CV Path 6 Flashcards
disease of small arteries and arterioles usually seen in patients with diabetes and HTN
arterioLOsclerosis
– variants of arterioLOsclerosis result in vessel wall thickening and luminal narrowing with concomitant downstream ischemic injury
hyperplastic and hyaline
least clinically significant arteriosclerosis
Monckeberg medial calcific sclerosis
arteriosclerosis that has no stenosis
Monckeberg medial calcific sclerosis
Monckeberg medial calcific sclerosis is age-related (> 50 years) degenerative process involving – with extension into media
internal elastic lamina of muscular arteries
The calcific deposit do not encroach on vessel lumen for –
Monckeberg medial calcific sclerosis
Monckeberg medial calcific sclerosis is radiographically visible and physically palpable but difficult –
to feel pulse
atherosclerosis is the disease of – arteries in which the basic lesion is the atheroma
elastic and large muscular
fibrofatty plaque within the intima, having a core of lipid and a covering fibrous cap
atheroma
leading cause of death in industrialized nations
atherosclerosis
death from atherosclerosis results from –
plaque rupture, thrombus formation, occlusion of arteries
prevalence of atherosclerosis
~100%
atheromatous plaque that starts in childhood
fatty streak (pre-atherosclerotic lesion)
fatty streak begins as –
yellow, flat spots
fatty streaks coalesce into –
elongated streaks (> 1 cm)
what does fatty streaks consist of?
lipid-laden macrophages
smooth muscle cells
few lymphocytes
little extracellular lipid in fine meshwork of fibrous and elastic tissue
fibrous plaque =
raised plaque
what does fibrous plaque consist of?
macrophages
smooth muscle cells
other leukocytes in connective tissue stroma
lipids
Is a complicated plaque clinically significant?
yes
what is complicated plaque?
fibrous plaque \+ calcification ulcercation hemorrhage rupture thrombosis
atherosclerosis is an – disease of the wall of medium and large arteries that is precipitated by elevated levels of low-density lipoprotein cholesterol in blood
inflammatory
what is atherogenesis?
response to injury hypothesis
complications of atherogenesis that leads to thrombus formation
plaque rupture or erosion
In coronary arteries, thrombus occludes the lumen –>
myocardial infarction (heart attack)
In carotid arteries, thrombi emobolize and cause –
cerebrovascular accidents (stroke)
leading cause of death in both males and females in industrialized nations
ischemic heart disease
ischemic heart disease encompasses several conditions related to – (imbalance between supply and demand)
myocardial ischemia
majority of ischemic heart disease cases result from – due to coronary atherosclerotic disease
reduction of coronary blood flow
4 groups of ischemic heart disease
angina
myocardial infarction
sudden cardiac death
chronic IHD with heart failure
groups of ischemic heart disease that is an irreversible change
myocardial infarction
MI: myocardium is particularly sensitive to ischemic injury and will undergo –
necrosis within 30 min
two patterns of MI
subendocardial and transmural
subendocaridal MI is ischemic necrosis limited to –
inner 1/3 to 1/2 ventricular wall
subendocardial MI is usually due to sufficiently – in the setting of severe coronary atherosclerosis
prolonged and severe reduction of blood pressure
subendocardial MI may also be due to – which become lysed before full thickness necrosis occurs
plaque disruption with superimposed thrombus
MI where ischemic necrosis involves >50% of the ventricular wall thickness
transmural
transmural MI is usually associated with – and superimposed occlusive thrombus
rupture of unstable atherosclerotic plaque
MI: subendocardial myocardium is the most susceptible area to ischemic injury and will become necrotic first because –
it is farthest away from the blood supply
each coronary artery has a specific – hence MI will have a specific area of injury
perfusion territory
anterior 2/3 IVS and anterior LV free wall
left anterior descending artery
lateral wall LV and anterolateral papillary muscle
left circumflex artery
posterior 1/3 IVS, posterior LV, posteromedial papillary muscle
right coronary artery
MI 1-3 days myocardial infarct exhibits –
dark mottling with yellow-tan areas
MI 7-10 days myocardial infarct exhibits –
central yellow-tan softening with hyperemic border
MI 24 hrs microscopic
coagulative necrosis
MI 1-3 days microscopic
acute inflammation
necrosis with neutrophils, neovascularization
MI 3 days - 2 weeks microscopic
granulation tissue
MI > 8 weeks
dense fibrosis
bleed into pericardial sac
cardiac tamponade
chronic ischemic heart disease is the dev of progressive heart failure due to long-term –
ischemic myocardial injury
chronic heart disease aka
ischemic cardiomyopathy
in chronic heart disease, coronary arteries exhibit –
moderate to severe atherosclerosis
in chronic heart disease, the heart becomes
enlarged and hypertrophied
in chronic heart disease, there are mutifocal areas of –
myocardial fibrosis
many cases of chronic heart disease is associated with history of –
angina pectoris or prior myocardial infarcts
primary cardiac tumors/neoplasms are rare and most are –
benign
examples of primary cardiac tumors
myxomas
fibroma
rhabdomyoma
malignant primary cardiac tumor
-sarcoma, lymphoma
non-neoplastic
thrombus and papillary fibroelastoma
what are more common metastatic neoplasms or cardiac tumors?
metastatic neoplasms
metastatic neoplasms usually involve –
pericardium (may involve myocardium)
most common tumors that metastasize to the heart
carcinomas of lung and breast
malignant melanoma
lymphomas and leukemia
most common primary tumor in adults
cardiac myxoma
90% of cardiac myxoma is located within –
atria (L:R = 4:1)
cardiac myxoma is thought to derive from differentiation of –
primitive multipotential mesenchymal cells
10% patients with myxomas
autosomal dominant inheritance
tumor syndrome
Carney complex
cardiac myxoma can cause valve obstruction by –
“ball-valve” mech
for cardiac myxomas, strokes due to – may occur
embolization
curative for cardiac myxomas
surgical removal
favored site of origin for cardiac myxoma
fossa ovalis in atrial septum
cardiac myxoma is almost always –
single, exophytic, polypoid, sessile (+/- hemorrhage)
cardiac myxoma histopatholy is composed of – embedded within abundant myxoid stroma
stellate or globular myxoma cells
most common primary cardiac tumor of children
cardiac rhabdomyoma
cardiac rhabdomyoma is a tumor of –
striated muscle
cardiac rhabdomyoma is thought to represent a – rather than a true neoplasm
hamartoma
cardiac rhabdomyoma is well-defined – mass
uncapsuled white/gray nodular
cardiac rhabdomyoma is usually –
multiple
histologically, cardiac fhabdomyoma is –
large polygonal cells with abundant glycogen vacuoles (spider cells)
most common primary malignant cardiac tumor
cardiac angiosarcoma
cardiac angiosarcoma usually affects —
right atrium
cardiac angiosarcoma may hematogenously spread to –
lung and liver
in cardiac angiosarcoma, vascular spaces are lined by atypical appearing –
malignant endothelial cells
in cardia angiosarcoma, immunohistochemistry is positive for –
markers of endothelial cell differentiation
