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