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PNS/Cardiology > Pathophysiology of Myocardial Diseases > Flashcards

Pathophysiology of Myocardial Diseases Flashcards

1
Q

What are the big 3 cardiomyopathies?

A

Dilated (congestive)
Hypertrophic
Restrictive

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2
Q

Describe the appearance of the heart in Dilated cardiomyopathy

A

4 chamber dilitation, especially at end of diastole

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3
Q

Describe the appearance of the heart in Hypertrophic cardiomyopathy

A

Hypertrophy of ventricle, but not concentric, just bulges in certain areas
Usually hypertrophic in ventricular septum under aortic valve, causing some obstruction of aortic outflow and subaortic stenosis
Atria is enlarged

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4
Q

Describe the appearance of the heart in Restrictive cardiomyopathy

A

Ventricles appear normal, but the ventricle is not able to dilate and relax during diastole
Atria is enlarged, can see fibrosis

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5
Q

Which of the three cardiomyopathies has a decreased ejection fraction?

A

Dilated

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6
Q

Which of the three cardiomyopathies is systolic dysfunction?

A

Dilated

Cannot contract properly

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7
Q

Which of the three cardiomyopathies is diastolic dysfunction?

A

Restrictive
(and partially Hypertrophic)

Cannot fill/relax properly

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8
Q

Which of the three cardiomyopathies has a decreased cardiac output?

A

Trick! ALL 3

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9
Q

What are the causes of dilated cardiomyopathy?

A

Heterogeneous causes

  • Genetic causes (30%)
  • Myocarditis
  • Alcoholism
  • Toxins (e.g. adrimycin used for breast cancer)
  • Peripartum
  • End stages of hypertension can mimic this
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10
Q

What are the causes of hypertrophic cardiomyopathy?

A

Genetic (50%)

- Amyloidosis can mimic this

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11
Q

What are the causes of restrictive cardiomyopathy?

A

Amyloid in adults
Idiopathic in children
- Pericardial constriction can mimic this

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12
Q

Which protein is mutated in hypertrophic cardiomyopathy?

A

Sarcomeric proteins

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13
Q

What will be a major finding on echo that will indicate dilated cardiomyopathy?

A

Increased left ventricular end diastolic diameter (LVEDD)

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14
Q

What will be clinical findings of dilated cardiomyopathy?

A

Congestive heart failure (ineffective contraction)
Mitral and tricuspid regurgitation (due to dilation)
EF <25%
Thombi may result in strokes

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15
Q

If patient develops dilated cardiomyopathy from Adriamycin toxicity, what will be seen in histology?

A

Vacuoles in the myocytes

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16
Q

What will be clinical findings of hypertrophic cardiomyopathy?

A

Present with arrhythmias, angina, sudden death (acute onset of symptoms)
LV outflow obstruction
LA dilatation

17
Q

Where will the area of abnormal hypertrophy usually be in hypertrophic cardiomyopathy?

A

Intraventricular septum, right below the aortic valve so it impinges on outflow

18
Q

What occurs to the mitral valve in hypertrophic cardiomyopathy?

A

Gets thickened
Exhibits systolic anterior motion of mitral valve (SAM)
Anterior leaflet

19
Q

What is the most common cause of restrictive cardiomyopathy in children?

A

Idiopathic

20
Q

What is the most common cause of restrictive cardiomyopathy in adults?

A

Amyloidosis

21
Q

What is the most common cause of restrictive cardiomyopathy in developing countries/tropics?

A

Endocardial fibrosis

22
Q

How does cardiac amyloid appear macroscopically and microscopically?

A

Dew drop appearance macroscopically in atria

Microscopically see amyloid wrapping around the myocytes

23
Q

What is the type of endomyocardial disease causing restrictive cardiomyopathy that is NOT seen only seen in the tropics?

A

Loffler endocarditis - hypereosinophilic disease

Eosinophils infiltrate endocardium, can cause thrombosis and scar

24
Q

What type of cardiomyopathy will myocarditis cause?

A

Dilated

25
Q

What are the 3 main types of myocarditis?

A

Lymphocytic (usually viral)
Hypersensitivity
Giant cell

26
Q

What is the most common type of myocarditis?

A

Lymphocytic

27
Q

What causes the damage to the myocytes in lymphocytic myocarditis?

A

Immune reaction to virus

28
Q

What two viruses most commonly cause lymphocytic myocarditis?

A 
Coxsackie B (enterovirus)
Adenovirus
29
Q

What will be seen histologically with lymphocytic myocarditis?

A

Myocytes necrosis
Lymphocytes everywhere
Upon survival, can exhibit fibrosis and scarring

30
Q

Is lymphocytic myocarditis seen more in children or adults?

A

Children

31
Q

Is hypersensitivity myocarditis seen more in children or adults?

A

Adults

32
Q

What causes hypersensitivity myocarditis?

A

Allergic reaction to medications, especially antibiotics

33
Q

What will be seen histologically with hypersensitvity myocarditis?

A

Eosinophils around blood vessels (not diffuse like in lymphocytic myocarditis)

34
Q

Is giant cell myocarditis seen more in children or adults?

A

Adults

35
Q

What causes giant cell myocarditis?

A

Thought to be immune

36
Q

What will be seen histologically with giant cell myocarditis?

A

Macrophage giant cells clearing necrotic myocytes

See lots of lymphocytes

PNS/Cardiology (33 decks)

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