Cardiovascular pathology

Question 1

New heart murmur

Answer 1

IE

Question 2

Nutmeg liver
Haemosiderin-laden macrophages in lungs
DIlated ventricles on PM

Answer 2

Left-sided HF

Question 3

Fever + pleuritic chest pain following MI

Answer 3

Dressler’s syndrome (AI)

Question 4

4 early complications of MI (EXAM Q)

Answer 4

1. Contractile dysfunction
2. Arrhythmia
3. Myocardial rupture (usually free wall - wall weakens when fibrosis occurring - tamponade)
4. Papillary muscle rupture (> valve incompetence)

Question 5

Later complications of MI (>1w)

Answer 5

Pericarditis (Dressler's syndrome)
Ventricular aneurysm (ballooning of wall due to fibrosis - reduced motility can form thrombus - embolism e.g. to SMA)

Question 6

Histology normal

SEE IMAGES HANDOUT

Answer 6

<6h post-MI

Question 7

Necrotic cell death
Contraction band necrosis (red wavy lines across fibres)
Loss of nuclei
Homogenous cytoplasm

Answer 7

1d post-MI

Question 8

Acute inflammatory response with neutrophils

Answer 8

1-4d post-MI

Question 9

Early scar formation

Collagen synthesis

Answer 9

2w post-MI

Question 10

Decellularising scar formation

Answer 10

2m post-MI

Question 11

Episodic flushing, abdominal cramps and diarrhoea
5-hydroxyindoleracetic acid producing tumours
Right sided valve abnormalities

Answer 11

Carcinoid syndrome

Question 12

Myocyte hypertrophy + disarray
AD
B-myosin heavy chain mutation
Too thick

Answer 12

HCM

Question 13

Progressive loss of myocytes
Alcohol
Too thin

Answer 13

DCM

Question 14

Mitral regurgitation
St Vitus Dance + pericarditis
Group A Strep throat a few weeks ago

Answer 14

Rheumatic fever

Question 15

AR + aortic dissection

Answer 15

Marfan’s

Question 16

Unexpected cardiac death
No symptomatic cardiac disease or 1h after onset of symptoms
Lethal arrhythmia
Possible underlying HOCM or prolonged QT
Ischaemia induced electrical instability

Answer 16

Sudden Cardiac death

Question 17

Nutmeg liver
Ankle swelling
Oedema

Answer 17

Right sided HF

Question 18

Critical stenosis

Answer 18

> 70%

Question 19

Most common site of coronary plaques

Answer 19

First few cm of LAD or LCX

Entire length of RCA

Question 20

Myocyte necrosis

Answer 20

MI

Question 21

Aortic valve calcification

Answer 21

Aortic stenosis

Question 22

Aortic regurgitation causes

Answer 22

Rigidity (rheumatic, degenerative)
Destruction (endocarditis)
Disease of aortic valve ring (Marfan’s, dissecting aneurysm, syphilis, ank spond = dilates - insufficient to cover increased area

Question 23

True aneurysm

Answer 23

Ballooning of all layers of wall

Question 24

Changes post-MI

Answer 24

1d: Necrosis
1-4d: Neutrophil infiltration
2w: Early scar formation with collagen
2m: Decellularising scar formation