Cv - Path Of Myocardial And Pericardial Disease

Front 1

cardiomyopathy general definition

Back 1

heart disease resulting from abnormality IN the myocardium

primary (don't know cause)
secondary (do know cause) - inflammation, toxin, etc

Front 2

diagnosis of cardiomyopathy

Back 2

endomyocardial biopsy is gold standard

Front 3

cardiomyopathy types

Back 3

dilated (congestive) - most common - ventricle is dilated with a larger lumen

hypertrophic - thick walls (with myofiber diarray often asymmetric dilation), small lumen

restrictive - least common - infiltrative -> noncompliant

Front 4

dialated congestive cardiomyopathy etiology

Back 4

heart progressively dialates

compensation by hypertrophy

eventually get contractile dysfunction -> decreased ejection fraction -> congestive heart failure

cause:
genetics - autodom - abnormal cytoskeletal proteins

myocarditis

ALCOHOL!!!!!!, drugs, hemochromatosis)

pregnancy - peripartum CM

Front 5

dialated congestive cardiomyopathy morphology

Back 5

flabby cardiomegaly - 4 chambers dialate and get insufficiency of valves

hypertrophy

mural thrumbi form

interstitial fibrosis

NOTE: morphologic change does not necessarily indicate severity

Front 6

hypertrophic cardiomyopathy characteristics/etiology

Back 6

get hypercontraction due to myocardial hypertrophy

hypertrophy causes a poorly compliant LV -> impaired filling

intermittent ventricular outflow obstruction due to thick septum blocking

----> decreased cardiac output

cause:
mutation in gene that encode sarcomeric proteins (most commonly myosin heavy chain)

Front 7

hypertrophic cardiomyopathy morphology

Back 7

see myocardial hypertrophy especially in the septum

heart gets real big - muscle fibers are unorganized - bad for electrical conduction -> arrhythmia

no ventricular dilation, but blockage of outflow and resultant mitral regurg will cause LEFT ATRIAL dilation

microscopic:
myocyte hypertrophy
myofiber disarry
interstitial fibrosis

Front 8

restrictive (infiltrative) cardiomyopathy

Back 8

primary decrease in ventricular compliance -> impaired filling during diastole -> decreased CO

systole uneffected

myocardial infiltration/fribrosis can cause arrythmias

cause:
amyloidosis
radiation fibrosis
sarcoidosis
others...

microscopic:
idiopathic -> interstitial fibrosis
disease specific findings

Front 9

myocarditis general definition, causes

Back 9

myocardial inflammation -> myocardial injury

infections - most often

coxsackievirus B most common in the US
chagas disease also very common

Front 10

myocarditis morpholgy

Back 10

mottled tissue with hemorrhagic areas

can be enlarged, flabby, thrombi formation

microscopic:
interstitial inflammation starts as focal then becomes diffuse

myocyte necrosis

inflammation will depend on type of infection (viral, fungi, bacterial, hypersensitivity)

Front 11

T/F large amounts of neutrophils in myocarditis always indicate bacterial infection

Back 11

false: bacterial myocarditis is rare, more likely a MI (also associated with neutrophils)

Front 12

giant cell myocarditis

Back 12

see mixed inflammatory cell infiltrate + multinucleate giant cells

extensive necrosis

very bad - treat with cardiac transplant

Front 13

myocarditis most likely effects who?

Back 13

mostly kids 1-10 years old

severe in infants and pregnant women

Front 14

cardiac transplant most common indication

Back 14

dilated cardiomyopathy

ischemic heart disease

Front 15

cardiac transplantation complications

Back 15

allograft rejection - lymphocyte infiltration

diffuse stenosing intimal proliferation - graft arteriopathy - low level rejection -> neointima formation of intamural arteries

Front 16

pericardial effusions types

Back 16

serous - systemic edema

chylous - due to communication with thoracic duct or lymph obstruction

serosanguinous - trauma

hemopericardium - blood in pericardial sac due to myocardial infarct, penetrating trauma, ruptured dissection, bleeding diathesis

consequences depend on how rapid the fluid accumulates

Front 17

acute pericarditis types

Back 17

serous effusion with little mixed inflammatory cell

fibrinous

hemorrhagic

purulent

caseous

Front 18

fibrinous pericarditis

Back 18

most common form of pericarditis

see with:
MI, autoimmune (SLE, RA, dressler), uremia, chest radiation, trauma

see fibrinous exudate "bread and butter" pericarditis

cloudy effusion with leukocytes, erythrocytes

Front 19

dressler syndrome

Back 19

autoimmune disease seen after MI

damage to myocardium releases antigens that simulate immune response

Front 20

mediastinopericarditis

Back 20

extension of bacterial/purulent pericarditis into the mediastium

Front 21

constrictive pericarditis

Back 21

purulent/bacterial pericarditis can cause fibrosis which encases the heart and makes it difficult for the heart to expand and fill - resembles restrictive cardiomyopathy

Front 22

acute pericarditis - hemorrhagic form

Back 22

acute pericarditis can be hemorrhagic or caseous


hemorrhagic:
blood mixed with fibrinous or suppurative effusion

causes:
malignant neoplasm of pericardial space (most common)

bacterial infection

bleeding diathesis

Front 23

acute pericarditis - caseous

Back 23

caused by TB most often, rearely fungal

-> fibrocalcific chronic constrictive pericarditis - very severe

Front 24

chronic pericarditis

Back 24

healed pericarditis

localized form(soldier's plaque) - focal - see epicardial plaque
_________
adhesive form - diffuse -> adhesions and obliteration of pericardial sac

usually adhesive form has no effect on cardiac function except with mediastinopericarditis - adhesions of parietal pericardium to surrounding structures -> heart strain -> hypertrophy
_________

constrictive pericarditis - idiopathic - ecnasement of heart in dense fibrous scar -> limits diastolic expansion -> decreased CO