Heart Pathology - Patho Colloq 5

Inflammations in the Heart

  • Endocarditis

    Infective septic endocarditis

    • valvular damage due to microorganism colonisation and inflammation

    • Etiology: bacteria, fungi, Ricketsia. chlamydia

    • Vegetations - fibrin, inflammatory cells. microorganisms

    • Overtime: chronic inflammation, fibrosis, calcinosis

  • Myocarditis

    Myocardial damage due to inflammation

    • Etiologic factors: infections (HIV, chlamydia, candida), immune reactions (pos-tviral, rheumatic fever, lupus), diseases of unknown etiology (sarcoidosis, giant cell myocarditis)


      Rheumatic Fever

      • Immunologically mediated

      • After Streptococcus A pharyngitis

      • Many organ systems are affected

      • Hypersensitivity or Streptococcus-induced autoimmunity

      Heart damage: acute rheumocarditis, chronic valvular damage esp. mitral stenosis

      Main manifestation: Pancarditis


      Acute rheumatic fever: Pancarditis

    • Aschoff granulomas in all layers of heart

    • Fibrinous exudate in pericardium

    • Fibrinoid necrosis and small vegetations in endocardium


      Chronic rheumatic fever: heart

    • Valvular fibrosis and deformity

    • Mitral Valve: thickened, chordae tendinae thickened and lack elasticity


  • Pericarditis

    • Acute: serous, fibrinous, purulent, haemorrhagic, (caseous)

    • Chronic: adhesive, constrictive

    Etiology: infections (viruses, bacteria), immune mediated (LED, Dressler syndrome after myocardial infarction), other (uremia, tumour, trauma, irradiation)


Cardiomyopathies (CMP)

Primary myocardial pathology

Types:

  • Dilated CMP

  • Hypertrophic CMP

  • Restrictive CMP


Dilated CMP

  • Progressive dilation

  • Systolic dysfunction

  • Causes: genetic, toxic including ethanol, myocarditis, pregnancy-induced, idiopathic

  • Heart weight increased, Fiber hypertrophy and atrophy, Interstitial and subendocardial fibrosis


Hypertrophic CMP

  • Myocardial Hypertrophy

  • Diastolic dysfunction

  • 1/3 outflow problems

  • Weight increased, wall thickened, hypercontractility, hypertrophy


Restrictive CMP

  • Primary decreased elasticity

  • Diastolic dysfunction

  • Mostly preserved systolic function

  • Normal size, myocardium dense, focal/diffuse interstitial fibrosis

Valvular Heart Diseases

Morphologic changes result in:

  • Stenosis: Mostly primary valvular pathology, usually chronic

  • Insufficiency: Primary valvular pathology, due to pathology in surrounding structures (aorta, papillary muscles), acute e.g. papillary muscle rupture, chronic

  • Combined lesion


Etiology:

  • Inborn

  • Acquired


Acquired mitral valvular disease

Mitral prolapse

Acquired aortic valvular disease


Complications after implantation of valvular prosthesis:

  • Thrombosis / thrombembolism

  • Bleeding due to anticoagulant use

  • Endocarditis

  • Mechanical wear-and-tear

  • Peri-implant pathology: granulations

Congenital Heart Pathologies

Atrial septal defect: Left-to-right shunt

  • Hyperload of pulmonary circulation

  • Insufficiency of right ventricle

  • Shunt reversal

  • Late-onset cyanosis

    • Eisenmenger syndrome

  • Fixed defect

Patent foramen ovale

  • Size adequate

  • Non-fusion

  • Transient flow

  • Paradoxical embolism is possible

Ventricular septal defect: left-to-right shunting

  • Most common congenital heart anomaly at birth

Patent ductus arteriosus

Tetralogy of Fallot: right-to-left shunt

Most frequent cyanotic congenital heart pathology

  • Stenosis in truncus pulmonalis: subpulmonal stenosis, valve stenosis

  • Right ventricular hypertrophy

  • Ventricular septal defect

  • Aortic valve location above septal defect

Aortic coarctation

  • Infantile (preductal) coarctation

  • Adult (post-ductal) coarctation: most common

Truncus arteriosus

  • Truncus arteriosus = truncus pulmonalis + aorta

Tricuspid atresia

  • Closed tricuspid valve

  • Blood flow is possible through atrial and ventricular septal defects