Pericardial and Myocardial Diseases

Question 1

indications for endomyocardial biopsy

Answer 1

grading of rejection in cardiac recipients

grading of anthracycline cardiotoxicity

diagnosis of myocarditis

confirmation of primary cariomyopathy

diagnosis of specific heart muscle disease

restrictive versus constrictive heart disease

Question 2

microscopic features of hypertrophic cardiomyopathy

Answer 2

myocyte hypertrophy

myofiber disarray

patchy interstitial fibrosis

endocardial fibrosis

thickened intramural coronary branches

Question 3

most common mutations in familial HCM

Answer 3

beta-myosin heavy chain

cardiac myosin-binding protein

troponin T

**autosomal dominant in 50% of mutations

Question 4

possible causes of hemopericardium

Answer 4

myocardial rupture or dissecting aortic aneurysm

Question 5

major parasitic cause of myocarditis

Answer 5

trypanosoma cruzi

Chaga’s disease

chronic disease is characterized by heart failure, cardiac dilatation, and dilatation of the esophagus and gut

Question 6

athlete’s heart due to isotonic (dynamic) exercise

Answer 6

running, cycling, swimming

increases venous return and ventricular ED diameter

increased SV and CO

LV thickens and myocardium hypertrophies eccentrically

mass-to-volume ratio is unchanged

Question 7

athlete’s heart due to isometric (static) exercise

Answer 7

weight lifting, shotputting

brief increases in pressure

hypertrophies in a concentric method

mass-to-volume ratio increases

Question 8

most common cause of sudden cardiac death in young athletes

Answer 8

hypertrophic cardiomyopathy

idiopathic left ventricular hypertrophy

congenital coronary artert anomalies

Question 9

causes of secondary cariomyopathies

Answer 9

toxic

metabolic

storage

infiltratice

neuromuscular

Question 10

microscopic features of dilated cardiomyopathy

Answer 10

myocyte hypertrophy

myocyte attenuation (stretching)

sarcoplasmic degeneration

interstitial fibrosis

endocardial fibrosis

lymphocytic myocarditis

Question 11

microscopic features of restrictive cardiomyopathy

Answer 11

eosinophilic endomyocarditis

endocardial fibrosis

patchy or diffuse interstitial fibrosis

myocyte hypertrophy

Question 12

tumors of the heart

Answer 12

rare occurrence, most common is cardiac myxoma, involving the left atrium or the mitral valve

leads to impariment of ventricular filling

arise from endothelial cells

benign and treatable surgically

primary tumors of the heart:

lymphomas

paipllary fibroelastomas

rhabdomyomas

angiosarcomas

rhabdomyosarcomas

Question 13

cardiac amyloidosis

Answer 13

interstitial deposition of eosinophilic material

agranulation of myocytes

can present with a restrictive pattern

Question 14

sarcoidosis

Answer 14

a systemic granulomatous disease of undetermined etiology

involving lymp nodes, lung, liver, spleen, eyes, phalangeal bones, and parotid glands

Question 15

common causes of acute pericarditis

Answer 15

T = trauma, tumor

U = uremia

M = myocardial infarction and medications

O = other infections

R = rheumatoid, autoimmune disorder, radiation

Question 16

Dressler’s Syndrome

Answer 16

fever, pericarditis, pleuritis, low grade fever, pericardial friction rub

treat with high-dose aspirin

Question 17

effect of volume and timing of fluid accumulation on intrapericardial pressure

Answer 17

In a rapidly developing effusion, the pressure increases dramatically

In a slowly developing effusion, the same volume produces less pressure

Question 18

effect of volume and timing of fluid accumulation on cardiac function

Answer 18

Once the interpericardial pressure gets up to 10-15 mmHg, the pulse pressure goes way down

Can’t raise central venous pressure over 15 mmHg

When the intrapericardial pressure approaches 15mmHg, can’t get return to the heart

Result is cardiac tamponade