Cardiac Pathology 3 - WordPress.com · 14/10/2016 · Cardiac Pathology 3: Valvular Heart Disease,...
Transcript of Cardiac Pathology 3 - WordPress.com · 14/10/2016 · Cardiac Pathology 3: Valvular Heart Disease,...
CardiacPathology3:ValvularHeartDisease,Cardiomyopathies,
andTumorsKris>neKra?s,M.D.
• BloodVessels• HeartI• HeartII
CardiacPathologyOutline
• BloodVessels• HeartI
• HeartFailure• CongenitalHeartDisease• IschemicHeartDisease• HypertensiveHeartDisease
CardiacPathologyOutline
• BloodVessels• HeartI• HeartII
• ValvularHeartDisease• Cardiomyopathies• Tumors
CardiacPathologyOutline
• BloodVessels• HeartI• HeartII
• ValvularHeartDisease
CardiacPathologyOutline
• Stenosisand/orinsufficiency
• Stenosis:failuretoopen
• Insufficiency:failuretoclose
• Murmurs
• Outcomedependsonseverityandspeedofdevelopment
ValvularHeartDisease
• Partofagingprocess
• Canoccuronnormalorcongenitallybicuspidvalves
• ResultsinincreasedLVpressure,LVhypertrophy,andrela>veischemia
• Angina,CHF,orfain>ng
CalcificAor>cStenosis
Calcificaor>cstenosis:normal(L)andbicuspid(R)valves
• Common(5%ofadultsinUS,F>M)
• Ballooningofmitralleaflets
• Myxoid/mucoidchangewithinleaflet
• Pathogenesisunknown
• Mostpa>entsasymptoma>c
MitralValveProlapse
Mitralvalveprolapse
• Rheuma>cfever:systemicinflammatorydiseaseoccurringafewweeksa?erstrepthroat
• Valves(esp.mitral)becomescarred• Consequence:stenosis(±regurgita>on)
Rheuma>cValvularDisease
• Bodymakesan>bodytostrepbugthatcross-reactswithan>gensinheartandjoints
• 2-3weeksa?erstrepthroat,pa>entgets:• migratorypolyarthri>s• pericardialfric>onrub,arrhythmias
• Chronicdiseasecanreappeardecadeslater• mitralstenosis,le?atrialenlargement,thrombi• increasedriskofinfec>veendocardi>s
• Longtermprognosisvariable
Rheuma>cFever
vegeta>ons Aschoffbody pericardi>s
StrepthroatAn>bodyproduc>on
An>bodycross-reac>onwithheart
Mitralstenosiswithcommissuralfusion
• Microbialinvasionofheartvalves,endocardium• Acuteendocardi>s
• highlyvirulentbuga`acksnormalvalve• halfofpa>entsdeadwithindaystoweeks
• Subacuteendocardi>s• lowvirulencebugcolonizesabnormalvalve• slowonset,longcourse,mostrecover
• Symptoms:fever,flu-likesymptoms• Complica>ons:sep>cemia,arrhythmias,renalfailure,systemicemboli
Infec>veEndocardi>s
Infec>veendocardi>s:vegeta>onsonvalve
Infec>veendocardi>s:splinterhemorrhageofnailbed
• BloodVessels• HeartI• HeartII
• ValvularHeartDisease• Cardiomyopathies
CardiacPathologyOutline
• Diversegroupofdisordersinwhichthereisintrinsicmyocardialdysfunc>on
• Lotsofcauses;someidiopathic
• Threegroups• dilatedcardiomyopathy• hypertrophiccardiomyopathy• restric>vecardiomyopathy
Cardiomyopathies
• Heartdilates,enlarges,andcan’tcontractwell
• Causes• viral• alcohol/toxin• gene>cabnormali>es• peripartum
• SlowlyprogressingCHF
• 70%ofpa>entsdeadwithin5years
DilatedCardiomyopathy
Dilated(L)andhypertrophic(R)cardiomyopathy
• MassivelyhypertrophiedLventriclecan’tfill
• Cause:muta>oninasarcomereproteingene
• Symptoms:atrialfibrilla>on,CHF,arrhythmia,suddendeath
• Treatment:drugstopromoteventricularrelaxa>onorsurgicalexcisionofpartofseptum
• Prognosis:about4%ofpa>entsdieeachyear
HypertrophicCardiomyopathy
Sarcomereofcardiacmuscle
• Heartwalliss>ff;can’tfillduringdiastole
• Cause:Idiopathicorsecondarytosystemicdisease(amyloidosis,hemochromatosis,sarcoidosis)
• Symptoms:shortnessofbreath,peripheraledema
• Treatment:noto?enhelpful
• 70%ofpa>entsdeadwithin5years
Restric>veCardiomyopathy
• BloodVessels• HeartI• HeartII
• ValvularHeartDisease• Cardiomyopathies• Tumors
CardiacPathologyOutline
Mostcommon:metasta>c• heartisararesiteofmetastasis• lungcancer,lymphomamostcommon
Primarytumorsuncommon• mostarebenign• mostcommon:myxoma
CardiacTumors
Cardiacmyxoma