Cardiac Pathology Flashcards
What is the caveat when dating myocardial infarctions?
If the patient has had ANY type of reperfusion therapy, you can no longer accurately date the infarct
BQ! If you see a heart slide showing giant cells, lymphocytes and eosinophils, what should be in your differential OTHER than sarcoidosis?
Giant cell myocarditis aka Fieldler’s myocarditis
Rapidly progressing disease of young adults, immediate need for transplant
Other differential is hypersensitivity myocarditis secondary to methyldopa (high yield!)
What type of myocarditis is being shown here and how can you tell?
Rheumatic myocarditis which is a pancarditis
The picture is showing Anitschkow cell from an Aschoff nodule—
fibrinoid necrosis of heart muscle
– Anitschkow cell (histiocytes with condensed chromatin give caterpillar like appearance)
– Aschoff cells (MN giant cells)
– Collagenolysis
What uncommon disorder is characterized by markedly thin RV replaced by fat?
Arrhythmogenic RV Dysplasia
What is molecular event seen in 50% of hypertrophic cardiomyopathy?
Defect in ß myosin heavy chain on chromosome 14 (50%)
What disease is this? (instant recognition!)
Fabry’s disease
X-linked recessive form of sphingolipidosis due to
deficiency of alphagalactosidase A
Angiokeratomas, renal insufficiency & cardiac failure
Histology: vacuolated myocytes
EM shows intralysosomal dense lamallae with concentric
or packed arrangement (Zebra bodies)
If stem gives a person who is taking Adriamycin, what is the next step in management?
GET EM!
Grading scheme based on sarcotubular dilatation
(vacuolization) and myofibrillar loss
Where do cardiac myxomas occur?
75% in the left atrium
What cardiac tumor is being shown?
Rhabdomyoma
MOST COMMONLY IN LEFT VENTRICLE
Most common primary cardiac tumor of
infancy and childhood
May be sporadic, but >50% associated with TS
Eosinophilic, polygonal cells with large glycogen-rich cytoplasmic vacuoles with stranding “spider cells”
What is a McCallum’s patch?
Endocardial inflammation in acute rheumatic heart disease
Endocardium becomes white (scar)
What is Libman Sacks endocarditis?
seen in lupus erythematosus
Vegetations covering both sides of valve surfaces
Fibrinoid necrosis & inflammation
Alterations in the expression of miRNAs (micro RNAs) is associated with which pathologic process in the heart?
Cardiac hypertrophy
What is the most common congenital heart malformation?
VSD
What is tetralogy of Fallot?
VSD with an obstruction of the right ventricular outflow track known as subpulmonary stenosis, an overriding aorta, and right ventricular hypertophy
What cardiac manifestation is most likely to develop secondary to carcinoid?
Tricuspid valve insufficiency
What syndrome has arrhythmogenic right ventricle cardiomyopathy and hyperkeratosis of the palmer and plantar skin surfaces and is from a mutation in the plakoglobin gene?
Naxos syndrome
What are the large, medium and small vessel vasculitides?
Large: Giant Cell Arteritis and Takayasu’s
Medium: polyarteritis nodosa and Kawasaki’s
Small: Wegener’s, Churg Strauss and microscopic polyangiitis
What cardiac tumor is positive for calretinin?
Cardiac myxoma
Other calretinin + tumors:
Adenomatoid tumor
Sex-cord stromal tumors
Adrenocortical tumors
Mesothelioma
What is the mutation in Carney syndrome (cardiac myxomas, endocrine issues, etc)?
Autosomal dominant mutation of PRKAR1A (protein kinase A)
Myxoid lesions: cardiac myxoma, skin angiomyxoma, myxoid fibroadenoma of the breast
Pigmented and calcifying lesions: spotty skin pigmentation, epithelioid blue nevus, pigmented nodular adrenocortical hyperplasia, psammomatous melanotic schwannoma, large cell calcifying sertoli cell tumor
Endocrine hyperactivity: pituitary adenoma, chondroid hamartoma
BQ SLIDE!
What is this lesion in the heart?
Rheumatic Heart Disease
Picture is showing the characteristic Aschoff nodule composed of Anitschkow cells (seen here)
This tumor shown:
- Second most common primary heart tumor, ¾ of all valve tumors
- Aortic valve
- Grossly resembles lambl excrescences (LE) but is on surface of valve and LE are on valve closure
- Histo – avascular papillae lined by endothelium
Papillary Elastofibroma
What is the main difference between giant cell myocarditis (shown here) and hypersensitivity myocarditis?
HS will have eosinophils (shown here)
What is the number one cause of bacterial myocarditis worldwide?
Corynebacterium diphtheriae
This lesion:
- Related to coronary artery dz but occurs only in transplant pts
- Histo – concentric intimal thickening of intramyocardial vessels
- Can see complete obstruction of vessel lumen and ischemic damage
- Limiting factor for long term success of heart transplant and main cause of death in long term survivors
Cardiac allograft vasculopathy
What are the lesions that recur after cardiac transplant?
- Sarcoid
- Giant cell myocarditis
- Amyloid
- Chagas’ dz
- Fabry dz
