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Cardiovascular > Pathology 3 > Flashcards

Pathology 3 Flashcards

1
Q

What is cardiomyopathy? What does it result in?

A
  • Any disease of cardiac muscle

* Changes in size of heart chambers and thickness of heart

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2
Q

What are classifications of cardiomyopathy? (4)

A
  • Dilated
  • Hypertrophic
  • Restrictive
  • Arrythmogenic right ventricular dysplasia
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3
Q

What is dilated cardiomyopathy? Histology?

A
  • Floppy heart that is 2-3 times bigger than normal (350g)

* Histology (microscope) features are non-specific

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4
Q

Causes of dilated CM? (4)

A
  • Genetics (50%) - genes that code for heart muscle proteins
  • Alcohol (very common in alcoholics)
  • Toxins
  • Chemotherapy agents e.g. doxorubicin (important to assess heart prior to commencing chemo)
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5
Q

Rare causes of dilated CM? (2)

Clinical features? (2)

A
  • Cardiac infection
  • Pregnancy

Clinical features

  • SOB
  • Poor exercise tolerance
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6
Q

What is hypertrophic cardiomyopathy? What does it result in? Why is it significant?

A
  • Big solid heart (not like DCM)
  • Results in diastolic dysfunction (systole is fine but heart cannot relax) so causes outflow obstruction
  • Significant because cause of sudden death in young athletes
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7
Q

Causes of hypertrophic CM?

A

Majority genetic e.g. beta myosin heavy chain, myosin binding protein C, alpha tropomyosin

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8
Q

Features of hypertrophic CM heart? (3)

Is the heart not healthier because it has stronger contraction? Why??

A
  • Bulging intraventricular septum
  • Outflow obstruction
  • LV luminal reduction due to massive walls

NO, it is pathological - coronary arteries that supply heart do not increase in size so will have areas of hypoxia/ischaemia

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9
Q

Histology of hypertrophic CM?

A

Disorganised myofibres - swirls rather than linear

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10
Q

What is restrictive cardiomyopathy? What does it result in? (2)

A
  • Lack of compliance due to rigidity - cannot stretch (relax) and fill so cannot contract properly to maintain CO
  • Diastolic dysfunction due to lack of filling
  • Bilateral dilation as a result of back pressure
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11
Q

Causes of restrictive CM? (5)

A

Deposition of something in myocardium

  • Metabolic byproducts e.g. iron
  • Amyloid
  • Sarcoid
  • Tumours
  • Fibrosis (following infection etc)
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12
Q

What is amyloidosis?

A

Cause of restrictive CM - abnormal deposition of abnormal protein throughout body

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13
Q

Classification of amyloidosis?

A
  • AA - related to chronic diseases like rheumatoid
  • AL - light chains, abnormal immunoglobulin
  • Haemodialysis….
    ……
    See post-lecture slides
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14
Q

What tissues do amyloids affect? What is a cause of some forms of amyloidosis?

A
  • All can affect the heart
  • Some are isolated to heart e.g. senile cardiac amyloidosis
  • May be localised to atrium
  • Can be inherited
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15
Q

Histology of amyloidosis? What systems does amyloidosis affect?

A
  • Waxy pink material
  • Amyloid protein staisn positive for “congo red” dye
  • Under polarised light, exhibits green birefringence
  • Pan-systemic - every single vessel will contain protein
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16
Q

What is arrythmogenic right ventricular dysplasia? What are the effects? (2) What are sufferers prone to?

A
  • Inherited disease - autosomal dominant with low penetrance so even though inherited, may not have disease
  • Right ventricle becomes largerly replaced by fat
  • Big and floppy, so non-contracile and prone to arrhythmias
  • Sufferers prone to sudden death
17
Q

What is myocarditis? Classifications? Most common cause?

