{"id":53,"date":"2019-02-24T11:13:01","date_gmt":"2019-02-24T11:13:01","guid":{"rendered":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/?p=53"},"modified":"2019-02-24T11:13:01","modified_gmt":"2019-02-24T11:13:01","slug":"some-notes-on-cardiac-pathology","status":"publish","type":"post","link":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/2019\/02\/24\/some-notes-on-cardiac-pathology\/","title":{"rendered":"Some Notes on Cardiac Pathology"},"content":{"rendered":"

Please note that I made these for my own use but thought they may be useful to others!<\/strong><\/p>\n

Cardiac Pathology<\/strong><\/p>\n

 <\/p>\n

Divided into diseases of the:<\/strong><\/p>\n

    \n
  1. Coronary arteries<\/li>\n
  2. Endocardium (including valves)<\/li>\n
  3. Myocardium (including congenital heart disease)<\/li>\n
  4. Pericardium<\/li>\n<\/ol>\n

     <\/p>\n

      \n
    1. Coronary arteries<\/strong><\/li>\n<\/ol>\n

       <\/p>\n

      Any vascular disease can involve these (e.g. vasculitis) but atheroma<\/em> is the important one.<\/p>\n

      Clinically:<\/em> angina, unstable angina and myocardial infarction (due to superimposed thrombosis secondary to ulceration or fissuring).<\/p>\n

       <\/p>\n

      Left coronary artery > <\/em><\/p>\n

        \n
      • anterior descending > anterior septum and wall of left ventricle<\/li>\n
      • circumflex branch > lateral wall of left ventricle<\/li>\n<\/ul>\n

         <\/p>\n

        Right coronary artery<\/em> > posterior septum and wall of left ventricle<\/p>\n

         <\/p>\n

        Distribution of infarction:<\/em><\/p>\n

          \n
        1. Subendocardial infarction due to severe, generalized disease.<\/li>\n
        2. Focal due to blockage of a major artery.<\/li>\n<\/ol>\n

           <\/p>\n

          \u00a0Complications of myocardial infraction:<\/strong><\/p>\n

           <\/p>\n

          Minutes:<\/strong><\/p>\n

          Arrhythmias<\/em>: ventricular fibrillation \/ heart block<\/p>\n

          Acute cardiac failure \/ cardiogenic shock<\/em><\/p>\n

           <\/p>\n

          Days:<\/strong><\/h1>\n

          Thromboses:<\/p>\n

            \n
          • Mural (over the infract) which may be followed by systemic embolisation<\/li>\n
          • Atrial thrombus (due to atrial fibrillation)<\/li>\n
          • (DVT which may be followed by pulmonary embolization)<\/li>\n<\/ul>\n

             <\/p>\n

            Week: <\/strong><\/p>\n

            Rupture (due to softening of muscle):<\/p>\n

              \n
            • Myocardium (leading to cardiac tamponade and death)<\/li>\n
            • Papillary muscle (mitral incompetence)<\/li>\n
            • Septum (left to right shunt)<\/li>\n<\/ul>\n

               <\/p>\n

              Pericarditis<\/p>\n

               <\/p>\n

              Weeks:<\/strong><\/p>\n

                \n
              • Chronic cardiac failure.<\/li>\n
              • Immune pericarditis (Desslers\u2019s syndrome)<\/li>\n<\/ul>\n

                 <\/p>\n

                Months:<\/strong><\/p>\n

                Cardiac aneurysm (due to fibrosis)<\/p>\n

                 <\/p>\n

                At any time:<\/strong><\/p>\n

                Another infarct<\/p>\n

                 <\/p>\n

                  \n
                1. B) Myocardium<\/strong><\/li>\n<\/ol>\n

                  \u00a0<\/strong><\/p>\n

                  Myocarditis<\/strong><\/p>\n

                  Causes:<\/p>\n

                  Infectious: <\/em><\/p>\n

                    \n
                  • Viral e.g. Coxsackie<\/li>\n
                  • Bacterial e.g. Borrelia (Lyme Disease)<\/li>\n<\/ul>\n

