PATHOLOGY- Heart disorders 3 Flashcards
what is pericarditis
inflammation of the pericardial sac
what is pericarditis caused by
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
what are the 2 forms of pericarditis
acute pericarditis
chronic pericarditis
what are the subtypes of acute pericardits
- Serous
- Serofibrinous / fibrinous
- Purulent / suppurative
- Haemorrhagic
- Caseous
what are the subtypes of chronic pericarditis
- Adhesive
- Adhesive mediastinopericarditis
- Constrictive pericarditis
What occurs in serous pericarditis
inflammation causes clear serous fluid accumulation
what is serous pericarditis generally caused by
non-infectous aetiologies
sometimes caused by inflammation in adjacent structures/ viral pericardi
list the non-infectous aetiologies that cause serous pericarditis
Immunologically mediated processes
- Rheumatic fever, SLE, scleroderma
Miscellaneous conditions
- Uraemia, neoplasia, radiation
what is the most frequent type of pericarditis
serofibrinous/fibrinous pericarditis
what is serofibrinous/fibrinous percarditis
combination of serous fluid and/or fibrinous exudate in pericardial sac
what are common causes of serofibrinous / fibrinous pericarditis
- Acute MI, Dresser’s syndrome
- Uraemia, radiation, rheumatic fever, SLE, trauma, surgery
describe the features of fibrinous pericarditis (without fluid)
- Dry, granular, roughened surface
- More intense inflammatory response compared to sero-fibrinous
what is Dressler’s syndrome
secondary pericarditis
Autoimmune reaction to antigens released following myocardial infarction
what is Dresslers syndrome also known as
post-MI syndrome
what are the classical clinical symptoms of dresslers syndrome
- Fever
- Pleuritic chest pain
- Pericardial effusion
what is the difference between dressler’s syndrome and acute pericarditis
NOT the same as acute pericarditis immediately after large MI - there is a delay of weeks in dressler’s
what is purulent / suppurative pericarditis
pus accumulation in the pericaridal sac
what causes purulent / suppurative pericarditis
infections
what are the features of Purulent / suppurative pericarditis
Red, granular, exudate i.e. pus (can be upto 500mls)
In purulent / suppurative pericarditis, what is caused if the inflammations extends beyond the pericardial sac
causes mediastino-pericarditis
what effect does the amount of pus have on the outcome of Purulent / suppurative pericarditis
complete resolution is rare because of amount of pus
how does Purulent / suppurative pericarditis resolve
Organisation by scarring
This can cause restrictive pericarditis
Can be serious if it stops the heart contracting effectively
what is haemorrhagic pericarditis
Blood mixed with serous (watery) or suppurative (pus)
effusion
what are 3 common causes of haemorrhagic pericarditis
- Neoplasia (malignant cells in effusion)
- Infections (inc TB)
- Following cardiac surgery -> cardiac tamponade
what is caseous pericarditis seen in
TB or fungal infections
list some subtype examples of chronic pericarditis
- adhesive pericarditis
- adhesive mediastinopericarditis
- constrictive pericarditis
what is adhesive pericarditis
Fibrosis / stringy adhesions obliterates pericardial cavity
what is adhesive mediastinopericarditis
Obliterated pericardial cavity with adherence to surrounding structures
what does Adhesive mediastinopericarditis follow
Follows pericarditis caused by infections, surgery or radiation
what does Adhesive mediastinopericarditis cause
Causes cardiac hypertrophy / cardiac dilation
what is Constrictive pericarditis
Heart encased in fibrous scar - limits cardiac
how is Constrictive pericarditis treated
by surgery to remove ‘shell’ around heart
what are the clinical features of pericarditis
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
why do you get pericardial friction rub with pericarditis
the 2 sides of the pericardial sac are rubbing together, producing a rubbing sound
what are 2 complications with pericarditis
pericardial effusion
cardiac tamponade
how much fluid do you have normally in the pericardial sac
<50ml
what may
-serous fluid
-blood
-pus
accumulation in the pericardial sac result in
- Serous fluid = pericardial effusion
- Blood = haemopericadium
- Pus = purulent / suppurative pericarditis
what is the effects if pericardial effusions are slow
time to enlarge without affecting heart function
what is the effects if pericardial effusions are sudden
no time for pericardial sac to enlarge so heart is compressed
give an example of why the pericardial sac may fill 200-300ml
haemopericardium due to post-MI rupture
what can sudden pericardial effusions cause
Cardiac tamponade
what is cardiac tamponade
clinical manifestation of impaired cardiac function due to compression of atria, ventricles or vena cavae
what is a cardiomyopathy
heart muscle disease i.e. disorder of myocardium
what are the 4 main types of cardiomyopathy
- Dilated
- Hypertrophic
- Restrictive
- Arrythmogenic right venticular cardiomyopathy
what is dilated cardiomyopathy
progressive dilation of ventricles
what does dilated cardiomyopathy lead to
contractile (systolic) dysfunction
describe what the heart looks like in dilated cardiomyopathy
Heart enlarged, heavy, flabby (due to dilation of chambers)
what do you see microscopically with dilated cardiomyopathy
monocyte hypertrophy with fibrosis
what are the casues of dilated cardiomyopathy
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.
