Pathology Flashcards
Cardiomyopathy
Disease of cardiac muscle
Often result in changes in size of heart chambers and thickness
3 Types of Cardiomyopathy
Dilated
Hypertrophic
Restrictive
Dilated Cardiomyopathy
Heart 2-3 times bigger
Flabby and floppy
Aetiology of dilated cardiomyopathy
Genetics Alcohol Chemo Cardiac infection Pregnancy (rare)
Clinical features of dilated cardiomyopathy
Heart failure
SOB
Poor exercise tolerance
Low ejection fraction/cardiac output
Hypertrophic Cardiomyopathy
Big solid hearts
Hypertrophic and strong contraction
Diastolic dysfunction - heart can’t relax
Myocardial becomes abnormally thickened
Heart cannot pump as effectively - outflow obstruction
Sudden death in athletes
Hypertrophic cardiomyopathy
Causes of hypertrophic cardiomyopathy
Genetic (inherited)
Restrictive cardiomyopathy
Walls of ventricle become stiff, but not necessarily thickened
Heart can look normal
Diastolic dysfunction
Bi-atrial dilatation as a result of back pressure
Causes of restrictive cardiomyopathy
May require biopsy
eg. deposit of amyloid, sarcoid
Or
Fibrosis following radiation
Amyloid
Abnormal deposition of an abnormal protein
AA
chronic diseases like rheumatoid arthritis
AL
Light chains
Abnormal immunoglobulin
Amyloid histology
Waxy pink material
Stains +ve for congo red
Apple green birefringence
Arrhythmogenic Right Ventricular Dysplasia
Genetic Syncope Arrhythmia Right ventricle largely replaced by fat Big and floppy
Myocarditis
Inflammation of the heart
Infectious vs non-infectious
Most commonly infectious
Infectious myocarditis
Viral Coxsackie A and B ECHO virus Chaga's disease Borrelia burgdorferi - lyme's disease HIV
Infectious myocarditis histology
Thickened ‘beefy’ myocarditis
Non-infectious myocarditis
Immune mediated hypersensitivity
Hypersensitivity to infection (Rheumatic fever after strep sore throat)
Hypersensitivity to drugs (eosinophilic myocarditis)
Systemic Lupus Erythematosus
Rheumatic Fever
Mitral stenosis (thickening and fusion of valves)
Short, thick chordae tendinae
Myocardium patchy and inflammed
Rheumatic fever histology
Aschoff Bodies
Pericarditis
Inflammation of pericardium layers
Causes of pericarditis
Infection Immune mediated (rheumatic fever) Idiopathic Uraemic (Renal failure) Post MI (Dressler's syndrome) Connective tissue disease
Infectious Pericarditis
Viruses = produce serous effusions
Bacterial = extension from elsewhere, pneumonia produce effusions
Fungi = immunosuppressed patients. Post transplant = effusions
TB
Complications of pericarditis
Pericardial effusion Tamponade Constrictive pericarditis Cardiac failure Death
Endocarditis
Affects heart lining, inflammation of valves
Infectious Endocarditis
IV drug users
Septicaemia
Rheumatic heart disease
Prosthetic valves, congenital defects, MV prolapse, calcific disease
HACEK
Haemophilus, Actinobacillus, Cardiobacteria, Eikenella, Kingella
IV Drug Users
Right sided
Candida
Staph Aureus
Prosthetic Valves
S. Epidermis
Pathology of endocarditis
Aggregates of organisms on heart valves called vegetations
Bacteria excite acute inflammation and bacterial and inflammatory cell products digest valve leaflets
Vegetations are friable and can cause emboli
Non Bacterial Thrombotic Endocarditis
Non-invasive and don’t destroy valves
Small and multiple vegetations
Associated with cancer
Lupus
Libman Sacks Endocarditis
Small sterile emboli
Undersurfaces of valves or on chords
Carcinoid Heart Disease
Carcinoid tumours - neoplasms of endocrine cells
Excess 5HIAA, seratonin, histamine, bradykinin
Flushing of skin
Nausea, vomiting and diarrhoea
Right sided valvular disease
Atrial myxoma
Commonest tumour of heart
90% atria, usually left
