Transfusion Pathology

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Cardiac Pathology 3
Valvular Heart Disease, Cardiomyopathies and
Other Stuff
Kristine Krafts, M.D.
October 20, 2009
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Cardiac Pathology Outline

• Blood Vessels
• Heart I
• Heart II
• Valvular Heart Disease
• Cardiomyopathies

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Cardiomyopathies

• Diverse group of disorders in which there is
  intrinsic myocardial dysfunction
• Lots of causes some idiopathic
• Three groups
• dilated cardiomyopathy
• hypertrophic cardiomyopathy
• restrictive cardiomyopathy

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Dilated Cardiomyopathy

• Heart dilates, enlarges, and cant contract well
• Causes
• viral
• alcohol/toxin
• genetic abnormalities
• peripartum
• Slowly progressing CHF
• 70 of patients dead within 5 years

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Dilated (L) and hypertrophic (R) cardiomyopathy
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Sarcomere of cardiac muscle
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Hypertrophic Cardiomyopathy

• Massively hypertrophied L ventricle cant fill
• Cause mutation in a sarcomere protein gene
• Symptoms atrial fibrillation, CHF, arrhythmia,
  sudden death
• Treatment drugs to promote ventricular
  relaxation or surgical excision of part of septum
• Prognosis about 4 of patients die each year

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Restrictive Cardiomyopathy

• Heart wall is stiff cant fill during diastole
• Cause Idiopathic or secondary to systemic
  disease (amyloidosis, hemochromatosis,
  sarcoidosis)
• Symptoms shortness of breath, peripheral edema
• Treatment not often helpful
• 70 of patients dead within 5 years

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Cardiac Pathology Outline

• Blood Vessels
• Heart I
• Heart II
• Valvular Heart Disease
• Cardiomyopathies
• Pericardial Disease

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Pericardial Disease

• Pericarditis
• secondary (MI, radiation, pneumonia) or primary
  (infectious)
• atypical chest pain
• dangers tamponade, chronic fibrosis
• Pericardial effusion
• serous (CHF), serosanguinous (aortic dissection),
  chylous (lymphatic obstruction)
• outcome depends on stretchiness of pericardial
  sac
• slow asymptomatic sudden catastrophic

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Acute pericarditis
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Cardiac Pathology Outline

• Blood Vessels
• Heart I
• Heart II
• Valvular Heart Disease
• Cardiomyopathies
• Pericardial Disease
• Tumors

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Cardiac Tumors

• Most common metastatic
• heart is a rare site of metastasis
• lung cancer, lymphoma most common
• Primary tumors uncommon
• most are benign
• most common myxoma

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Cardiac myxoma