A
  • Inflammation of the heart
  • Infectious vs non-infectious
  • Most commonly infectious e.g. viral, bacterial, fungal, protozoal, helminthic
18
Q

Most common cause of infectious myocarditis? Examples? (5)

A

Most are viral

  • e.g. Coxsackie A and B
  • ECHO virus
  • Chaga’s disease - trypanosomiases in South America
  • Borrelia burgdorferi - Lyme’s disease
  • HIV
19
Q

Features of infectious myocarditis heart? Histology?

A
  • Thickened beefy myocardium

* Inflammatory infilrate on cardiac biopsy

20
Q

Cause of non-infectious myocarditis? Examples? (3)

A

Immune mediated hypersensitivity reactions

  • Hypersensitivity to infection e.g. rheumatic fever after strep throat
  • Hypersensitivty to drugs e.g. eosinophilic myocarditis
  • Systemic lupus erythematous (SLE)
21
Q

Cardiac features of rheumatic fever? (4)

A
  • Mitral stenosis with thickening and fusion of valve leaflets
  • Short, thick chordae tendinae
  • Myocardium also inflammed
  • Aschoff bodies (immune cells, lymphocytes, macrophages - not quite a granuloma as central destruction region)
22
Q

Pericarditis? Causes? (6)

A

Inflammation of pericardial layers

  • Infection
  • Immune mediated e.g. rheumatic fever
  • Idiopathic
  • Uraemic e.g. renal failure
  • Post-MI e.g. Dressler’s syndrome
  • Connective tissue disease e.g. SLE
23
Q

Examples of infectious pericarditis? (4)

A
  • Virus - esp ECHO virus produce serous effusions
  • Bacterial - from elsewhere e.g. pneumonia resulting in purulent effusions
  • Fungi - immunosuppressed, post-transplant, produce purulent effusions
  • Tuberculus - caseous material in sac - produces CONSTRICTIVE pericarditis
24
Q

Uraemic pericarditis? Pericarditis post-MI?

A
  • Urea build-up can cause inflammation of pericardium

* Dressler’s syndrome (many weeks post-MI)

25
Q

Complications of pericarditis? (5)

A
  • Pericardial effusion
  • Tamponade
  • Constrictive pericarditis - fibrotic response, when collagen cross links it contracts, constricting the heart
  • Cardiac failure
  • Death
26
Q

Endocarditis? Classifications?

A
  • Affects heart lining but generally refers to inflammation of the valves
  • Infectious or non-infectious
27
Q

Causes of infectious endocarditis? (5)

A
  • Virulent bacterial or fungal infection
  • IV drug abuse and septicaemia e.g. staph aureus
  • Prosthetic valves
  • Congenital heart disease
  • Calcific disease
28
Q

Microbiology of infectious endocarditis?

A

????

Post lecture

29
Q

Pathology of infectious endocarditis? (2)

A
  • VEGETATIONS on heart valves
  • Bacteria cause acute inflammation and bacterial and inflammatory cell products digest valve leaflets

….more post lecture

30
Q

Cardiac complications of infectious endocarditis? (4)

A
  • Acute valvular incompetence
  • Cardiac output failure
  • Abscesses
  • Fistulae

MORE????

31
Q

Systemic effects of infectious endocarditis? (5)

A
  • Osler’s nodes
  • Janeway lesions
  • Roth spots
  • Finger clubbing
  • Splinter haemorrhages

…MORE :(

32
Q

Non-infectious endocarditis?

A

See fucking post-lecture slides

33
Q

Non-bacterial thrombotic endocarditis (NBTE)? Effects? (2) Associated with?

A

Non-invasive and doesn’t destroy valves

  • Small and multiple vegetations
  • Embolic disease

Associated with

  • Cancer (marantic) esp mucinous adenocarcinomas
  • Hypercoagulable states
34
Q

What endocarditis is systemic lupus erythematous associated with? Effects? (3)

A

Libman-Sacks endocarditis

  • Often asymptomatic
  • Small sterile emboli
  • Affects valves/chords
35
Q

Carcinoid heart disease…

A

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Cardiovascular (28 decks)

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