CVS Pathology Flashcards
Based on Devesh Mishra book and class notes.
1
Q
Histological layers of a Blood Vessel?
What are each made of?
A
T. intima - single layer of endothelium
T. media - smooth muscles, elastic tissue
T. adventitia - collagen, elastic fibres.
2
Q
Types of capillaries?
A
Continuous type - No gaps
Sinusoidal type - gaps + in endothelium and BM.
Fenestrated type - gaps + only in BM.
3
Q
Veins which are valveless are?
A
Common Iliac. V
Vena cava
4
Q
Diff b/w arteries and Veins?
A
Thin wall
have valves
scanty elastic tissue
5
Q
Neoinitima?
A
seen after vascular injuries.
combination of intima and media.
intima will have smooth muscles derived from medial hyperplasia.
6
Q
Vasuclar pathologies in HTN?
A
Hyaline arteriolosclerosis
Hyperplastic arteriolosclerosis
7
Q
Hyaline arteriolosclerosis?
A
Diabetic angiopathy, Benign nephrosclerosis, Benign HTN.
diffuse pink hyaline thickening - luminal stenosis.
8
Q
Hyperplastic arteriolosclerosis?
A
Malignant HTN.
Concentric laminated/Onion-skin app.
Hyperplasia of smooth muscles and
Fibrinoid necrosis/ necrotising arteriolitis.
9
Q
Arteriosclerosis?
A
Wall thickening
Loss of elasticity.
10
Q
Patterns of arteriosclerosis?
A
ARTERIOLOSCLEROSIS - small, medium arteries and arterioles.
DM, HTN - as hyperplastic and hyaline types.
MONCKEBERG MEDIAL SCLEROSIS - medial calcification in muscular arteries.
>50yrs
Non obstructive, no clinical significance.
ATHEROSCLEROSIS - MC pattern with clinical significance.
due to intimal damage.
11
Q
Modifiable R/f for atherosclerosis?
A
Other than being fat and having all bad habits :p
Lipoprotein A
Trans unsaturated FA
Chlamydia, pneumonia, CMV, HSV
12
Q
Non- modifiable R/f for atherosclerosis?
A
Male
Old
Stress - Type A personality
Hyper- homocysteinemia
13
Q
Theory of Atherosclerosis?
A
Inflammatory response to endothelial injury.
monocyte, platelet adhesion - growth factor release - smooth muscle proliferation in intimal and matrix synthesis.
14
Q
what are foam cells?
A
when macrophages and smooth muscle cells accumulate oxidised LDL.
15
Q
Fatty streaks
A
Earliest lesions.
Intimal collections of foamy macrophages and smooth muscle cells.
16
Q
Mature atherosclerotic plaque?
A
Fibrous cap - smooth muscle cells, macrophages, foam cells, lymphocytes, collagen, elastin, proteoglycans.
Necrtoic core - dead cells, lipid, cholesterol, foam cells, plasma proteins.
17
Q
complications of plaque?
A
Rupture, ulceration, erosion
Hemorrhage
Aneurysmal dilatation
Thrombus formation.
18
Q
MC blood vessel affected in atherosclerosis?
LC affected blood vessel?
A
Abdominal aorta (below renal.A and above iliac bifurcation).
Circle of Willis
19
Q
what is an Aneurysm?
A
Localised abnormal dilatation of blood vessel or wall of heart.
20
Q
Types of Aneurysm?
A
True
Pseudo-
Mycotic
Syphylitic and so on
21
Q
True aneurysm?
A
covered by all 3 vessel wall layers.
ass. with atherosclerosis, post-MI ventricular aneurysm.
22
Q
Pseudo-aneurysm?
A
Extravascular hematoma.
MCC - Post-MI rupture.
23
Q
Mycotic aneurysm?
A
due to bacterial infection weakening vessel wall.
MCC - Staph
MC site - Femoral.A
24
Q
Syphilitic aneurysm?
A
a/k/a Leutic aneurysm. Tertiary stage of syphilis. MC site- Ascending aorta. Linear calcification - characteristic. Tree barking app. - Intimal wrinkling Cor Bovium/ cow's heart - cardiac hypertrophy - due to AR.
25
Syndromes ass. with Aortic dissection?
Marfan's
| Ehlers Danlos. S
26
MCC of Aortic dissection?
HTN
27
MC pre existing Histologic change for Aortic Diss.?
Cystic medial degeneration.
28
Types of classification of Aortic diss.?
2 Types:
De baker classification (Anatomical) - not used now
Stanford's classification (Prognostic) - commonly used.
