myocardial and pericardial dz

inflamm process that results in injury to cardiac myocytes, interstitium, vascular tissue and/or pericardium

viral
-coxsackie (ECHO, CMV, influenza, poliomyelits, HIV)

-sepsis, emboli, direct extension
-staph, strep, meningococcus, leptospirosis
-lyme
-exotoxin

candida, aspergillus, cryptococcus

toxoplasmosis
chaga's dz (direct myofiber parasitization, apical LV aneurysms)

trichinella
-encyst in skeletal muscle

-non-caseating granulomas
-focal areas of non-specific lymphocytic myocarditis

1) eosinophilic myocarditis
2) necrotizing eosinophilic myocarditis

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

individual fibers will hypercontract and tear themselves apart

CHF - heart dilated
dysrhythmia

lymphocytic

lymphocytic

lymphocytic

suppurative

granulomatous

granulomatous

granulomatous

granulomatous

eosinophillic

eosinophilic

eosinophilic

eosinophilic

contraction band necrosis

vacuolization and myofibril loss

HD due to primary abnormality not HTN, CHD, valvular dz, or CAD

characterized by otherwise unexplained ventricular dysfunction

impaired myocardial contraction and progressive chamber dilation

-postinflammatory (viral, sarcoid)
-nutritional/toxic (alcoholism, thiamine deficiency)
-heritable (AD, cytoskeleton)
-peripartum (early in pregancy)

dystrophin, desmin, sarcolemic proteins: cardiac myosin heavy chain, mito proteins

-progressive 4-chamber hypertrophy and dilatation
-mural thrombi
-interstitial fibrosis
-vent endocardial fibrosis

sporadic or familial
-AD
-chrom 14
-relation to Naxos syndrome (plantar palmar hyperkeratosis, abnormal gene codes from plakoglobin)

-focal thinning of RV wall
-fatty infiltration and fibrosis
-subepicardial fibrosis of LV - foamy appearance of myofibrils

-gradual replacement of RV muscle by fat
-arrythmias (v-tach)
-sudden death

hypertrophic, hypercontractile, poor compliance

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

disoriented, tangled, and hypertrophied myocardial fibers

-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

26 years
-dyspnea
-obstructive symptoms - syncope, dizziness, chest pain
-dysrhytmia
-CHF

-danger of syncope
-sudden death
-young athletes

a fib with mural thrombosis
mitral valve IE
CHF
sudden death

-myofiber disarray lacking
-unrecognized chronic HTN
-HCM

diminished ventricular distensibility
-imparied diastolic filling
-loss of systolic function not prominent feature
-stiffening
-infiltrative process that interfere with pumping action

-normal size or slightly enlarged ventricles having firm walls
-atrial enlargement
-interstitial fibrosis
-hypertrophy not prominent feature

-amyloid
-endomyocardial fibrosis
-loefflers endocarditis
-endocardial fibroelastosis
-fibrosis caused by radiation therapy

-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

-african children and young adults
-subendocardial fibrosis of ventricles
-variable inflammation

-endomyocardial fibrosis
-mural thrombi
-peripheral and tissue eosinophilia

-porcelain hearts
-focal or diffuse endocardial thickening - not myocardium
-usually LV
-course is proportional to severity

myxoma

-true neoplasm
-LA in fossa ovalis area
-pedunculated, gelatinous, soft - may be hemorrhagic
-multipotential mesenchymal cells

-valve dysfunction
-embolization
-constitutional symptoms (malaise, fever) due to secretion of IL6
-carney syndrome

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

angiosarcoma

RA or pericardium

rhabdomyosarcoma

teratocarcinoma

usually on valves
R - children
L - adults

pericardium
-may cause effusion

effusion (serous, fibrinous)
blood
pus

accum of serious transudate in pericardial sac
-systemic edema from CHF and other edematous conditions

clear, straw colored protein rich exudate with inflamm cells

systemic lupus erythematosus, rheumatic fever, viral infections

MI, uremia, rheumatic fever

fibrin rich exudate

dry, finely granular, dull

serofibrinous: more inflammation and more thicker fluid (yellow-red)

direct extension
blood seeding
lymph extension
direct introduction during surgery/trauma

-grossly, cloudy or frankly purulent inflamm exudate
-caused by bacterial infection
-red, granular, exudates

-blood and fibrin/ suppuration
-malignant tumor involving pericardium; granular appearance
-bacterial and tubercular infections

-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

tuberculosis or pyrogenic staph