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68 Cards in this Set

  • Front
  • Back
what is myocarditis
inflamm process that results in injury to cardiac myocytes, interstitium, vascular tissue and/or pericardium
most common type of infective myocarditis
viral
-coxsackie (ECHO, CMV, influenza, poliomyelits, HIV)
bacterial infective myocarditis
-sepsis, emboli, direct extension
-staph, strep, meningococcus, leptospirosis
-lyme
-exotoxin
fungal infective myocarditis
candida, aspergillus, cryptococcus
most common protozoa causing infective myocarditis
toxoplasmosis
chaga's dz (direct myofiber parasitization, apical LV aneurysms)
metazoa cause of infective myocarditis
trichinella
-encyst in skeletal muscle
pathological findings in sarcoid noninfective myocarditis
-non-caseating granulomas
-focal areas of non-specific lymphocytic myocarditis
2 types of immunologic non-infective myocarditis
1) eosinophilic myocarditis
2) necrotizing eosinophilic myocarditis
cardiotoxicity caused by chemicals with pathological findings
antineoplastic agents: anthracyclines (lipid peroxidation of myocyte membranes), cyclophasphamide (vascular injury leads to myocardial hemorrhage), interferon

CAs and sympathomimetics:
(contraction band necrosis)
amphetamines, cocaine, ethanol
contraction band necrosis
individual fibers will hypercontract and tear themselves apart
clincial presentation of myocarditis
CHF - heart dilated
dysrhythmia
pathological presentation of:
viral myocarditis
lymphocytic
pathological presentation of:
allograft rejection
lymphocytic
pathological presentation of:
salmonella
lymphocytic
pathological presentation of:
bacterial
suppurative
pathological presentation of:
fungi
granulomatous
pathological presentation of:
sarcoid
granulomatous
pathological presentation of:
acid-fast bacteria
granulomatous
pathological presentation of:
giant cell
granulomatous
pathological presentation of:
hypersensititivity
eosinophillic
pathological presentation of:
parasites
eosinophilic
pathological presentation of:
asthma
eosinophilic
pathological presentation of:
necrotizing eosinophilic myocarditis
eosinophilic
pathological presentation of:
CA and sympathomimetics
contraction band necrosis
pathological presentation of:
anthracyclines
vacuolization and myofibril loss
what is cardiomyopathy
HD due to primary abnormality not HTN, CHD, valvular dz, or CAD

characterized by otherwise unexplained ventricular dysfunction
pathophysiology of dilated/congestive cardiomyopathy
impaired myocardial contraction and progressive chamber dilation
etiologies of dilated/congestive cardiomyopathy
-postinflammatory (viral, sarcoid)
-nutritional/toxic (alcoholism, thiamine deficiency)
-heritable (AD, cytoskeleton)
-peripartum (early in pregancy)
mutant cytoskeletal proteins seen in dilated/congestive cardiomyopathy
dystrophin, desmin, sarcolemic proteins: cardiac myosin heavy chain, mito proteins
pathological findings in dilated/congestive cardiomyopathy
-progressive 4-chamber hypertrophy and dilatation
-mural thrombi
-interstitial fibrosis
-vent endocardial fibrosis
right ventricular cardiomyopathy cuases
sporadic or familial
-AD
-chrom 14
-relation to Naxos syndrome (plantar palmar hyperkeratosis, abnormal gene codes from plakoglobin)
pathological findings of ARVD
-focal thinning of RV wall
-fatty infiltration and fibrosis
-subepicardial fibrosis of LV - foamy appearance of myofibrils
presentation of ARVD
-gradual replacement of RV muscle by fat
-arrythmias (v-tach)
-sudden death
pathophysiology of hypertrophic cardiomyopathy
hypertrophic, hypercontractile, poor compliance
what causes hypertrophic cardiomyopathy
mutations: encoding for sarcomeric proteins (B myosin heavy chain chrom 14, cardiac troponin T and O, myosin-binding protein C, alpha tropomyosin myosin light chain)