29
Cystic medial necrosis occurs in which conditions?
```
Marfan's
Ehlers danlos. S
Pregnancy (3rd tri)
Congenital Bicuspid aortic valve
Familial thoracic aortic aneurysm. S
```
30
Large vessel vasculitis?
```
GCA (Temporal arteritis)
Takayasu Arteritis (TA) (Pulseless disease)
```
31
Medium vessel vasculitis?
```
PAN (immune cell-mediated)
Kawasaki disease (KD) (Anti-endothelial cell Ab's)
```
32
Small vessel vasculitis?
Immune complex mediated- SLE
HSP
Good Pasteur's disease(GPD)
Pauci immune mediated - Miscroscopic polyangitis (MP) (vasculitis w/o asthma/granuloma)
Granulomatosis with polyangitis (Wegners granulomatosis)
Churg strauss. S (CSS) (asthma+Granuloma+eosinophilia)
33
What is ANCA?
They are group of auto-Ab's directed against components of Neutrophils.
2 types- p-ANCA
c-ANCA
34
p-ANCA?
```
Perinuclear ANCA.
Target Ag- MPO (Anti-MPO)
seen in-
CSS
MP
GPS
IBD
Wegners. G(25%)
Idiopathic cresentric GN
Drug- Hydralazine
```
35
c-ANCA?
Cytoplasmic location/staining.
target Ag- cytoplasm protein- Pr3
seen in- Wegners..G (70%)
36
Giant cell/Temporal arteritis?
MC vasculitis- adults
Focal granulomatous inflammation - cranial vessels
MC-Superficial temporal.A
Segmental nodular thickening with narrowing of lumen
vessel wall- Granulomatous inflammation+ langhans giant cells
Fragmentation of internal elastic lamina
MC symptom- Localised temporal headache
MS symptom- Jaw claudication
Most feared complication - permanent blindness (ophthalmic.A)
Raised ESR
ass. with Polymyalgia Rheumatica
Normocytic normochromic.A
37
Takayasu's Arteritis?
a/k/a Aortic Arch. S
Granulomatous vasculitis of Aortic arch and its branches.
Thick wall- narrow lumen
filling-defect on fluoroscopy distal to stenotic/obstructed area.
<50yrs
same features in>50yrs- Giant cell Aortitis
MC- subclavian vessels (pulseless disease)
LC- Coronary vessels
elevated ESR
Anemia
38
Intermediate vessel vasculitis?
Behcet's disease.
39
PAN?
Systemic necrotising vasculitis- Medium sized arteries.
Varying age of lesions- in same biopsy
Classical PAN- Non-Granulomatous
MC- affects kidneys(arcuate.A), but no GN
spares- Lungs
ANCA (-ve)
ass. with chronic Hep-B (30%)- HbSAg +ve
MC vasculitis ass. with Mononeuritis multiplex
Segmental transmural fibrinoid necrosis
elastic lamina fragmentation
MCC of death- Renal failure
40
MCC - Mononeuritis multiplex?
Overall - DM
| amongst vasculitis- PAN
41
MC vasculitis in Paeds?
HSP
42
MC vasculitis causing death in paeds?
KD (Coronary arteries)
43
MC vasculitis in adults?
GCA
44
Kawasaki disease?
a/k/a Mucocutaneous LN syndrome
children <5yrs
100% clinical diagnosis
Etiology- Anti-endothelial Ab's
coronary vasculitis- coronary ectasia- aneurysm
MCC of death- MI- due to Aneurysmal rupture
elevated ESR & CRP
Thrombocytosis
treatment- IV-IG
45
Diagnosis of KD?
Fever>/= 5days + any 4/5 :
* b/l non-exudative conjunctivitis (red eye)
* strawberry tongue, cracked lips, throat redness
* Palmar and plantar erythema------- } diff. from
* polymorphous rash (MC-trunk)------} pharyngitis
* Large LN in neck (>1.5cm)
Diagnosis also confirmed, if:
fever + only 3 of the above are present with documented 2DECHO or angio evidence of CAD.
46
TAO
Buerger's disease
R/f- smoking, >35yrs age
HLA-A-9, HLA-B5 associated
HLA-B12 is protective for TAO
Segmental, thrombosing, inflammation with secondary extension into veins & nerves.
Thrombus will have Neutrophilic mmicroabscesses surrounded by granulomatous inflammation.
Early feature- Raynaud's
Intermittent claudication
excruciating pain even at rest- due to neural involvement.
47
where all micro abscesses are seen?
