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Pathology - Diseases of the Pericardium
Terms in this set (47)
What are the 3 functions of the pericardium?
fixes heart in mediastinum (limits motion), prevents extreme dilation of heart during sudden rises of intracardiac volume, and barrier to limit spread of infection
What are the 3 causes of pericarditis?
infectious agents, immunologically mediated, miscellaneous
What infectious agents cause pericarditis?
virus, pyogenic bacteria, TB, fungi, and parasites
What are the immunologically mediated causes of pericarditis?
rheumatic fever, SLE, scleroderma, postcardiotomy, post-MI (Dressler) syndrome, drug hypersensitivity reaction
What are miscellaneous causes of pericarditis?
MI, uremia, after cardiac surgery, neoplasia, trauma, radiation
What are the 5 types of acute pericarditis?
serous, fibrinous and serofibrinous, purulent or suppurative, hemorrhagic, caseous
What are noninfectious causes of serous pericarditis?
rheumatic fever SLE, scleroderma, tumors, and uremia
What is infection of contiguous tissues that cause serous pericarditis?
bacterial pleuritis could irritate the pericardium and cause a sterile serous effusion
What is another cause of serous pericarditis?
well defined viral infection somewhere else in the body (URI, pneumonia, parotitis)
What are the histological finding of serous pericarditis?
mild inflammatory infiltrate in epicardial fat, lymphocytes
What is the most frequent type of acute pericarditis?
fibrinous and serofibrinous
What are the 8 causes of fibrinous and serofibrinous pericarditis?
Acute MI, Post-infarction (Dressler) syndrome, Uremia, Chest radiation, Rheumatic fever, SLE, Trauma, Routine cardiac surgery
What is fibrinous and serofibrinous pericarditis?
serous fluid mixed with a fibrinous exudate
What is the histology of the fibrinous part?
dry with fine granular roughening (routine cardiac surgery)
What is the histology of the serofibrinous part?
more intense with more yellowish/brown opaque fluid with leukocytes, red cells, and fibrin
What can a fibrin aggregation cause (adhesion)?
loud pericardial friction rub
What are signs of pericarditis?
severe pleuritic pain in anterior chest, systemic febrile reactions, signs of cardiac failure
What causes purulent pericarditis?
Caused by an invasion of microbes; Either by extension from a neighboring infection or lymph, seeding by blood, or
directly during cardiotomy
What does the exudate look like in purulent pericarditis?
ranges from thick and cloudy to total purulent
What does the serosal surface look like in purulent pericarditis?
The serosal surface is reddened, granular and coated with exudate; Think: bread and butter being pulled off a carpet!
What can happen as a result of purulent pericarditis?
Subsequent scarring usually cause constrictive pericarditis
What are the systemic signs of purulent pericarditis?
very high fever and chills
What is hemorrhagic pericarditis usually caused by?
malignant neoplasm w/in the pericardial space, underlying bleeding diathesis, TB, post cardiac surgery
What does the exudate look like in hemorrhagic pericarditis?
blood and fibrinous or suppurative effusion
What causes caseous pericarditis?
TB and maybe some fungi
What can caseous pericarditis lead to?
chronic, fibrocalcific, constrictive pericarditis
What is chronic (healed) pericarditis?
Acute pericarditis of any etiology may result in chronic pericarditis
What does chronic (healed) pericarditis cause?
Fibrous thickenings ("soldier's plaque"), Delicate, stringy adhesions may obliterate the pericardial sac (adhesive pericarditis), Rarely interfere with cardiac function
What is adhesive mediastinopericarditis?
Pericardial sac is obliterated and the parietal layer adheres to the surrounding structures
What can cause adhesive mediastinopericarditis?
infectious pericarditis, cardiac surgery, or chest irradiation
What happens to cardiac function in adhesive mediastinopericarditis?
is super strained because with each contraction it pulls on the attached structures; increased workload --> hypertrophy and dilation
What is constrictive pericarditis?
heart becomes incased in fibrous or fibrocalcific scar
What can cause constrictive pericarditis?
caseous pericarditis and purulent or suppurative
What happens to cardiac function in constrictive pericarditis?
limits diastolic expansion --> decreased cardiac output; heart sounds distant or muffled
What are rheumatologic disorders?
rheumatoid arthritis, SLE, systemic sclerosis, ankylosing spondylitis, psoriatic arthritis
What can rheumatoid arthritis cause in the heart?
fibrinous pericarditis, granulomatous rheumatoid nodules in myocardium, rheumatoid valvulitis
What is acute rheumatic fever?
Acute, immunologically mediated multisystem inflammatory disease; children; Follows a Group A Streptococcal pharyngitis by 10 days to 6 weeks; acute rheumatic carditis
What are the major criteria for diagnosis of acute rheumatic fever?
carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules
What are the minor criteria for diagnosis of acute rheumatic fever?
arthralgia, fever, elevated ESR and CRP, prolonged PR interval
What is the Jones criteria of acute rheumatic fever?
two major or one major and two minor
What are the associations of acute rheumatic fever?
greater population density, poverty, poor living conditions, undernourishment
Why has there been a decrease in acute rheumatic fever?
increased healthcare, better living conditions, penicillin
What is the pathogenesis of acute rheumatic fever?
hypersensitivity reaction by group A Strep and create antibodies against M proteins
What are the clinical presentations of acute rheumatic fever?
between 5-15 y/o, antiobodies to strep enzymes found, arthritis, migratory polyarthritis with fever, carditis (frictional rubs, tachycardia, arrhythmias)
What are the valves that are effect in chronic rheumatic heart disease in decreasing order?
mitral > mitral and aortic > tricuspid = pulmonic (rare)
What happens in rheumatic mitral valve disease?
fibrosis of leaflets (fish mouth), thickened, shortened and fused chordae tendinae
What is seen in chronic rheumatic heart disease?
diffuse fibrosis, commissural fusion, calcification, neovascularization, thickening/shortening/fusion of chordae tendinae
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