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Flashcards in Cardiac histopath Deck (43):
1

Mechanical complications of MI (4)

1) Cardiogenic shock ( loss of muscle = ventricular dysfunction) 2) Heart failure 3) Rupture of papillary muscles - AR, rupture of ventricular wall - haemopericardium, septum - left to right shunt 4) Ventricular aneurysm

2

Arrythmias following MI

Most common AF, most likely to die VF (within 24hrs)

3

Pericardial complications following MI (3)

1) Pericarditis - just post MI 2) Dresslers - triad: chest pain + fever + effusion (weeks after) 3) Pericardial effusion

4

Path - 6 hours post MI

Normal histology

5

6-24 hours post MI histology (3)

Loss of nuclei homogenous cytoplasm Cell necrosis

6

1-4 days post MI histology

Invasion of polymorphs followed by macrophages

7

5-10 days post MI histology

Clearing of debris complete

8

1-2 weeks post MI histology (4)

Myofibroblasts Collagen synthesis Angiogenesis Granulation tissue

9

Weeks to months post MI histology(2)

Strengthening, decellularising scar tissue

10

Causes of HF (6)

IHD Arrythmias Valve disease HTN DCM Myocarditis

11

Complications of HF (7)

Arrythmias Sudden death Pulmonary oedema Pulmonary embolism Hepatic cirrhosis - nutmeg liver DVT Peripheral oedema

12

LV failure signs (3)

Pulmonary congestion leads to pulmonary oedema: 1) Dyspnoea 2) Orthopnea 3) PND 4) Wheeze

13

RV Failure signs (3)

Usually due to LHF, but can also be pulmonary HTN 1) Ascites 2) Peripheral oedema 3) Facial congestion

14

3 types of cardiomyopathies

Dilated Restrictive Hypertrophic

15

Causes of Dilated Cardiomyopathy (5) & mech (systolic or diastolic dysfunction)

Systolic dysfunction (LVEF) < 40%

  1. idiopathic
  2. alcohol
  3. genetic
  4. sarcoid
  5. haemachromatosis

16

Causes of Restrictive Cardiomyopathy

1) Amyloidosis 2) Sarcoidosis 3) Radiation induced fibrosis

17

Causes of Hypertrophic Cardiomyopathy

1) Genetic 2) Storage disease

18

Is there systolic or diastolic dysfunction in restrictive cardiomyopathy?

Diastolic

19

Is there systolic or diastolic dysfunction in hypertrophic cardiomyopathy?

Diastolic

20

What do you see in pt with HCM histologically? (1)

Myocyte disarray

21

Inheritance pattern of HCM?

Autosomal Dominant

22

Mutations in which genes in HCM? (3)

Genes encoding sarcomeric proteins:

1) bMHC - most common

2) Trop T - high risk of sudden death

3) MYBP-C

23

Arrythmogenic Right Ventricular Cardiomyopathy (ARVC)

Myocyte loss with fibrofatty replacement seen in RV

24

Which structure is affected in pt with ARVC?

Desmosomes of Cardiac muscle

25

Most common causative pathogen in acute rheumatic fever?

Lancefield Group A Strep Peak age 5-15 yrs

26

Pathophysiology of acute rheumatic fever (briefly)?

Antigen mimicry: react with myosin, troponin etc.

27

Diagnosis of Acute rheumatic fever? (2 things)

JONES Criteria + ASOT titres +ve

J - Joint involvement (migrating polyarthralgia) O - Heart is O shaped - myocarditis N - Nodules (sub cut) E - Erythema marginatum S - Syndenham's Chorea

28

Histology of Acute rheumatic fever (3 things)

1) Vegetations - beady &amp; fibrous like veruccae

2) Aschoff bodies - small giant cell granulomas

3) Anitschkov myocytes - regenerating myocytes

29

Pathology &amp; vegetation characteristics of infective endocarditis

Colonisation of valves by microbes

Large, irregular masses on valve cusps extending to chordae

30

Pathology of non-bacterial thrombotic endocarditis

DIC/ hypercoagulable states

31

Vegetation characteristics of non-bacterial thrombotic endocarditis

vegetations are formed of thrombi and attached to lines of closure

32

Path of Libman-Sacks endocarditis

Unknown, associated with SLE &amp; anti-phospholipid syndrome

33

Vegetation characteristics of Libman-Sacks endocarditis

Small, sterile platelet rich vegetations

34

Bacteriaemia in IE causes: (5)

1) Poor dental hygeine

2) Dental treatments

3) Cannulae and lines

4) IVDU

5) Cardiac surgery and pacemakers

35

Predisposing factors for IE - basically problems in valves ((5)

1) Calcified valves

2) Prosthetic valves

3) Prev rheumatic fever

4) Congenital defects

5) Mitral regurg

36

2 most common pathogens causing SUBACUTE IE:

Strep. Viridans &amp; S. Epidermis

37

2 most common pathogens causing ACUTE IE:

Strep Pyogenes &amp; S. Aureues

38

Clinical features of IE ( at least 6)

Fever Malaise Rigors

Roth Spots

Janeway lesions

Oslers nodes

Splinter Haemorrhages

New murmur

39

Most common Valves affected in IE

Aortic or mitral UNLESS IVDU

40

Treatment of IE

Benzylpenicillin + Gentamicin

41

Mitral valve prolapse Signs + symptoms

SOB &amp; Chest pain

Mid systolic click + Late systolic murmur

42

Causes of aortic regurg (3 categories)

1) Rigidity - rheumatic, degenerative

2) Destruction - IE

3) Dilation - valve can no longer cover increased SA: Marfans Cystic medial degeneration Dissecting aneurysm

43

Types of Pericarditis (4) &amp; causes

1) Fibrinous (MI, Uraemia)

2) Purulent (Staph)

3) Granulomatous (TB)

4) Haemorrhagic (Tumour, TB, Uraemia)