Pathology Of Heart Failure - Rush

Front 1

In pressure overload, the predominant heart alteration seen is _________.

Back 1

hypertrophy

Front 2

In ___________ overload, chamber dilation is the predominant alteration.

Back 2

volume

Front 3

In end stage heart failure, which morphologic changes are usually seen?

Back 3

both - hypertrophy and dilation

Front 4

Changes to cells in concentric hypertrophy

Back 4

-cells become wider, but not longer
-wall becomes thicker (hypertrophy not dilation)

Front 5

Sarcomere arrangement in concentric hypertrophy

Back 5

more sarcomeres are produced and arranged in parallel

Front 6

Changes to cells in eccentric hypertrophy

Back 6

-cells become wider AND longer
-chamber dilates in proportion to increased thickness (wall thickness may be normal or even below normal)

Front 7

How can you measure dilation?

Back 7

Heart weight (since wall thickness may be normal or below normal)

Front 8

Sarcomere arrangement in eccentric hypertrophy

Back 8

-more are produced and arranged in series

Front 9

Hypertensive heart disease would primarily result in what kind of hypertrophy?

Back 9

concentric

Front 10

Cor Pulmonale (Isolated Right Heart failure) would result in what? What causes it?

Back 10

right ventricular dilation - due to pulmonary hypertension

Front 11

What changes would result from mitral valve insufficiency?

Back 11

left atrial dilation

Front 12

What is the most common cause of heart failure?

Back 12

ischemic heart disease

Front 13

In addition to elements of both dilation and hypertrophy, what changes would you see in ischemic heart disease?

Back 13

atherosclerosis of coronary arteries and perhaps old areas of infarct

Front 14

Normal heart weight

Back 14

250-350g

Front 15

The greatest increase in heart mass would result from what two abnormalities?

Back 15

aortic regurgitation or hypertrophic cardiomyopathy (HCM)

Front 16

Three main classes of cardiomyopathies

Back 16

-dilated
-hypertrophic
-restrictive

Front 17

What is the most common type of cardiomyopathy?

Back 17

dilated

Front 18

What is the least common cardiomyopathy?

Back 18

restrictive

Front 19

Dilated cardiomyopathy is characterized by a dilated ________________ and ____________ dysfunction.

Back 19

ventricular chamber; systolic

Front 20

It typically becomes apparent between the ages of ________.

Back 20

20-50

Front 21

Five possible etiologies of DCM

Back 21

-genetic
-myocarditis
-alcohol
-pregnancy
-idiopathic (many may be myocarditis)

Front 22

Most common cause of DCM

Back 22

genetic (20-50%)

Front 23

What kinds of gene mutations can cause DCM?

Back 23

-mutations in genes involving cytoskeletal proteins
-mutations in mitochondrial DNA

Front 24

X-Linked DCM is caused by a dysfunction in what gene

Back 24

dystrophin (a cytoskeletal protein)

Front 25

What kind of genetic mutations are the most common cause of DCM presenting in childhood?

Back 25

mitochondrial DNA mutation

Front 26

In myocarditis, the cause of injury is what?

Back 26

inflammation

Front 27

Acute myocarditis will present with what symptoms?

Back 27

fatigue, dyspnea, palpitations, fever, precordial pain

Front 28

Type of cardiomyopathy caused by alcohol and chemotherapeutic agents

Back 28

toxic cardiomyopathy

Front 29

When in pregnancy does peripartum cardiomyopathy present?

Back 29

third trimester or first 6 months post-partum

Front 30

What is the most common outcome?

Back 30

spontaneous recovery

Front 31

Genetic condition in which the ventricle (right more commonly than left) is severely thinned (myocyte loss) and replaced by fatty infiltration and interstitial fibrosis

Back 31

Arrythmogenic Right Ventricular Cardiomyopathy

Front 32

An individual with a "banana-shaped" LV showing asymmetric septal hypertrophy may have what?

Back 32

HCM/HOCM/IHSS

Front 33

What is HCM/HOCM/IHSS?

Back 33

Hypertrophic (obstructive) cardiomyopathy or idiopathic hypertrophic subaortic stenosis - left ventricular hypertrophy without systemic disease causing it (a primary cardiomyopathy)

Front 34

Mutations in genes responsible for what cause HOCM?

Back 34

proteins of the contractile unit - the sarcomere

Front 35

The most common genetic mutation responsible for HOCM is what?

Back 35

mutation in the beta-myosin heavy chain

(other common mutations - in toponin-T and myosin binding protein C)

Front 36

What histological changes may be seen in HOCM?

Back 36

-disorganization of the myocytes and contractile elements within the cells
-extreme myocyte hypertrophy
-interstitial fibrosis (due to ischemia)

Front 37

Describe the involvement of the mitral valve in HOCM

Back 37

-increased blood flow pulls the anterior leaflet of the mitral valve into the aortic outflow tract, increasing the obstruction already there due to the hypertrophic septum (IHSS)

Front 38

Restrictive cardiomyopathy causes ________ dysfunction

Back 38

diastolic (ventricles stiff and can't fill appropriately)

Front 39

Describe the ventricular, atrial and microscopic findings of restrictive cardiomyopathy

Back 39

-normal or slightly enlarged ventricles with no dilation
-bilateral atrial dilation (blood backs up)
-patchy or diffuse interstitial fibrosis microscopically

Front 40

Small, semitranslucent "drops of wax" on the atrial endocardial surfaces, particularly on the left, is typical of what restrictive cardiomyopathy?

Back 40

cardiac amyloidosis

Front 41

Endomyocardial disease associated with other anomalies that is most common in first two years of life and usually occurs in the left ventricle only, that presents as shown

Back 41

endocardial fibroelastosis

Front 42

Endomyocardial disease of unknown etiology which affects ventricles only and is found in children in tropical areas

Back 42

endomyocardial fibrosis

Front 43

Loeffler endomyocarditis is caused by damage by what cells?

Back 43

eosinophils

Front 44

What are two general causes of restrictive cardiomyopathy?

Back 44

-endomyocardial diseases
-amyloidosis

Front 45

A large, heavy, floppy heart with mural thrombi as shown is characteristic of what?

Back 45

DCM (dilated)