CVS

Question 1

If you see nothing, look for…

Answer 1

amyloid

emboli

Question 2

cardiomyopathies

Answer 2

hypertrophic/HOCM: all genetic (50% familial)

dilated: idiopathic, familial (25%), toxic, postviral, others
restrictive: ischaemic, amyloid, sarcoid

ARVD (familial) - fat in RV wall

left ventricular non-compaction - spongy LV wall

Question 3

myocarditis (inflammatory cardiomyopathy)

Answer 3

lymphocytic (viral)

eosinophilic (hypersensitivity)

giant cell

granulomatous (exclude infection)

rheumatic fever

toxic (drugs)

Question 4

cardiac valve vegetations

Answer 4

infective endocarditis

rheumatic heart disease

non-bacterial thrombotic endocarditis (no inflammation or destruction of valve)

Libman-Sacks endocarditis (SLE)

Question 5

cardiac neoplasms

Answer 5

atrial myxoma (Carney complex)

rhabdomyoma (tuberous sclerosis)

cardiac sarcoma

lymphoma

mets

Question 6

Beurger disease (clinical and morph)

Answer 6

young men, heavy smokers

small-medium arteries and veins of limbs

vasculitis with thrombotic occlusion

neuts and giant cell in thrombus

Question 7

benign vascular tumours

Answer 7

capillary haemangioma (GLUT1+)

cavernous haemangioma/lymphangioma

arteriovenous malformation (thick and then vessels, A-V anastomoses, dx on arteriography)

epithelioid haemangioma (ALHE)

venous haemangioma

spindle cell haemangioma

Question 8

capillary haemangioma subtypes

Answer 8

infantile: RICH, NICH (rapidly- or non-involuting congenital haemangioma)

tufted angioma

verrucous angioma

cherry angioma

pyogenic granuloma

Question 9

intermediate vascular tumours

Answer 9

kaposiform HE (deep soft tissue infnants, assoc Kasabach-Merritt syndrome)

retiform HE (looks like rete testis, with hobnail cells)

Dabska tumour (papillary intralymphatic angioendothelioma)

KS (patch, plaque or nodular)

Question 10

malignant vascular tumours

Answer 10

EHE

angiosarcoma (and epithelioid angiosarcoma)

Question 11

reactive and ectatic vascular tumours

Answer 11

Masson tumour

glomeruloid haemangioma (Castlemans/POEMS)

port wine stain

venous lake

angiokeratoma

Question 12

large (elastic) vessel vasculitis

Answer 12

giant cell arteritis

Takayasu arteritis (younger, more necrosis)

Both have granulomatous inflammation, use elastic stain in both

Question 13

medium vessel vasculitis

Answer 13

1) Kawasaki disease (mucocutaneous lymph node syndrome): coronary artery in children, necrosis
2) polyarteritis nodosa: esp gut and kidney, fibrinoid necrosis
3) any of the small vessel vasculitides

Question 14

fibrinoid necrosis in a vasculitis

Answer 14

polyarteritis nodosa

Wegeners

Churg-Strauss

rheumatoid vasculitis

Question 15

pauci immune (no IgG on IF) small vessel vasculitis

Answer 15

Wegeners (respiratory tract, glomeruli): basophilic necrosis, giant cells, cANCA

Churg-Strauss (lungs, organs): palisading necrosis, eosinophils

microscopic polyangiitis (lungs, kidney): pANCA

Question 16

immune mediated small vessel vasculitis (not distinguishable on histology - need clinical/serology). All have leukocytoclasis.

Answer 16

Henoch-Schonlein

cryoglobulinaemia

rheumatoid vasculitis

lupus vasculitis

Question 17

aortic valve stenosis

Answer 17

bicuspid AV

calcific aortic stenosis

post-inflammatory

post-rheumatic

Question 18

aortic valve insufficiency

Answer 18

1) root dilatation:

age related (minimal or no change)

bicuspid valve

Marfans

2) aortitis:

takayasu

giant cell arteritis

rheumatoid arteritis

syphilis

Question 19

mitral valve disease

Answer 19

stenosis: post inflammatory, post rheumatic

regurgitation:

1) mitral valve prolapse (myxoid degeneration) +/- Marfan or Ehlers-Danlos
2) annular dilatation (normal structure - caused by papillary muscle dysfunction in DCM or IHD)

Question 20

right side valve disease

Answer 20

congenital (eg ToF)

carcinoid heart disease

pulmonary artery hypertension

Fen-phen valvulopathy (anorectic drug)