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Y3 IWB > PATHOLOGY- Heart disorders 3 > Flashcards

PATHOLOGY- Heart disorders 3 Flashcards

1
Q

what is pericarditis

A

inflammation of the pericardial sac

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2
Q

what is pericarditis caused by

A

Infections
- Viruses (Coxsackie B), bacteria, TB, fungi, parasites

Immunolgically mediated processes
- Rheumatic fever, SLE, scleroderma, post-cardiotomy
- Late post-MI = Dresser’s syndrome, drug hypersensitivity

Miscellaneous conditions
- Post-MI (early), uraemia, cardiac surgery, neoplasia
- Trauma, radiation

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3
Q

what are the 2 forms of pericarditis

A

acute pericarditis
chronic pericarditis

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4
Q

what are the subtypes of acute pericardits

A
  • Serous
  • Serofibrinous / fibrinous
  • Purulent / suppurative
  • Haemorrhagic
  • Caseous
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5
Q

what are the subtypes of chronic pericarditis

A
  • Adhesive
  • Adhesive mediastinopericarditis
  • Constrictive pericarditis
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6
Q

What occurs in serous pericarditis

A

inflammation causes clear serous fluid accumulation

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7
Q

what is serous pericarditis generally caused by

A

non-infectous aetiologies

sometimes caused by inflammation in adjacent structures/ viral pericardi

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8
Q

list the non-infectous aetiologies that cause serous pericarditis

A

Immunologically mediated processes
- Rheumatic fever, SLE, scleroderma

Miscellaneous conditions
- Uraemia, neoplasia, radiation

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9
Q

what is the most frequent type of pericarditis

A

serofibrinous/fibrinous pericarditis

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10
Q

what is serofibrinous/fibrinous percarditis

A

combination of serous fluid and/or fibrinous exudate in pericardial sac

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11
Q

what are common causes of serofibrinous / fibrinous pericarditis

A
  • Acute MI, Dresser’s syndrome
  • Uraemia, radiation, rheumatic fever, SLE, trauma, surgery
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12
Q

describe the features of fibrinous pericarditis (without fluid)

A
  • Dry, granular, roughened surface
  • More intense inflammatory response compared to sero-fibrinous
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13
Q

what is Dressler’s syndrome

A

secondary pericarditis
Autoimmune reaction to antigens released following myocardial infarction

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14
Q

what is Dresslers syndrome also known as

A

post-MI syndrome

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15
Q

what are the classical clinical symptoms of dresslers syndrome

A
  1. Fever
  2. Pleuritic chest pain
  3. Pericardial effusion
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16
Q

what is the difference between dressler’s syndrome and acute pericarditis

A

NOT the same as acute pericarditis immediately after large MI - there is a delay of weeks in dressler’s

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17
Q

what is purulent / suppurative pericarditis

A

pus accumulation in the pericaridal sac

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18
Q

what causes purulent / suppurative pericarditis

A

infections

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19
Q

what are the features of Purulent / suppurative pericarditis

A

Red, granular, exudate i.e. pus (can be upto 500mls)

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20
Q

In purulent / suppurative pericarditis, what is caused if the inflammations extends beyond the pericardial sac

A

causes mediastino-pericarditis

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21
Q

what effect does the amount of pus have on the outcome of Purulent / suppurative pericarditis

A

complete resolution is rare because of amount of pus

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22
Q

how does Purulent / suppurative pericarditis resolve

A

Organisation by scarring
This can cause restrictive pericarditis
Can be serious if it stops the heart contracting effectively

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23
Q

what is haemorrhagic pericarditis

A

Blood mixed with serous (watery) or suppurative (pus)
effusion

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24
Q

what are 3 common causes of haemorrhagic pericarditis

A
  • Neoplasia (malignant cells in effusion)
  • Infections (inc TB)
  • Following cardiac surgery -> cardiac tamponade
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25
Q

what is caseous pericarditis seen in

A

TB or fungal infections

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26
Q

list some subtype examples of chronic pericarditis

A
  1. adhesive pericarditis
  2. adhesive mediastinopericarditis
  3. constrictive pericarditis
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27
Q

