Pathology

Question 1

Cardiomyopathy

Answer 1

Disease of cardiac muscle

Often result in changes in size of heart chambers and thickness

Question 2

3 Types of Cardiomyopathy

Answer 2

Dilated
Hypertrophic
Restrictive

Question 3

Dilated Cardiomyopathy

Answer 3

Heart 2-3 times bigger

Flabby and floppy

Question 4

Aetiology of dilated cardiomyopathy

Answer 4

Genetics
Alcohol 
Chemo
Cardiac infection
Pregnancy (rare)

Question 5

Clinical features of dilated cardiomyopathy

Answer 5

Heart failure
SOB
Poor exercise tolerance
Low ejection fraction/cardiac output

Question 6

Hypertrophic Cardiomyopathy

Answer 6

Big solid hearts
Hypertrophic and strong contraction
Diastolic dysfunction - heart can’t relax
Myocardial becomes abnormally thickened
Heart cannot pump as effectively - outflow obstruction

Question 7

Sudden death in athletes

Answer 7

Hypertrophic cardiomyopathy

Question 8

Causes of hypertrophic cardiomyopathy

Answer 8

Genetic (inherited)

Question 9

Restrictive cardiomyopathy

Answer 9

Walls of ventricle become stiff, but not necessarily thickened
Heart can look normal
Diastolic dysfunction
Bi-atrial dilatation as a result of back pressure

Question 10

Causes of restrictive cardiomyopathy

Answer 10

May require biopsy
eg. deposit of amyloid, sarcoid
Or
Fibrosis following radiation

Question 11

Amyloid

Answer 11

Abnormal deposition of an abnormal protein

Question 12

AA

Answer 12

chronic diseases like rheumatoid arthritis

Question 13

AL

Answer 13

Light chains

Abnormal immunoglobulin

Question 14

Amyloid histology

Answer 14

Waxy pink material
Stains +ve for congo red
Apple green birefringence

Question 15

Arrhythmogenic Right Ventricular Dysplasia

Answer 15

Genetic 
Syncope 
Arrhythmia
Right ventricle largely replaced by fat
Big and floppy

Question 16

Myocarditis

Answer 16

Inflammation of the heart
Infectious vs non-infectious
Most commonly infectious

Question 17

Infectious myocarditis

Answer 17

Viral 
Coxsackie A and B 
ECHO virus
Chaga's disease 
Borrelia burgdorferi - lyme's disease
HIV

Question 18

Infectious myocarditis histology

Answer 18

Thickened ‘beefy’ myocarditis

Question 19

Non-infectious myocarditis

Answer 19

Immune mediated hypersensitivity
Hypersensitivity to infection (Rheumatic fever after strep sore throat)
Hypersensitivity to drugs (eosinophilic myocarditis)
Systemic Lupus Erythematosus

Question 20

Rheumatic Fever

Answer 20

Mitral stenosis (thickening and fusion of valves)
Short, thick chordae tendinae
Myocardium patchy and inflammed

Question 21

Rheumatic fever histology

Answer 21

Aschoff Bodies

Question 22

Pericarditis

Answer 22

Inflammation of pericardium layers

Question 23

Causes of pericarditis

Answer 23

Infection
Immune mediated (rheumatic fever)
Idiopathic
Uraemic (Renal failure)
Post MI (Dressler's syndrome)
Connective tissue disease

Question 24

Infectious Pericarditis

Answer 24

Viruses = produce serous effusions
Bacterial = extension from elsewhere, pneumonia produce effusions
Fungi = immunosuppressed patients. Post transplant = effusions
TB

Question 25

Complications of pericarditis

Answer 25

``` Pericardial effusion Tamponade Constrictive pericarditis Cardiac failure Death ```

Question 26

Endocarditis

Answer 26

Affects heart lining, inflammation of valves

Question 27

Infectious Endocarditis

Answer 27

IV drug users Septicaemia Rheumatic heart disease Prosthetic valves, congenital defects, MV prolapse, calcific disease

Question 28

HACEK

Answer 28

Haemophilus, Actinobacillus, Cardiobacteria, Eikenella, Kingella

Question 29

IV Drug Users

Answer 29

Right sided Candida Staph Aureus

Question 30

Prosthetic Valves

Answer 30

S. Epidermis

Question 31

Pathology of endocarditis

Answer 31

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

Question 32

Non Bacterial Thrombotic Endocarditis

Answer 32

Non-invasive and don't destroy valves Small and multiple vegetations Associated with cancer

Question 33

Lupus

Answer 33

Libman Sacks Endocarditis Small sterile emboli Undersurfaces of valves or on chords

Question 34

Carcinoid Heart Disease

Answer 34

Carcinoid tumours - neoplasms of endocrine cells Excess 5HIAA, seratonin, histamine, bradykinin Flushing of skin Nausea, vomiting and diarrhoea Right sided valvular disease

Question 35

Atrial myxoma

Answer 35

Commonest tumour of heart | 90% atria, usually left