AD, variable expression
microscopic characteristics of hypertrophic cardiomyopathy
disoriented, tangled, and hypertrophied myocardial fibers
pathologic findings in hypertrophic cardiomyopathy
-disproportionate hypertrophy of IVS (asymmetrical) - localized, subaortic (most common), midventricular, apical
-small LV chamber size
-interventricular septum myofiber disarray - quilt on microscope
-dilated atria
-thickened mitral valve
-LV outflow track endocardial fibrosis
clinical presentation of hypertrophic cardiomyopathy
26 years
-dyspnea
-obstructive symptoms - syncope, dizziness, chest pain
-dysrhytmia
-CHF
risk of LV outflow track endocardial fibrosis
-danger of syncope
-sudden death
-young athletes
complications of hypertrophic cardiomyopathy
a fib with mural thrombosis
mitral valve IE
CHF
sudden death
idiopathic concentric LVH
-myofiber disarray lacking
-unrecognized chronic HTN
-HCM
pathophysiology of restrictive cardiomyopathy
diminished ventricular distensibility
-imparied diastolic filling
-loss of systolic function not prominent feature
-stiffening
-infiltrative process that interfere with pumping action
idiopathic RCM findings
-normal size or slightly enlarged ventricles having firm walls
-atrial enlargement
-interstitial fibrosis
-hypertrophy not prominent feature
secondary restrictive HD 4 types
-amyloid
-endomyocardial fibrosis
-loefflers endocarditis
-endocardial fibroelastosis
-fibrosis caused by radiation therapy
amyloid as secondary RCM
-senile cardiac amyloid
-atrial and ventricular forms: isolated atrial amyloidosis deposits consist of ANP; atrioventricular form protein related to transthyretin
-all layers of heart can be involved: cnal ead to myofiber atrophy and cause dysrrthymias
EMF details
-african children and young adults
-subendocardial fibrosis of ventricles
-variable inflammation
loefflers endocarditis
-endomyocardial fibrosis
-mural thrombi
-peripheral and tissue eosinophilia
endocardial fibroelastosis
-porcelain hearts
-focal or diffuse endocardial thickening - not myocardium
-usually LV
-course is proportional to severity
most common primary cardiac tumor
myxoma
myxoma details
-true neoplasm
-LA in fossa ovalis area
-pedunculated, gelatinous, soft - may be hemorrhagic
-multipotential mesenchymal cells
clinical presentation of myxoma
-valve dysfunction
-embolization
-constitutional symptoms (malaise, fever) due to secretion of IL6
-carney syndrome
rhabdomyoma findings
spider cells
-msot common primary cardiac in children
-ventricular
-hamartomas
-assoc with tuberous sclerosis: nonmalignant tumors to grow in brain; devo delay, seizures, behavoir problems
most common primary cardiac malignant tumor

location
angiosarcoma

RA or pericardium
second most common primary cardiac malignancy
rhabdomyosarcoma
intrapericardial cardiac tumor
teratocarcinoma
location of papillary fibroelastoma
usually on valves
R - children
L - adults
secondary tumors most commonly involve
pericardium
-may cause effusion
types of fluid accumulation in percardial dz
effusion (serous, fibrinous)
blood
pus
hydropericardium
accum of serious transudate in pericardial sac
-systemic edema from CHF and other edematous conditions
serous acute pericarditis
clear, straw colored protein rich exudate with inflamm cells
serous acute pericarditis associated with
systemic lupus erythematosus, rheumatic fever, viral infections
fibrinous acure pericarditis associated with
MI, uremia, rheumatic fever

fibrin rich exudate
appearnace of fibrinous acute pericarditis
dry, finely granular, dull

serofibrinous: more inflammation and more thicker fluid (yellow-red)
purulent acute pericarditis infection
direct extension
blood seeding
lymph extension
direct introduction during surgery/trauma
presentation of purulent acute pericarditis
-grossly, cloudy or frankly purulent inflamm exudate
-caused by bacterial infection
-red, granular, exudates
hemorrhagic acute pericarditis presentation
-blood and fibrin/ suppuration
-malignant tumor involving pericardium; granular appearance
-bacterial and tubercular infections
chronic/healed pericarditis presentation
-fibrous tissue with small foci of calcification
-fibrous thickening and scarring of pericardium w/ loss of elasticity
-dec cardiac action and venous return
-mimicking signs and symptoms of RHF
cause of chronic/healed pericarditis
tuberculosis or pyrogenic staph