what is adhesive pericarditis

A

Fibrosis / stringy adhesions obliterates pericardial cavity

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28
Q

what is adhesive mediastinopericarditis

A

Obliterated pericardial cavity with adherence to surrounding structures

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29
Q

what does Adhesive mediastinopericarditis follow

A

Follows pericarditis caused by infections, surgery or radiation

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30
Q

what does Adhesive mediastinopericarditis cause

A

Causes cardiac hypertrophy / cardiac dilation

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31
Q

what is Constrictive pericarditis

A

Heart encased in fibrous scar - limits cardiac

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32
Q

how is Constrictive pericarditis treated

A

by surgery to remove ‘shell’ around heart

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33
Q

what are the clinical features of pericarditis

A

Sharp central chest pain
- Exacerbated by : movement, respiration, laying flat
- Relieved: sitting forwards
- Radiating: shoulders / neck
- Differentials : angina, pleurisy

Pericardial friction rub
- Loudest with diaphragm, left sternal edge

Fever, leucocytosis, lymphocytosis, pericardial effusion

34
Q

why do you get pericardial friction rub with pericarditis

A

the 2 sides of the pericardial sac are rubbing together, producing a rubbing sound

35
Q

what are 2 complications with pericarditis

A

pericardial effusion
cardiac tamponade

36
Q

how much fluid do you have normally in the pericardial sac

A

<50ml

37
Q

what may
-serous fluid
-blood
-pus
accumulation in the pericardial sac result in

A
  • Serous fluid = pericardial effusion
  • Blood = haemopericadium
  • Pus = purulent / suppurative pericarditis
38
Q

what is the effects if pericardial effusions are slow

A

time to enlarge without affecting heart function

39
Q

what is the effects if pericardial effusions are sudden

A

no time for pericardial sac to enlarge so heart is compressed

40
Q

give an example of why the pericardial sac may fill 200-300ml

A

haemopericardium due to post-MI rupture

41
Q

what can sudden pericardial effusions cause

A

Cardiac tamponade

42
Q

what is cardiac tamponade

A

clinical manifestation of impaired cardiac function due to compression of atria, ventricles or vena cavae

43
Q

what is a cardiomyopathy

A

heart muscle disease i.e. disorder of myocardium

44
Q

what are the 4 main types of cardiomyopathy

A
  • Dilated
  • Hypertrophic
  • Restrictive
  • Arrythmogenic right venticular cardiomyopathy
45
Q

what is dilated cardiomyopathy

A

progressive dilation of ventricles

46
Q

what does dilated cardiomyopathy lead to

A

contractile (systolic) dysfunction

47
Q

describe what the heart looks like in dilated cardiomyopathy

A

Heart enlarged, heavy, flabby (due to dilation of chambers)

48
Q

what do you see microscopically with dilated cardiomyopathy

A

monocyte hypertrophy with fibrosis

49
Q

what are the casues of dilated cardiomyopathy

A

Genetic (20 - 50% cases)
* Autosomal dominant (mainly)
* Cytoskeletal proteins gene mutation

Alcohol (10-20%) and other toxins
* E.g. chemotherapy

Others
* SLE, scleroderma, thiamine def., acromegaly, thyrotoxicosis, diabetes.

50
Q

what age does dilated cardiomyopathy usually occur

A

any age but commonly 20-50

51
Q

what are the clinical features of dilated cardiomyopathy

A

Slow progressive signs / symptoms of CCF
- Shortness of breath, fatigue, and poor exertional capacity

52
Q

what is
- the survival time for dilated cardiomyopathy
- the % of those who survive this time
- the cause of death of patients with cardiomyopathy

A

5 year survival
around 25%
death due to CCF, arrythmia/embolism (intra-cardiac thrombus)

53
Q

what is the treatment for cardiomyopathy

A
  • Cardiac transplantation
  • Long-term ventricular assist (can induce regression)
54
Q

what is hypertrophic cardiomyopathy

A

defined by myocardial hypertrophy
in absence of an obvious cause e.g. hypertension

55
Q

what does hypertrophic cardiomyopathy do to the heart

A
  • Poorly compliant (stiff) left ventricular myocardium
  • Diastolic dysfunction with preserved systolic function (heart cant relax but can contract)
  • Intermittent ventricular outflow obstruction (1/3 cases)
56
Q

what does a heart with hypertrophic csrdiomyopathy look like

A

thick walled
heavy
hyper-contracting

57
Q

what is hypertrophic cardiomyopathy the main cause of

A

unexplained left ventricle hypertrophy

58
Q

100% of hypertrophic cardiomyopathy cases are __

why?

