Download Pericardial Diseases ©2010 Mark Tuttle

Pericardial Diseases
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©2010 Mark Tuttle
Serous (transudate): Passive effusion
o Low protein
o No cells
Purulent (exudate): Active effusion
o High protein
o Many WBCs
o Infectious
Malignant: Metastatic disease
Disease
Acute Pericarditis
Serous pericarditis
Causes
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Hemopericardium
- Infections Agents
If 500+ml blood  tamponade  sudden death
o Viruses, pyogenic bacteria, tuberculosis, fungi, parasites
o Ruptured myocardium
- Presumably Immunologically Mediated
 Myocardial Infarction
o Rheumatic Fever
 Trauma
o Systemic Lupus Erythmatosus (SLE), Scleroderma
o Aortic dissection
o Postcardiotomy (Heart surgery)
 Hypertension
o Postmyocardial infarction (Dressler) syndrome
 Marfan syndrome
 Look for anti-myocardial AB
- Miscellaneous: Myocardial infarction, uremia, surgery, neoplasia, trauma, radiation
Symptoms
Pathogenesis
Histology
- Infectious (viral)
- Usually autoimmune
diseases
(SLE, RA, scleroderma)
- Malignancy
- 50-200ml fluid
- Scant inflammatory
cells
Fibrinous pericarditis
- Post-MI (Dressler) synd.
- Uremia
- Rheumatic Fever
- Sharp chest pain
- Fever
- Friction rub
Purulent pericarditis
- Infectious bacterial
o Direct extension of a
pneumonia.
- Seeding from the blood
- Lymphatic extension
- Direct introduction
during cardiotomy
- Malignancy
- Bacterial infection
- Postcardiotomy
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The amount of inflammation is minimal, so no
exudation of fibrin occurs. The dark stippled dots in
the yellow fluid and on the epicardial surface
represent scattered inflammatory cells. Serous
pericarditis is marked by fluid collection. Rarely, the
fluid collection may be large enough to cause
tamponade.
- Yellow, cloudy fluid
- Rough epicardial surface
- Fibrin, WBCs and RBCs
- Strands of pink fibrin extending outward. There is
underlying inflammation. Eventually, the fibrin can be
organized and cleared, though sometimes adhesions
may remain
- Extensive purulent exudate
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- Follows suppurative
inflammation (or TB)
- Suppurative or
hemorrhagic pericarditis,
eg. Staph or TB
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Hemorrhagic pericarditis
Chronic Pericarditis
Adhesive Mediastino
pericarditis
Constrictive Pericarditis
Uncommon
- Pulsus paradoxicus
 hear beats but no
pulse felt distally
- Sac obliterated and adhered to adjacent struct.
- Increased strain  hypertrophy and/or dilation
- Pericardial space obliterated by scar/calcification
- Severe cardiac dysfunction (tamponade)
See granulomas from M. tubercolosis
Vascular Neoplasms
©2010 Mark Tuttle
Disease
Symptoms/Location
Pathogenesis
Telangiectasias: abnormally prominent capillaries, venules, arterioles that create focal red lesions on the skin and mucous membranes
Nevus Flammeus
- A “birthmark” characterized by being deep purple - Usually on the head & neck
and flat
- Usually fade over time
- Composed of dilated capillaries
- Special type: “port wine stain”, does not fade
o May grow proportionately with the child
Spider Talangiectasias
- Arteries/arterioles
- Associated with hyperestrogenism
- Arranged in a radial fashion about a central core
o Pregnancy
- Located on upper body (ex face, neck, chest)
o Liver cirrhosis (ex. Alcoholism) – can’t break it down
Benign Neoplasms
Hemangiomas – capillary
- Skin, subcutaneous, oral cavity, lips
- Begin to fade after 1-3 years
type
- Liver, spleen, kidney
- 80% regress after 5 years
- “Strawberry-type” on infants
Cavernous Hemangioma
- Large cavernous vascular channels
- Same locations as others, except sometimes in brain
Glomus tumors
- Painful, modified smooth muscle timors
- Arise in the distal digits from the Glomus body, small
arteries under the nail
Malignant Neoplasms
Hemangiosarcoma
- Young, no gender predilection
- Atypical (anaplastic) endothelial cells
- Skin, liver, spleen, lungs, bones, retroperitoneum - Associated with known carcinogens
o Polyvinyl chloride (liver)
Kaposi’s Sarcoma
- Classic/European:
Chronic
- Caused by Karposi
- Lymphadenopathic: Endemic
Sarcoma-associated
(same distrib as Burkitt Lymphoma in Africa)
+ tat protein
Herpesvirus (KSHV =
- Immunosuppressed
HHV8)
- AIDS-associated:
Epidemic
Tumors of the heart
Myxoma (CT tumor)
(Benign)
Cardiovascular effects of
noncardiac neoplasms
- Direct Consequences of
Tumor
o Pericardial and
myocardial metastases
o Large vessel obstruction
o Pulmonary tumor emboli
- Indirect Consequences of
Tumor (Complications of
Circulating Mediators)
o Nonbacterial thrombotic
endocarditis
o Carcinoid heart disease
o Pheochromocytomaassociated heart disease
o Myeloma-associated
amyloidosis
- Effects of Tumor Therapy
o Chemotherapy
o Radiation therapy
- 90% in atria
- Left: right atria – 4:1
- 10% have Carney syndrome
Hyperpigmentation, endocrinopathy, skin
- Diagnose by echocardiogram
Most often attached to the atrial wall, but can arise on a
valve or in a ventricle. They can produce a "ball valve" effect
by intermittently occluding the atrioventricular valve orifice.
Embolization of fragments of tumor may also occur.
Lipoma (Benign)
Rhabdomyoma (Benign)
- Subendocardium, subepicardium, or myocardium
- Most common child heart tumor
- Grows in the myocardial layer
- Asymptomatic or ball-valve obstructions/arrhythmias
- Associated w/ tuberous sclerosis: TSC1 normally inhibits
mammalian target of Rapamycin (!!! ) mTOR
Angiosarcoma (Malignant)
Metastatic (Malignant)
- Identical to those occurring elsewhere
- Ex. Constrictive cardiomyopathy w/amyloidosis resulting from multiple myeloma
Most common