                    \u00a0<\/strong><\/p>\n

                    Toxic:<\/em> e.g. Diphtheria<\/p>\n

                     <\/p>\n

                    Immunological<\/em> e.g. Rheumatic fever<\/p>\n

                     <\/p>\n

                    Cardiomyopathy: <\/strong><\/p>\n

                    Definition: <\/strong>Heart muscle disease not due to ischaemia, hypertension, valvular disease or inflammation<\/p>\n

                    \u00a0<\/strong><\/p>\n

                      \n
                    1. Dilated cardiomyopathy:<\/em> end stage of the above (which has burnt out), alcohol or pregnancy<\/li>\n
                    2. Hypertrophic cardiomyopathy:<\/em> autosomal dominant<\/li>\n
                    3. Restrictive cardiomyopathy:<\/em> endomyocardial, fibro-elastosis, amyloid, haemochromtosis<\/li>\n<\/ol>\n

                       <\/p>\n

                      Rheumatic fever<\/strong><\/p>\n

                      Preceded by streptococcal sore throat.<\/p>\n

                      Type 2 hypersensitivity reaction (antibodies to streptococci cross react with antibodies to myocardium.<\/p>\n

                       <\/p>\n

                      Clinical features<\/strong><\/p>\n

                        \n
                      • General: fever etc.<\/li>\n
                      • Skin: nodules<\/li>\n
                      • CNS: chorea<\/li>\n
                      • Heart:<\/li>\n
                      • Pericarditis<\/li>\n
                      • Myocarditis (Aschoff bodies- collections of macrophages)<\/li>\n
                      • Endocarditis including valves \u2013 may lead to chronic valve disease (see below)<\/li>\n<\/ul>\n

                         <\/p>\n

                        Congenital Heart Disease<\/p>\n

                         <\/p>\n

                        Risk factors: e.g. Down\u2019s syndrome, rubella, thalidomide<\/p>\n

                         <\/p>\n

                          \n
                        1. Left to right shunts e.g. atrial or ventricular septal defects ( if untreated may reverse<\/li>\n
                        2. Right to left shunt \u201c Cyanotic\u201d<\/li>\n<\/ol>\n

                          e.g. Tetralogy of Fallot:<\/em><\/p>\n

                            \n
                          • large ventricular septal defect<\/li>\n
                          • pulmonary stenosis<\/li>\n<\/ul>\n

                            3) \u00a0overriding of the aorta<\/p>\n

                            4) \u00a0right ventricular hypertrophy<\/p>\n

                             <\/p>\n

                             <\/p>\n

                              \n
                            1. C) Endocardium<\/strong><\/li>\n<\/ol>\n

                               <\/p>\n

                              Valve disease<\/strong><\/p>\n

                               <\/p>\n

                              Mitral valve:<\/strong><\/p>\n

                              \u00a0<\/strong><\/p>\n

                              Leads to dilation and hypertrophy of the left atrium<\/p>\n

                              In incompetence there is, also, dilatation of the left ventricle<\/p>\n

                               <\/p>\n

                              Incompetence: <\/strong><\/p>\n

                                \n
                              • Post -inflammation: rheumatic fever<\/li>\n
                              • Infective endocarditis<\/li>\n
                              • Left ventricular failure<\/li>\n
                              • Myocardial infarction<\/li>\n
                              • \u201cFloppy mitral valve syndrome\u201d<\/li>\n<\/ul>\n

                                 <\/p>\n

                                Stenosis:<\/strong><\/p>\n

                                  \n
                                • Post-inflammation: rheumatic fever<\/li>\n<\/ul>\n

                                   <\/p>\n

                                  Complications:<\/strong><\/p>\n

                                    \n
                                  • Atrial fibrillation<\/li>\n
                                  • Infective endocarditis<\/li>\n<\/ul>\n

                                     <\/p>\n

                                     <\/p>\n

                                    Aortic valve:<\/strong><\/p>\n

                                     <\/p>\n

                                    Stenosis:<\/strong><\/p>\n

                                      \n
                                    • Age related calcification<\/li>\n
                                    • Calcification of abnormal valve:<\/li>\n<\/ul>\n

