Heart Diseases 4

Myocardial and pericardial diseases By Prof. Adel Montasser

Cardiomyopathy Def.: slowly progressive heart failure mainly due to primary myocardial disease, not secondary to inflammatory, ischemic, valvular or hypertensive heart disease 3 types:   

Dilated Hypertrophic Restrictive

Dilated cardiomypathy Causes:    

Idiopathic Alcohol Genetic Chronic anemia

Morphology: 

Cardiomegaly, 900 gm., all chambers dilated.

Mechanism of heart failure: 

Systolic dysfunction due to impaired contractility

Hypertrophic cardiomyopathy Causes:   

Idiopathic Genetic, storage diseases Infants of diabetic mothers

Morphology:    

Marked Cardiomegaly Mostly asymmetric hypertrophic Lt. ventricle Septal base cushion Micro: Irregular muscle fiber hypertrophy and fibrosis

Hypertrophic cardiomyopathy Mechanism of heart failure: 

Diastolic dysfunction, due to improper filing and impaired relaxation

Clinical:  

Usually favorable course May be complicated by    

Atrial fibrillation Anginal attacks Infective endocarditis Sudden death

Restrictive cardiomyopathy Cause: 

Idiopathic, amyloidoses, hemochromatosis, radiation induced fibrosis

Mechanism of failure: 

Diastolic dysfunction, impaired filling due to restriction

Morphology: 

Ventricles normal or slightly enlarged

Complications:  

Progressive H.F Mural thrombosis

Myocarditis Definition: Injury of cardiac myocytes due to inflammation

Causes: 

Infection   



Immune mediated 



Viruses, as coxsackie, echo, influenza Bacteria ,fungi Parasites as trypanosomiasis ‘chaga’s dis.’,trichenosis Rheumatic, SLE, drugs

Unknown causes  

Sarcoidosis Giant cell myocarditis

Myocarditis Morphology Gross: normal or dilated heart, flabby, patchy hemorrhage may be suppuration, calcification Microscopic 

Focal myocyte necrosis with inflammation and features which may indicate the cause as: Excess neutrophils- Suppuration Aschoff bodies------- rheumatic Fibrinoid necrosis--- SLE Lymphocytes --- viral Caseous granuloma-> tuberculous Parasites in myocytes--> Chaga’s disease Cysts with larva, calcified- trichenosis

Myocarditis Clinical  

May be asymptomatic with complete recovery May be complicated by: Mural thrombosis- thromboembolism Arrhythmias--- sudden death Heart failure

pericarditis Causes Infection Viral Bacterial: pyogenic, tuberculous Fungal

M.I Immunologic Rheumatic Rheumatoid SLE

Other causes Uremia Radiation Traumatic

Pericarditis. Morphology Serofibrinous: The most common Caused mostly by rheumatic F & M I

Suppurative Caused by pyogenic organisms as…. Route: Hematogenous or from adjacent organs Morphology : suppuration

Hemrrhagic: Tuberculosis Malignancy Post-surgical MI

Caseous Tuberculosis, may be fungal Hematogenous or direct spread

Chronic healed pericarditis

Adhesive pericarditis   



Pericardial fibrous adhesions Pericardiomediastiinal Usually follow serofibrinous or suppurative inflammation May interfere with heart action--- H F

Constrictive pericarditis     

Fibrous ring constricting pericardium May be calcified Usually follow tuberculous pericarditis Result in chronic venous congestion Surgically correctable

Pericardial effusion Transudate Generalised edema

Serous Wet serofibrinous inflammation

Serosanguinous Bloody Tuberculosis, malignancy, cardiac tamponade

Chylous Milky fluid due to lymphatic obstruction

Tumors of the heart Primary: Rare Myxoma Lt atrium Thrombosis Sudden heart failure

Rhabdomyoma, lipoma, mesothelioma

Secondary More common than primary Breast ,lung, others

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