Myocarditis and Pericarditis

Question 1

Two categories myocardial disease

Answer 1

Cardiomyopathy

Specific heart muscle disease

Question 2

How do you diagnose myocarditis?

Answer 2

Endomyocardial biopsy

Question 3

Clinical associations with dilated cardiomyopathy

Answer 3

Gradual development of CF

4 chamber hypertrophy with dilation

Question 4

Causes of Dilated cardiomyopathy

Answer 4

Familial Causes
Alcohol
Previous Myocarditis
Pregnancy associated with nutritional deficiency

Question 5

Clinical picture of a dilated cardiomyopathy patient

Answer 5

Slowly developing CHF, progressive and unremitting
May have precipitous decompensation
50% die in 2 years – needs transplant

Question 6

Morphology of dilated cardiomyopathy

Answer 6

2-3X normal size hearts, all chambers
Mural Thrombi Common
Patchy Subendocardial Scars
Functional Mitral Regurg

Question 7

Histology of dilated cardiomyopathy

Answer 7

Hypertrophied myofibers, stretched

Interstitial and endocardial fibrosis

Question 8

Clinical associations of hypertrophic cardiomyopathy

Answer 8

Muscular hyper-contracting heart

HF from decreased chamber size, poor compliance, and lower SV

Question 9

Causes of hypertrophic cardiomyopathy

Answer 9

100% genetic – Sarcomere proteins or mitochondrial energy defects

Question 10

Problems seen in hypertrophic cardiomyopathy patients

Answer 10

Atril fibrillation w/ mural thrombus formation
Infective endocarditis on MV
Intractable CF
Sudden Death

Question 11

What is IHSS

Answer 11

Idiopathic hypertrophic subaortic stenosis

Question 12

Histology of hypertrophic cardiomyopathy

Answer 12

Extensive myocyte hypertrophy (diameter over 40um)

Myofiber disarray, interstitial and replacement fibrosis

Question 13

Restrictive Cardiomyopathy. Clinical associations

Answer 13

Inability of myocardium to expand, contractile fxn normal

Question 14

Causes of Restrictive Cardiomyopathy

Answer 14

Infiltrative diseases like

AMYLOIDOSIS, HEMACHROMATOSIS, LEUKEMIA, STORAGE DISEASES, RADIATION, CONSTRICTIVE PERI

Question 15

Three kinds or restrictive cardiomyopathy

Answer 15

Endocardial fibrosis
Loeffler’s endomyocarditis
Endocardial fibroelastosis

Question 16

What happens in endocardial fibrosis

Answer 16

Children/teens in Africa/Tropics
Fibrosis of endo and subendocardium
Can involve mitral/tri valve
Can lead to mural thrombi

Question 17

What happens in Loeffler’s endomyocarditis

Answer 17

No geographic restriction

EOSINOPHILS, leukoctosis

Question 18

What happens in Endocardial fibroelastosis

Answer 18

Focal or diffuse, Cartilage-like fibroelastic thickening
First 2 years
W/ other congenital abnormalities

Question 19

Adriamycin can cause…

Answer 19

toxicity from lipid peroxidation in the heart
Swelling and vacuolization
Fix by stopping the drug

Question 20

What is seen on the heart with pheochromocytoma

Answer 20

Contraction band necrosis

Question 21

Common Infectious causes of myocarditis

Answer 21

Usually viral + immune attack (CocsackieAorB, Echo, Polio)
Chagas Disease
Trichinosis
Diptheria
Lyme
AIDS

Question 22

Noninfectious causes of myocarditis

Answer 22

Drug hypersensitivity
Rheumatic Fever
SLE
Sarcoidosis

Question 23

Morphology of myocarditis

Answer 23

Diffuse of patchy involvement
Interstitial mono nuclear, predominantly lymphocytic inflammatory infiltrate.
Focal necrosis

Question 24

Describe giant cell myocarditis

Answer 24

Widespread inflammatory cellular infiltrate containing multinucleate giant cells, interspersed with lymphocytes, eosinophils, plasma cells, and macrophages with necrosis

Question 25

Six kinds of pericarditis

Answer 25

``` Serous Fibrinous/Serofibrinous Purulent/Suppurative Hemorrhagic Caseous Chronic ```

Question 26

Serous pericarditis -- Important details

Answer 26

Non-infectious inflammation (RF, SLE, Scleroderma, Tumors, Uremia)

Question 27

Most frequent type of pericarditis

Answer 27

Fibrinous and serofibrinous pericarditis

Question 28

Causes of Fibrinous and serofibrinous pericarditis

Answer 28

MI, Dresler's Syndrome, Uremia, Radiation, Rheumatic Fever, Trauma

Question 29

What is Dressler's Syndrome

Answer 29

autoimmune condition which appears several weeks following MI

Question 30

Most common primary tumor of the heart in children? adults?

Answer 30

Kids -- Rhabdomyosarcoma | Adults -- Myxoma

Question 31

Why is chronic pericarditis a misnomer?

Answer 31

Healed stage of acute pericardial inflammation Results in plaque like thickenings, obliteration of sac in worst forms Dense fibroadhesions may result in constrictive pericarditis, reduction of CO

Question 32

What is adhesive mediastinopericarditis?

Answer 32

Pericardial sac is obliterated and the cardiac structures are adhered to, making the heart work much harder. Massive cardiac hypertrophy ad dilation

Question 33

Usual cause of adhesive mediastinopericarditis?

Answer 33

Chest irradiation

Question 34

Beriberi is associated with...

Answer 34

Dilated myocardial disease