                                      Congenital bicuspid<\/p>\n

                                      Post -inflammation: rheumatic fever<\/p>\n

                                       <\/p>\n

                                      Leads to marked cardiac hypertrophy and the risk of sudden death<\/p>\n

                                       <\/p>\n

                                      Incompetence<\/strong><\/p>\n

                                        \n
                                      • Post -inflammation: rheumatic fever<\/li>\n
                                      • Infective endocarditis<\/li>\n
                                      • Dilatation of valve ring e.g. Marfan\u2019s syndrome<\/li>\n<\/ul>\n

                                         <\/p>\n

                                        Leads to dilatation and hypertrophy<\/p>\n

                                         <\/p>\n

                                         <\/p>\n

                                        Infective endocarditis <\/strong><\/p>\n

                                         <\/p>\n

                                        Vegetations form on the valves<\/p>\n

                                         <\/p>\n

                                          \n
                                        1. Acute: <\/strong><\/li>\n<\/ol>\n

                                          Pathogenic organism (e.g. staphylococcus aureus) and normal valve<\/p>\n

                                           <\/p>\n

                                            \n
                                          1. Subacute:<\/strong><\/li>\n<\/ol>\n

                                            Less pathogenic organism (e.g. streptococcus viridans, from the mouth, or enterococci, from the gut) and an abnormal valve<\/p>\n

                                             <\/p>\n

                                             <\/p>\n

                                            Complications:<\/strong><\/p>\n

                                              \n
                                            • Systemic features: Fever etc.<\/li>\n
                                            • Embolisation of vegetations<\/li>\n<\/ul>\n

                                              Infected infarcts in the brain or kidneys<\/p>\n

                                              Splinter haemorrhages<\/p>\n

                                               <\/p>\n

                                               <\/p>\n

                                              Other causes of valve vegetations<\/strong><\/p>\n

                                              e.g. marantic in patients with cancer<\/p>\n

                                               <\/p>\n

                                               <\/p>\n

                                                \n
                                              1. D) Pericardium<\/strong><\/li>\n<\/ol>\n

                                                 <\/p>\n

                                                Classified according to appearance<\/strong><\/p>\n

                                                  \n
                                                1. Fibrinous e.g. myocardial infarction<\/li>\n
                                                2. Serous e.g. rheumatic fever<\/li>\n
                                                3. Purulent e.g. bacterial infection<\/li>\n
                                                4. Haemorrhagic e.g. traumatic, tumour<\/li>\n
                                                5. Fibrotic +\/- calcification (chronic) = constrictive pericarditis g. TB<\/li>\n<\/ol>\n

                                                   <\/p>\n

                                                   <\/p>\n

                                                  Pericardial haemorrhage:<\/strong><\/p>\n

                                                    \n
                                                  1. Myocardial infarction<\/li>\n
                                                  2. Dissecting aortic aneurysm<\/li>\n<\/ol>\n

                                                     <\/p>\n","protected":false},"excerpt":{"rendered":"

                                                    Please note that I made these for my own use but thought they may be useful to others! Cardiac Pathology   Divided into diseases of the: Coronary arteries Endocardium (including valves) Myocardium (including congenital heart disease) Pericardium   Coronary arteries   Any vascular disease can involve these (e.g. vasculitis) but atheroma is the important one. […]<\/p>\n","protected":false},"author":1119,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[290089,290088],"tags":[],"class_list":["post-53","post","type-post","status-publish","format-standard","hentry","category-cardiac-pathology","category-undergraduate-pathology"],"_links":{"self":[{"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/posts\/53","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/users\/1119"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/comments?post=53"}],"version-history":[{"count":2,"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/posts\/53\/revisions"}],"predecessor-version":[{"id":55,"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/posts\/53\/revisions\/55"}],"wp:attachment":[{"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/media?parent=53"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/categories?post=53"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/tags?post=53"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}