6. Protein-Calorie Malnultrition
●Vacuolar degeneration of myofibrils
●Esp in conducting tissue
●Sudden death common, possibly from
arrythmia
●During recovery findings of CHF often
seen
●Malnourished children sensitive to
digoxin, use diuretic only
7. Beriberi Heart Disease
●Thiamine deficiency 2° ingesting highly
milled rice as staple food
●Also occurs in chronic alcoholism
●Peripheral vasodilatation - high output
state
●Reduced renal blood flow with retention
of Na+ & water
●Increased blood volume & biventricular
failure
8. Beriberi - diagnostic criteria
●Hx/O Thiamine Deficiency
●Exclusion of other causes of heart disease
●High output failure
●Evidence of peripheral neuritis or pellagra
●Rapid response to therapeutic trial of
Thiamine
13. Idiopathic Congestive
Cardiomyopathy- Etiology
●Multifactorial disease - ETOH, HTN,
Malnutrition, viral myocarditis
●West African study 40% had chronic
ETOH use + malnutrition
●Grp B Coxsackieviruses implicated if
febrile illness concurrent with CHF
14. Idiopathic Congestive
Cardiomyopathy- Pathology
●Low output failure
●Heart grossly enlarged - 500-600 gms
●Trabeculae carneae are smoothed out
●Thrombus often seen in apical region
●Mitral/tricuspid rings dilated without
evidence of intrinsic valvular disease
●Often present with 1° or more often 2° HTN
17. Tropical Endomyocardial
Fibrosis- Epidemiology
●In Uganda - as common a cause of cardiac
failure as RHD
●Uganda - seen in 25% of cardiac necropsies
●More common in poorer socioeconomic
conditions
●In endemic areas 50% occur in persons < 15
yrs of age
19. Tropical Endomyocardial
Fibrosis- Pathology
●Fibrosis of mural endocardium
●Thrombus deposition followed by
fibrotic organization
●Early in disease embolization may
occur
●Usual extends to the mitral and tricuspid
valve apparatus
20. Tropical Endomyocardial
Fibrosis- Pathology
●Valvular regurgitation can often occur
●Restriction of cardiac filling/cardiac output
●R-ventricle infundibulum hypertrophied and
dilated
●Severe R-sided failure symptoms can be
seen (ascites/hepatomegaly)
●L-ventricular involvement results in MR &
PAH
21. Tropical Endomyocardial
Fibrosis- Clinical Findings
●May manifest in first several months in life
●Usually recognized in advanced stages
●Symptoms advance rapidly
●Process is usually biventricular
●High venous pressure causes exopthalmos,
periorbital facial edema, jaundice
22. Tropical Endomyocardial
Fibrosis- Clinical Findings
●Ascites almost always seen, but peripheral
edema rare
●Pericarditis present approx 40% cases -
aggravates restrictive cardiomyopathy
●Peripheral cyanosis and clubbing common 2°
low cardiac output
●Cachexia, protein-losing enteropathy, cardiac
cirrhosis with hepatic failure - terminal events
25. Acute Pericarditis
●Fibrinous
○Friction rub in acute rheumatic pericarditis
○Viral pericarditis - grp B coxsackie virus
●Serous
○Childhood/adult pericardial TB
○Endemic areas for endomyocardial fibrosis,
childhood effusion implys this Dx
26. Acute Pericarditis
●Suppurative
○ Common in tropics - most commonly S. pneumoniae 2°
pneumonia or S. aureus 2° osteo
○ Syndrome of cough + dyspnea + toxemia + friction rub +
increasing heart size
○ Mortality > 35% even with prompt Dx/Rx
●Amebic Pericarditis
○Rare complication of liver abscess
○Rupture into pericardial sac
○“Anchovy paste” pus