Flashcards in Cardiomyopathy, Myocarditis, Pericardial Disease Deck (26)
What is cardiomyopathy and what are the 3 types of cardiomyopathy?
Primary abnormality of the myocardium
-cardiac dysfunction not attributable to the pressure or volume overload
*primary disease of myocardium
1. dilated cardiomyopathy
2. hypertrophic cardiomyopathy
3. restrictive cardiomyopathy
What is dilated cardiomyopathy? What do you see on a trichrome stain?
1. most common
2. contractile (systolic) dysfunction
3. four chamber dilation
4. 2-3 X normal weight
myocyte hypertrophy and interstitial fibrosis
What are non-genetic causes of dilated cardiomyopathy?
2. peri partum
3. toxic (e.g. alcohol)
What are genetic causes of dilated cardiomyopathy?
cytoskeleton or mitochondria
-->defect in force generation, force transmission and or myocyte signaling
What does dilated cardiomyopathy lead to? How do you treat it?
progressive systolic congestive heart
-heart failure symptoms
-mural thrombi with embolic complications
What is hypertrophic cardiomyopathy? What does it lead to?
Idiopathic hypertrophic subaortic stenosis (IHSS)
Hypertrophic obstructive cardiomyopathy (HOCM)
1. marked LV myocardial hypertrophy
-septum>free wall hypertrophied -->banana shaped LV cavity
1. abnormal diastolic filling
2. left ventricular outflow obstruction
-anterior mitral valve leaflet contacts ventricular septum
What does hypertrophic cardiomyopathy look like histologically?
What are the causes of hypertrophic cardiomyopathy?
100% genetic causes
-mutation in genes that encode proteins of sarcomeres
What are some outcomes to hypertrophic cardiomyopathy? What are the treatments?
1. diastolic heart failure
2. exertional dyspnea
3. harsh systolic ejection murmur
4. anginal pain
5. intractable heart failure
6. arrhythmias-some have defib put in becuase can go into fatal arrhythmias
7. SUDDEN DEATH IN YOUNG ATHLETES
Medical therapy enhancing ventricular relaxation
Surgical excision of muscle
What is restrictive cardiomyopathy?
primary decrease in ventricular compliance
-ability to expand markedly limited
-impeded left ventricular filling during diastole
-systolic function preserved
-LV cavity size normal
What could cause restrictive cardiomyopathy?
idiopathic, radiation fibrosis, amyloidosis (amyloid build up), sarcoidosis (granulomas), inborn errors of metabolism, endocardial fibroelastosis, loeffler endomyocarditis (eosinophilia)
What is an amyloid?
deposits in extracellular space
causes tissue damage
multiple proteins can deposit as amyloid
1. beta pleated sheet configuraion
2. congo red staining in tissue
-apple green under polarized light
What is myocarditis?
inflammatory process resulting in myocardial injury
What are infectious ways of getting myocarditis?
1. Enterovirus- Coxsackie A and B
-most common etiology in US***
2. Borrelia burgdorferi-Lyme disease
1. Trypanosoma cruzi (Chaga's disease)
-endemic in areas of south africa
What are noninfectious ways of getting myocarditis?
1. Hypersensitivity reactions
2. Rheumatic fever
3. Giant cell myocarditis
What are clinical manifestations of myocarditis and what can it lead to?
1. Asymptomatic or nonspecific symptoms-fever, fatigue
-Congestive heart failure
-Acute congestive heart failure
-progression to dilated cardiomyopathy-virus resolves itself but still ongoing inflammatory injurty in heart
What can fill a pericardial effusion? What does a slow effusion do? What happens with a fast effusion?
clear yellow serous fluid-severe heart failure, blood-trauma or malignancy, or pus-bacterial
Slow: may not be clinically significant, globular enlargement of heart on CXR
Rapid: compress atria and vena cava, compress ventricles, restrict cardiac filling, cardiac tamponade
What is pericarditis? What causes it?
-inflammation of pericardium
-usually secondary to cardiac, thoracic, or systemic process
What is fibrinous pericarditis?
1. irregular shaggy pericardial surface
-acute viral pericarditis
-acute rheumatic fever
(bread and butter)
pericardial friction rub
What is suppurative (fibrinopurulent) pericarditis?
acute bacterial infection
What causes hemorrhagic pericarditis?
What causes caseous pericarditis?
What symptoms are seen with pericarditis?
-EKG changes (diffuse ST elevation)
What can happen in healing of pericarditis?
1. -Focal plaque-like thickening
2. Mild adhesions
3. constrictive pericarditis
What is constrictive pericarditis? How is it treated?
-pericardial space obliterated
-heart surrounded by dense scar
-diastolic expansion limitied-reduced cardiac output