Pathology of Myocardial Disease

Question 1

Definition of cardiomyopathy:

Answer 1

Heterogenous group of diseases of myocardium associated with mechanical and electrical dysfunction that exhibit ventricular hypertrophy or dilation due to variety of causes that are frequently genetic.

part of heart or part of systemic disorder leading to cardiovascular death or progressive heart failure.

secondary to ischemia, valve abnormalities are not cardiomyopathies

Question 2

Hypertrophic

Answer 2

Diastolic Dysfunction

Risk of sudden death in young athletes

Thickening left ventricular wall

Question 3

Dilated cardiomyopathy

Answer 3

Enlarged of all cardiac chambers

systolic dysfunction

most common type

Question 4

Restrictive Cardiomyopathy

Answer 4

rigid ventricular walls, diastolic dysfunction, least common type

Question 5

Dilated Cardiomyopathy

Answer 5

affects individuals between ages 20 -50

CHF symptoms with dyspnea, fatigue, and exertion. End stage ejection is less than 25%

Annual mortality is high as 50%

some individuals respond to pharmacologic therapy and cardiac transplantation is increasing in major centers

Question 6

Clinical Cardiomyopathy

Answer 6

1. Decreased exercise capacity
2. fatigue, dyspnea
3. orthopnea
4. irregular heart rate
5. s3 and s abnormal
6. jvd
7. hepatomegaly
8. murmur

Question 7

Dilated Cardiomyopathy in Morphology

Answer 7

progressive cardiac dilation and systolic dysfunction…

familial but can result from diverse causes–> primary and secondary forms

Genetic: 50% of cases

Myocarditis: Coxsackie B

alcohol abuse

pregnancies

adriamycin

Question 8

Dilated Cardiomyopathy:

Answer 8

Decreased exercise capacity

Fatigue dyspnea

orthopnea

irregular heart rate

abnormal s3 and s4

JVD

Hepatomegaly

Murmur

Question 9

Dilated Cardiomyopathy Causes

Answer 9

DCM–> morphologically and functionally progressive cardiac dilatation and contractile dysfunction.

50% are familial, mutations in TTN gee accounts for DCM

Myocarditis and Cocksackie B

Alcohol abuse and cardiomyopathy

adriamycin an antineoplasic agent

Pregnancies

catecholmines and individuals with pheochromocytomas

Question 10

What is morphology of Cardiomyopathy?

Answer 10

In DCM the heart is enlarged, flabby and heavy

Mural thrombi are common

4 chamber dilation

Question 11

Hypertrophic cardiomyopathy main features

Answer 11

reduced stroke volume due to impaired diastolic filling

Major causes: A fib, mural thrombi with emboli, ventricular arrhythmia

Natural History of HCM is variable

Natural history of HCM is variable, Beta blockers decrease contractility and also surgical excision of cardiac muscle

Question 12

What is the gene mutation involved in cardiomyopathy

Answer 12

it is gene encoding for beta myosin heavy chain (B-MHC)

Question 13

What is the morphology of HCM?

Answer 13

Massive myocardial hypertrophy without ventricular dilatation

Assymetric septal hypertrophy with thickening of the ventricular septum

Question 14

What is the histology of the HCM?

Answer 14

Massive myocyte hypertrophy, myofiber disarray, interstitial fibrosis

Question 15

Restrictive Myocarditis

Answer 15

Characterized by primary decrease in ventricular compliance.

Contractile function, systolic of the left ventricle is unaffected.

Clinical symptoms of heart failure

Question 16

What is the etiology of restrictive myocarditis:

Answer 16

Idiopathic or associated with specific processes that affect the myocardium, mainly radiation fibrosis, amyoidosis, sarcoidosis, malignant tumors, and inborn errors of metabolism.

Question 17

What is the diagnosis of Restrictive Myocarditis

Answer 17

electrocardiogram, chest X-ray, catherization, CT scan, histologic eam, and radionucleotide studies

Question 18

Restricitive cardiomyopathy etiology

Answer 18

Infiltrative causes: amyloid, sarcoid

Non-infiltrative causes: idiopathic, scleroderma

Other causes: hemochromatosis, diffuse