what age does dilated cardiomyopathy usually occur
any age but commonly 20-50
what are the clinical features of dilated cardiomyopathy
Slow progressive signs / symptoms of CCF
- Shortness of breath, fatigue, and poor exertional capacity
what is
- the survival time for dilated cardiomyopathy
- the % of those who survive this time
- the cause of death of patients with cardiomyopathy
5 year survival
around 25%
death due to CCF, arrythmia/embolism (intra-cardiac thrombus)
what is the treatment for cardiomyopathy
- Cardiac transplantation
- Long-term ventricular assist (can induce regression)
what is hypertrophic cardiomyopathy
defined by myocardial hypertrophy
in absence of an obvious cause e.g. hypertension
what does hypertrophic cardiomyopathy do to the heart
- 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)
what does a heart with hypertrophic csrdiomyopathy look like
thick walled
heavy
hyper-contracting
what is hypertrophic cardiomyopathy the main cause of
unexplained left ventricle hypertrophy
100% of hypertrophic cardiomyopathy cases are __
why?
genetic
- Mutations sarcomeric proteins
- Can be sporadic
list the clinical features of hypertrophic cardiomyopathy
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.
what are the complications of hypertrophic cardiomyopathy
- 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)
what is the treatment for hypertrophic cardiomyopathy
- Decrease heart rate and contractility - beta adrenergic blockers.
- Reduction of the mass of the septum, which relieves the outflow tract obstruction
what are the possible clinical outcomes of both dilated cardiomyoptahy and hypertrophic cardiomyopathy
heart failure
sudden death
atrial fibrillation
stroke
what is restrictive cardiomyopathy
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)
describe the morphology of a heart with restrctive cardiomyopathy
- Ventricles normal size / slightly enlarged chambers normal
- Myocardium is firm and noncompliant
Whjat is arrythmogenic right ventricular cardiomyopathy also known as
arrhythmogenic R.V. dysplasia
what type of disease is arrythmogenic right ventricular cardiomyopathy and how many people does it affect
Genetic disease (A.D.)
~1 in 5000
what effect does arrythmogenic right ventricular cardiomyopathy have on the heart
right ventricle dilation
myocardial thinning
fibrofatty replacement of right ventricle
what is arrythmogenic right ventricular cardiomyopathy
disorder of cell-cell desmosomes
what effect does exercise have on Arrythmogenic right ventricular cardiomyopathy
cells detach and die
what symptoms does Arrythmogenic right ventricular cause
Silent, syncope, chest pain, palpitations
what can Arrythmogenic right ventricular cardiomyopathy lead to
sudden cardiac death (esp in young/during exercise)
what is myocarditis
Infective (or inflammatory) process of heart muscle that causes myocardial injury
what is the cause of mkst cases of myocarditis
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
what are the broad clinical eatures of myocarditis
- Asymptomatic
- Heart failure, arrhythmias and sudden death
- Non-specific symptoms - fatigue, dyspnea, palpitations, precordial discomfort, and fever
- Can mimic acute MI
- DCM can develop
how common are heart tumours
what % of heart tumours are benign
90%
what are the 5 main type of heart tumours
Myxomas
fibromas
lipomas
papillary elastofibroma
rhabdomyoma
what is the most common type of heart tumour
myxomas- 90% of myxomas occur in atria, mostly left
what are myoxmas caused by
present due to valvular obstruction, embolization or systemic symptoms.
what are papillary elastofibromas and where do they arise
- ‘Spikey’ shaped tumours, usually indolent but can present via embolization.
- Mostly arise on valves
who are rhabdomyoma heart tumours common in
mostly common in children
