cardiac pathology: valvular heart disease, cardiomyopathies and other stuff

36
Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

Upload: octavia-morris

Post on 25-Dec-2015

222 views

Category:

Documents


6 download

TRANSCRIPT

Page 1: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

Cardiac Pathology:Valvular Heart Disease,

Cardiomyopathies and Other Stuff

Page 2: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Blood Vessels• Heart I• Heart II

Cardiac Pathology Outline

Page 3: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Blood Vessels• Heart I

• Heart Failure• Congenital Heart Disease• Ischemic Heart Disease• Hypertensive Heart Disease

Cardiac Pathology Outline

Page 4: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Blood Vessels• Heart I• Heart II

• Valvular Heart Disease• Cardiomyopathies• Pericardial Disease• Tumors

Cardiac Pathology Outline

Page 5: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Blood Vessels• Heart I• Heart II

• Valvular Heart Disease

Cardiac Pathology Outline

Page 6: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Stenosis and/or insufficiency

• Stenosis: failure to open

• Insufficiency: failure to close

• Murmurs: blood ejects rapidly through the stenosis

Valvular Heart Disease

Page 7: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Part of aging process

• Results in – increased LV pressure– LV hypertrophy– Relative ischemia

• Angina, CHF, or fainting (syncope)

Calcific Aortic Stenosis

Page 8: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

Calcific aortic stenosis

Page 9: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff
Page 10: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Common (5% of adults in US, F>M)

• Ballooning of mitral leaflets back into the upper heart chamber

• Myxoid/mucoid change within leaflet

• Pathogenesis unknown

• Most patients asymptomatic– May have headaches, fatigue, chest pains

Mitral Valve Prolapse

Page 11: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

Mitral valve prolapse

Page 12: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

Rheumatic Valvular Disease

• Rheumatic fever: systemic inflammatory disease occurring a few weeks after strep throat

• Valves (esp. mitral) become scarred

• Consequence: stenosis (± regurgitation)

Page 13: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Body makes antibody to strep bug that cross-reacts with antigens in heart and joints

• 2-3 weeks after strep throat, patient gets:• migratory polyarthritis• pericardial friction rub, arrhythmias

• Chronic disease can reappear decades later• mitral stenosis, left atrial enlargement, thrombi• increased risk of infective endocarditis

• Long term prognosis variable

Rheumatic Fever

Page 14: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

vegetations Aschoff body pericarditis

Strep throatAntibody production

Antibody cross-reaction with heart

Page 15: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff
Page 16: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

Mitral stenosis with commissural fusion

Page 17: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Microbial invasion of endocardium and/or heart valves

• Acute endocarditis• highly virulent bug attacks normal valve• half of patients dead within days to weeks

• Subacute endocarditis• low virulence bug colonizes abnormal valve• slow onset, long course, most recover

• Symptoms: fever, flu-like symptoms• Complications: septicemia, arrhythmias, renal

failure, systemic emboli

Infective Endocarditis

Page 18: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

Infective endocarditis: vegetations on valve

Page 19: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff
Page 20: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

•Vegetation

Page 21: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff
Page 22: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

Infective endocarditis: splinter hemorrhage of nail bed

Page 23: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Blood Vessels• Heart I• Heart II

• Valvular Heart Disease• Cardiomyopathies

Cardiac Pathology Outline

Page 24: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Diverse group of disorders in which there is intrinsic myocardial dysfunction

• Lots of causes; some idiopathic

• Three groups• Dilated congestive cardiomyopathy• Hypertrophic cardiomyopathy• Restrictive cardiomyopathy

• Non-inflammatory conditions that cause impaired myocardial function

Cardiomyopathies

Page 25: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Heart dilates, enlarges, and can’t contract well• Ejection fraction typically falls, ESV and EDV increase =

stretching of myocardium

• Causes• viral• Alcohol (main cause)/toxin• genetic abnormalities• peripartum

• Slowly progressing CHF

• 70% of patients dead within 5 years

Dilated (Congestive) Cardiomyopathy

Page 26: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

Dilated (L) and hypertrophic (R) cardiomyopathy

Page 27: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Massively hypertrophied L ventricle can’t fill

• Cause: mutation in a sarcomere protein gene– Septum enlarges disproportionately

• Symptoms: atrial fibrillation, CHF, arrhythmia, sudden death

• Treatment: drugs to promote ventricular relaxation or surgical excision of part of septum

• Prognosis: about 4% of patients die each year

Hypertrophic Cardiomyopathy

Page 28: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

Sarcomere of cardiac muscle

Page 29: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Heart wall is stiff; can’t fill during diastole

• Cause: Idiopathic or secondary to systemic disease (amyloidosis, hemochromatosis, sarcoidosis)

• Symptoms: shortness of breath, peripheral edema

• Treatment: not often helpful

• 70% of patients dead within 5 years

Restrictive Cardiomyopathy

Page 30: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Blood Vessels• Heart I• Heart II

• Valvular Heart Disease• Cardiomyopathies• Pericardial Disease

Cardiac Pathology Outline

Page 31: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Pericarditis• Secondary (MI, radiation, pneumonia) or primary

(infectious)• Atypical chest pain• Dangers: tamponade, chronic fibrosis

• Pericardial effusion• Serous (CHF), serosanguinous (aortic dissection),

chylous (lymphatic obstruction)• Outcome depends on stretchiness of pericardial sac• Slow = asymptomatic; sudden = catastrophic

Pericardial Disease

Page 32: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

Acute pericarditis

Page 33: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

Types of Pericardial Disorders

• Pericardial effusion – The accumulation of fluid in the pericardial

cavity

• Cardiac tamponade – Slow or rapid compression of the heart due to

accumulation of fluid, pus, or blood in pericardial sac

Page 34: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Blood Vessels• Heart I• Heart II

• Valvular Heart Disease• Cardiomyopathies• Pericardial Disease• Tumors

Cardiac Pathology Outline

Page 35: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

• Most common: metastatic• Heart is a rare site of metastasis• Lung cancer, lymphoma most common

• Primary tumors uncommon• Most are benign• Most common: myxoma

Cardiac Tumors

Page 36: Cardiac Pathology: Valvular Heart Disease, Cardiomyopathies and Other Stuff

Cardiac myxoma