum causing asymmetric hypertrophy

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18
Q

What is the etiology of HCM

A

Almost exclusively genetic
Usually seen in younger patients due to genetic disorder

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19
Q

Pathophysiology of HCM

A
  • Asymmetric myocardial hypertrophy (10% concentric)
  • Greater thickening of septum than LV free wall
  • Obstruction of blood flow (HOCM) 1/3 of cases
  • Diastolic dysfunction and impaired compliance
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20
Q

What is the differential diagnosis of HCM

A

symmetric/concentric hypertrophy due to HTN/aortic stenosis

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21
Q

How does HCM cause diastolic dysfunction

A

extensive hypertrophy causes a rigidity in the muscle = interferes with relaxation during diastole

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22
Q

What is seen in this image

A

HCM: thickness of the septum > LV free wall
small number of patients can show symmetry

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23
Q

What is seen in this image

A

Concentric hypertensive hypertrophy (NOT HCM)

24
Q

What is seen in the gross picture of HCM

A
  • Ventricular hypertrophy (no dilation)
  • Reduced LV cavity
  • Altered configuration of ventricular cavity ‘banana-like’
25
Q

What is seen in this image

A

Banana-shaped ventricle due to hypertrophic obstructive cardiomyopathy (HOCM)

26
Q

What is myocardial disarray

A

seen in HCM

27
Q

What is seen in this image

A

HCM: enlarged muscle fibers, myocardial disarray

28
Q

What is the microscopic picture seen in HCM

A
  • Severe myocyte hypertrophy
  • Myofiber disarray
  • Interstitial and replacement fibrosis
  • Intramural coronary dysplasia
29
Q

What is intramural coronary dysplasia

A

Medial thickening & Luminal narrowing seen in HCM

30
Q

What is seen in this image

A

Green circle: Intramural coronary dysplasia
Yellow circle: Enlarged muscle fibers (whorled arrangement, myofiber disarray )
Black bracket: interstitial fibrosis

31
Q

What are the 2 main causes of RCM

A
  1. Endomyocardial Fibrosis
  2. Infiltrative (eg. Amyloidosis, Sarcoidosis)
32
Q

Pathophysiology of RCM

A

Diastolic dysfunction & Impaired compliance
Due to rigidity

33
Q

What is seen in the gross picture of RCM

A
  • Ventricles are normal/slightly enlarged
  • Cavities not dilated
34
Q

What is seen in the microscopic picture of RCM

A
  • Endomyocardial fibrosis
  • Amyloid, sarcoid granuloma, etc.
  • Interstitial fibrosis
35
Q

What is seen in this image

A

Loss of trabeculation - Endomyocardial fibrosis
RCM

36
Q

What stain is used in this slide and what does it show

A

Masson’s stain (fibrous tissue stained blue)
Endomyocardial Fibrosis

37
Q

What is Endomyocardial Fibrosis

A

Fibrosis under endocardium and inner layer of myocardium

38
Q

What is seen in these pictures

A

Amyloidosis RCM
Left: amyloid is stained pink by H&E
Right: amyloid stained greenish by Sulphated Alcian Blue

39
Q

What is seen in this image

A

Cardiac Sarcoidosis
Granuloma, giant cells and some inflammatory cells

40
Q

What is myocarditis and what are the affects

A

Inflammation of myocardium
Generalized, regional, focal

41
Q

What are the causes of myocarditis

A
  • Direct involvement (infected valve may spread to adjacent myocardium)
  • Hypersensitivity due to certain drugs
  • Toxins
42
Q

What is the prognosis of myocarditis

A
  • Immediate effects can be serious (acute HF = sudden death)
  • Recovery is common
43
Q

What are the types of Myocarditis

A
  • Viral
  • Bacterial
  • Toxic
  • Immunological
  • Giant Cell (GCM)
44
Q

Describe the Causes of Viral Myocarditis

A
  • Caused by Coxsackie B or A
    sometimes influenza, HIV, COVID-19
45
Q

Describe the Presentation of Viral Myocarditis

A
  • Generalised interstitial inflammation
  • Mainly lymphocytes, some macrophages
  • Can be asymptomatic (subclinical)
  • Can cause sudden death
46
Q

What is seen in this image

A

viral myocarditis
- myocardial fibers with early necrotic changes
- many lymphocytes some macrophages

47
Q

What is the pathophysiology of bacterial myocarditis

A
  • Direct spread from infected valves/bloodstream
  • Focal suppuration
  • Necrosis, polymorphic infiltration, interstitial edema
48
Q

What is seen in this image

A

Bacterial myocarditis
- Focus with necrosis tissue, bacterial colonies, polymorphs infiltration and between interstitial

49
Q

What is seen in this image

A

bacterial myocarditis (slightly darker than normal tissue)

50
Q

What causes Toxic Myocarditis

A
  • Toxins of bacteria (Diphtheria - Typhoid - Pneumonia)
  • Drugs or Chemicals
51
Q

Describe the presentation of Toxic Myocarditis

A
  • Generalized muscle damage with foci of necrosis
  • Infiltrate with lymphocytes and macrophages
52
Q

Describe Causes of Immunological Myocarditis

A

Rheumatic, SLE (Libman Sacks)

53
Q

What is Giant Cell Myocarditis

A

Rare inflammatory disease o myocardium
- Affects previously healthy young adults
- Commonly fatal
- Etiology unknown

54
Q

What is the presentation of GCM

A
  • Yellow-grey or grey foci throughout myocardium
  • Mural thrombi
55
Q

What is seen in this image

A

GCM
- Multifocal necrosis
- Inflammatory infiltrate of lymphocytes and histiocytes
- Multinucleated giant cells

CVS Pathology (7 decks)

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