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
 Viruses, as coxsackie, echo, influenza
 Bacteria ,fungi
 Parasites as trypanosomiasis ‘chaga’s dis.’,trichenosis
 Immune mediated
 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
Thank You