Non Ischaemic Myocardial Disease

Question 1

What is cardiomyopathy?

Answer 1

Any disease of the cardiac muscle. Slide 4

Question 2

What can cardiomyopathy be classified into?

Answer 2

Dilated
Hypertrophic
Restrictive
Slide 5

Question 3

What is dilated cardiomyopathy?

Answer 3

A big heart, usually 2/3 times normal.

The heart is flabby and floppy. Slide 7

Question 4

What causes dilated cardiomyopathy?

Answer 4

50% Genetics
Toxins
Excessive alcohol
Chemotherapy agents. 
Cardiac infection (rare)
Pregnancy (rare) 
Slide 9-11

Question 5

What does dilated cardiomyopathy present clinically?

Answer 5

Usually the general picture of heart failure.
SOB
Poor exercise tolerance
Low cardiac output.
Slide 13

Question 6

What is hypertrophic cardiomyopathy and what are the causes?

Answer 6

Big solid hearts with disorganised myofibers.
They are hypertrophic and contract fine.
However they have diastolic dysfunction as the heart cannot relax.
Genetic causes e.g. myosin binding protein C. Slide 13, 14+16

Question 7

What is restrictive cardiomyopathy?

Answer 7

There is a lack of compliance due to the stiffness of the heart.
Diastolic dysfunction
Often looks normal. Slide 17

Question 8

What are causes of restrictive cardiomyopathy?

Answer 8

Can need a biopsy.
Deposition of something in the myocardium.
Metabolic byproducts e.g. iron
Amyloid
Sarcoid
Tumours
Slide 17+19

Question 9

What is amyloid?

Answer 9

Abnormal deposition of an abnormal protein in beta sheets where the body cannot get rid of them.
Slide 20

Question 10

Histologically, what does amyloid look like and how can it be detected?

Answer 10

It is a waxy pink.

Stains positively for Congo Red stain and then put under polarised light and turns apple green. Slide 23

Question 11

What is Arrhythmogenic Right Ventricular Dysplasia?

Answer 11

A genetic disease with syncope and arrhythmias and can result in sudden death.
It is when the right ventricle becomes replaced by fat and big and floppy. Slide 26+27

Question 12

What does infectious myocarditis look like and what are causes of it?

Answer 12

Thickened ‘beefy’ myocardium

Most causes are viral:
Coxsackie A and B
ECHO virus

Lyme’s disease
HIV
Chaga’s disease from S. America. Slide 31+32

Question 13

What are causes of non infectious myocarditis?

Answer 13

Hypersensitivity to infection - Rheumatic fever
Hypersensitivity to drugs - eosinophilic myocarditis.
SLE. Slide 34

Question 14

What is a sign of rheumatic fever histology?

Answer 14

Aschoff bodies

Slide 36

Question 15

What is pericarditis and what are causes?

Answer 15

Inflammation of pericardial layers.
Causes:
Infection 
Immune mediated (rheumatic fever)
Idopathic 
Renal favour
Slide 37

Question 16

What are complications of pericarditis?

Answer 16

Pericardial effusions
Tamponade
Constrictive pericarditis. Slide 43

Question 17

What organisms could cause endocarditis, where does it usually involve and how do the organisms aggregate?

Answer 17

It usually occurs on the valves.
THey aggregate in vegetations on the valves.
Haemophilus, actinobacillus, cardiobacteria, eikenella, kingella (HACEK)
For IV drug users:
Candida, staph aureus.
Prosthetic valves: S. epidermidis. Slide 46-48

Question 18

What systemic manifestations can occur from endocarditis?

Answer 18

Oslers nodes
Janeway lesions
Roth spots
Splinter Haemorrhages
Septicaemia
Septic emboli
Mycotic aneurysms. Slide 54

Question 19

What are causes of non infectious endocarditis?

Answer 19

Rheumatic fever
SLE
Non bacterial thrombotic endocarditis (marantic)
Slide 56

Question 20

What is non-bacterial thrombotic endocarditis?

Answer 20

NBTE
Small and multiple vegetations that don’t destroy heart valves.
Can cause embolic disease and are associated with cancer. Slide 57

Question 21

How can lupus cause endocarditis?

Answer 21

Libman sacks endocarditis

Small sterile emboli on undersurfaces of valves or on chords. Slide 59

Question 22

What is carcinoid heart disease?

Answer 22

Carcinoid tumours are neoplasms of neuroendocrine cells.

Slide 61

Question 23

What are signs and symptoms of carcinoid heart disease?

Answer 23

Excess serotonin, histamine, bradykinin produced by tumour.
Flushing
Nausea, D+V
Produces right sided cardiac valve disease. Slide 62

Question 24

What is an example of a tumour of the heart?

Answer 24

Atrial myxoma
Most common but still very rare
Is benign and can cause obstruction of the valves. Slide 65