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MD2 Ambulatory Care and Emergency Medicine > Cardiac Pathology > Flashcards

Cardiac Pathology Flashcards

1
Q

What is the adverse effect of taking verapamil and a beta blocker together?

A

Dangerous bradycardia

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2
Q

What is hypertrophic cardiomyopathy?

A

Variable hypertrophy in distribution and extent of LV/both ventricles

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3
Q

What are the morphological features of hypertrophic cardiomyopathy?

A

Myocyte hypertrophy and disarray
Interstitial fibrosis
Thickened intima of small intramyocardial arteries

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4
Q

What are the different pathophysiologies of hypertrophic cardiomyopathy?

A

Impaired ventricular compliance > diastolic failure
Impaired LV outflow
Ischaemia from increased muscle mass and abnormal intramyocardial arteries +/- increased wall stress related to outflow obstruction

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5
Q

What is the clinical picture of hypertrophic cardiomyopathy?

A 
Asymptomatic
Due to ischaemia +/- increased wall stress
- Arrhythmias
- Angina
- Heart failure
Due to abnormal myofibres
- Arrhythmias
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6
Q

When does hypertrophic cardiomyopathy usually present?

A

Before 4th decade

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7
Q

What is the aetiology of hypertrophic cardiomyopathy?

A

Genetic

  • Autosomal dominant
  • Mutations in genes encoding sarcomeric proteins
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8
Q

Where do watershed infarcts occur?

A

Borders between cerebral vascular territories > little-no anastamoses

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9
Q

What are the two different types of acute tubular necrosis?

A

Ischaemic

Nephrotoxic

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10
Q

What pathology happens in shock to the major organs?

A

Acute myocardial ischaemia > subendocardial necrosis
Kidney - acute tubular necrosis
Liver - centrilobular necrosis
Acute respiratory distress syndrome/diffuse alveolar damage

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11
Q

What is the most common type of cardiomyopathy?

A

Idiopathic dilated cardiomyopathy

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12
Q

What does idiopathic dilated cardiomyopathy do?

A

Dilation and impaired contraction of LV/both ventricles

Often also affects atria

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13
Q

What is the morphology of idiopathic dilated cardiomyopathy?

A

Eccentric hypertrophy of LV +/- RV
Myocyte hypertrophy
Interstitial and endocardial fibrosis

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14
Q

When does idiopathic dilated cardiomyopathy often become apparent?

A

3rd-4th decade of life

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15
Q

What are the clinical features of idiopathic dilated cardiomyopathy?

A 
Deteriorating biventricular failure
Arrhythmias
- Sudden death
Thromboembolic complications
Steady course +/- improvement
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16
Q

What is the aetiology of idiopathic dilated cardiomyopathy?

A 
Genetic
Possible factors
- Viral
- Toxic
- Autoimmune
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17
Q

What are some conditions in which dilated cardiomyopathy can occur?

A 
Peripartum period
Haemochromatosis
Alcohol
Certain drugs
Ischaemia
Some neuromusuclar diseases; eg: Duchenne's muscular dystrophy
18
Q

What is restrictive cardiomyopathy?

A

Rigid but not necessarily thickened ventricles

Impaired diastolic filling > failure

19
Q

What is restrictive cardiomyopathy related to?

A

Fibrosis of endomyocardium

Infiltration of myocardium; eg: amyloid in primary/secondary/senile amyloidosis

20
Q

What is arrhythmogenic right ventricular cardiomyopathy?

A

Replacement of cardiomyocytes by fibro-fatty tissue
Serious arrhythmias
Sudden death

21
Q

What is the aetiology of arrhythmogenic right ventricular cardiomyopathy?

A

Autosomal dominant

Variable penetrance

22
Q

What is myocarditis?

A

Inflammation and necrosis/degeneration of myocytes

23
Q

What are the causes of myocarditis?

A 
Infection
Sarcoidosis
Giant cell myocarditis
Acute rheumatic fever
Toxic 
Drugs
Transplant rejection
24
Q

What viruses can cause myocarditis?

A

Coxsackie

Echoviruses

25
Q

What protozoans can cause myocarditis?

A

Chaga’s disease

Toxoplasma

26
Q

What causes toxic myocarditis?

A

Diphtheria

27
Q

How can drugs cause myocarditis?

A

Hypersensitivity

Cardiotoxic

28
Q

What is the most common type of myocarditis?

A

Viral

29
Q

What is the microscopic appearance of viral myocarditis?

A

Patchy mononuclear infiltrate

Myocardial necrosis

30
Q

What is the macroscopic appearance of viral myocarditis?

A

Mottled/dilated/normal

31
Q

What are the clinical features of viral myocarditis?

A 
Asymptomatic
Flu-like illness
Chest pain
Syncope
Rapid onset heart failure
Arrhythmias
Sudden death
32
Q

What are the outcomes of viral myocarditis?

A

Resolution
Rapid deterioration
Slow progression to dilated cardiomyopathy

33
Q

What are the complications of cardiac sarcoid?

A

Arrhythmias
Heart failure
Sudden death

34
Q

What is sudden death?

A

Unexpected fatal event within 1 hour of beginning of symptoms/without symptoms in apparently healthy subject/not severe disease

35
Q

What is the pathophysiology of ventricular tachyarrhythmias?

A

Automaticity of diseased ventricular myocytes
Wave propagation of ventricular impulse interrupted by diseased muscle > intraventricular re-entry
Abnormalities of repolarisation

36
Q

What are some causes of sudden cardiac death in young people due to coronary artery disease?

A 
Congenital coronary artery anomalies
Vasculitis
Coronary emboli
Spontaneous dissection
Atherosclerosis
37
Q

What are some causes of sudden cardiac death in young people due to the myocardium?

A 
Hypertrophic cardiomyopathy
Dilated cardiomyopathy
Arrhythmogenic cardiomyopathy
Myocarditis
LVH of >50% by mass
38
Q

What are some causes of sudden cardiac death in young people due to morphological conduction pathways?

A

Wolf-Parkinson-White disease
Sarcoidosis
Autoimmune associated inflammation; eg: ankylosing spondylitis

39
Q

What are some causes of sudden cardiac death in young people due to valves?

A

Congenital aortic stenosis > LVH

Floppy/myxomatous mitral valve

40
Q

What are some causes of sudden cardiac death in young people that are acquired?

A 
Thiuzides
Macrolides
Methodone
Halperidol
Selective reuptake inhibitors
Antihistamines
Hypothyroidism
Hypocalcaemia
Cocaine
41
Q

What can cause an aortic rupture?

A

Dissection

Infection

42
Q

How can aortic dissection cause death?

A

Haemopericardium > tamponade
Coronary artery narrowing > myocardial ischaemia/infarction
Rupture > hypovolaemia
Acute aortic valve incompetence

MD2 Ambulatory Care and Emergency Medicine (29 decks)

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