A

genetic
- Mutations sarcomeric proteins
- Can be sporadic

59
Q

list the clinical features of hypertrophic cardiomyopathy

A

Decreased stroke volume
- Impaired diastolic filling - reduced chamber size / compliance of hypertrophied left ventricle

Obstruction to the left ventricular outflow
- 25% of patients

Exertional dyspnoea (severe shortness of breath when exercising) due to above

Systolic ejection murmur
- Ventricular outflow obstruction
- Anterior mitral leaflet moves toward the ventricular septum during systole.

60
Q

what are the complications of hypertrophic cardiomyopathy

A
  • Atrial fibrillation
  • Mural thrombus formation - embolization / stroke
  • Cardiac failure
  • Ventricular arrhythmias
  • Sudden death, especially in some affected families (most common causes of sudden death in athletes)
61
Q

what is the treatment for hypertrophic cardiomyopathy

A
  • Decrease heart rate and contractility - beta adrenergic blockers.
  • Reduction of the mass of the septum, which relieves the outflow tract obstruction
62
Q

what are the possible clinical outcomes of both dilated cardiomyoptahy and hypertrophic cardiomyopathy

A

heart failure
sudden death
atrial fibrillation
stroke

63
Q

what is restrictive cardiomyopathy

A

Primary decrease in ventricular compliance
- Impaired ventricular filling during diastole

Idiopathic or secondary (infiltration)
- fibrosis, amyloidosis, sarcoidosis, metastatic tumors or deposition of metabolites (inborn errors of metabolism)

64
Q

describe the morphology of a heart with restrctive cardiomyopathy

A
  • Ventricles normal size / slightly enlarged chambers normal
  • Myocardium is firm and noncompliant
65
Q

Whjat is arrythmogenic right ventricular cardiomyopathy also known as

A

arrhythmogenic R.V. dysplasia

66
Q

what type of disease is arrythmogenic right ventricular cardiomyopathy and how many people does it affect

A

Genetic disease (A.D.)
~1 in 5000

67
Q

what effect does arrythmogenic right ventricular cardiomyopathy have on the heart

A

right ventricle dilation
myocardial thinning
fibrofatty replacement of right ventricle

68
Q

what is arrythmogenic right ventricular cardiomyopathy

A

disorder of cell-cell desmosomes

69
Q

what effect does exercise have on Arrythmogenic right ventricular cardiomyopathy

A

cells detach and die

70
Q

what symptoms does Arrythmogenic right ventricular cause

A

Silent, syncope, chest pain, palpitations

71
Q

what can Arrythmogenic right ventricular cardiomyopathy lead to

A

sudden cardiac death (esp in young/during exercise)

72
Q

what is myocarditis

A

Infective (or inflammatory) process of heart muscle that causes myocardial injury

73
Q

what is the cause of mkst cases of myocarditis

A

Coxsackie A&B viruses most common cause in West
Chagas disease (Trypanosoma cruzi) protozoa
* important non-viral cause (endemic in South America) - 10% die acutely

74
Q

what are the broad clinical eatures of myocarditis

A
  • Asymptomatic
  • Heart failure, arrhythmias and sudden death
  • Non-specific symptoms - fatigue, dyspnea, palpitations, precordial discomfort, and fever
  • Can mimic acute MI
  • DCM can develop
75
Q

how common are heart tumours

A
76
Q

what % of heart tumours are benign

A

90%

77
Q

what are the 5 main type of heart tumours

A

Myxomas
fibromas
lipomas
papillary elastofibroma
rhabdomyoma

78
Q

what is the most common type of heart tumour

A

myxomas- 90% of myxomas occur in atria, mostly left

79
Q

what are myoxmas caused by

A

present due to valvular obstruction, embolization or systemic symptoms.

80
Q

what are papillary elastofibromas and where do they arise

A
  • ‘Spikey’ shaped tumours, usually indolent but can present via embolization.
  • Mostly arise on valves
81
Q

who are rhabdomyoma heart tumours common in

A

mostly common in children

Y3 IWB (31 decks)

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