[TIPS]
TAO
Sezary.S
Psoriasis
IBD
48
Microscopic Polyangitis?
a/k/a Hypersensitivity vasculitis/ Leukocytoclastic vasculitis.
similar to PAN, but involves small vessels.
have p-ANCA
all lesions- of same age.
segmental fibrinoid necrosis - media
focal transmural necrotising lesions.
No granuomatous inflammation.
```
Necrotising GN (90%)
Pulmonary capillaritis- common
```
hemoptysis, hematuria, proteinuria,purpura, bowel pain/bleeding.
49
Leukocytoclastic meaning?
fragmented neutrophilic nuclei within and around vessel walls.
50
Wegner's Granulomatosis?
Triad-
* Necrotising/ granulomatous vasculitis of small vessels of lung & airway.
* Necrotising granulomas of upper & lower RT
Focal Necrotising & cresentric GN.
granulomas - fuse - nodules & cavities.
Renal lesions - FSGS & scarring to Proliferative(crescentic) GN.
c-ANCA (70%) & p-ANCA(25%) +ve
males
around 40yrs.
features- b/l persistent pneumonitis. (nodules & cavities)-95%
chronic sinusitis- 90%
mucosal ulcerations of nasopharynx- 75%
Renal lesions- 80%
treatment- steroids, Cyclophoshamide, TNF antagonists.
51
what is limited Wegner's?
disease involving only RS.
52
Churg- Strauss syndrome?
Vasculitis + eosinophilis
Can be a side effect of Motelukast/ Zafirlukast use.
small vessel necrotising vasculitis with asthma
allergic rhinitis
peripheral eosinophilia
granulomas.
resemble PAN, but with eosinophils and granulomas.
p-ANCA +ve <50%
eosinophilic infiltrates - ass. with cardiomyopathy.
MCC of death - Cardiac involvement.
53
HSP?
Mc vasculitis- children
a/k/a Anaphylactoid purpura.
IgA deposits
Tetrad-
* Palpable purpura (due to vasculitis)
* Arthritis
* GN
* Abdominal pain.
Renal involvement - 10-50% of HSP.
Thrombocytosis
Raised IgA & ESR
Mild leukocytosis.
54
Hypersensitivity Angitis?
due to Hypersensitivity
Leukocytoclastic vasculitis
Palpable purpura of LL
Criteria for diagnosis:
* >16yrs
* Maculopapular skin rash
* use of any drug prior to symptoms
* purpura
* biopsy - rash- neutrophils around small vessels.
55
Behcet's disease?
Anti-endothelial cell Ab's.
Target Ag- human alpha enolase.
small vessel neutrophilic vasculitis.
Triad:
* Recurrent oral aphthous ulcers
* genital ulcers
* uveitis
Ass. with HLA-B5, B51.
also TH-17 cells- recruit neutrophils
56
Tumors of Blood vessels?
Benign- Hemangioma - Capillary.H
Cavernous.H
Pyogenic.H
Intermediate(Boderline)- Kaposi Sarcoma
Malignant - Angiosarcoma
57
Capillary.H?
MC type - vascular tumor
affects skin & mucous.M
Unencapsulated, > 1mm
closely packed aggregates of capillaries
partially/completely thrombosed.
```
a/k/a juvenile strawberry.H
variant present at birth
MC- face
Reddish/pinkish
regresses as child grows. (by 7yrs)
```
58
Cavernous.H?
```
Unencapsulated
1-2 cm
MC sites - Skin,Liver
Locally destructive, do not regress
Thrombosis & dystrophic calcification- common
```
VON HIPPEL LINDAU. S- chromosome 3p
cavernous.H in cerebellum ,brain stem, eye + angiomatous cystic neoplasms in pancreas & liver.
59
Pyogenic.H?
Ulcerated polypoid variant of capillary.H
occurs following trauma.
proliferating capillaries, interspersed with edema
inflammatory infiltrates- resemble granulation tissue.
a/k/a pregnancy tumor- Granuloma Gravidarum
occurring in- gingiva of 1% of pregnant women
regress spontaneously after pregnancy.
60
Kaposi Sarcoma?
```
HHV 8
2nd MC malignancy in HIV.
MC site - Skin of feet
MC extracutaneous site - LN
MC site in GIT- Duodenum
```
Gross- 3 stages- patch, plaque, nodule.
Nodular stage- sheets of plump, proliferative spindle cells & endothelial in the dermis/ s/c tissue
Attempted vessel formation.
61
Diagnosis of Vascular tumors?
IHC
* CD31 (PECAM)
* CD34
* Factor VIII (weibel palade bodies)
62
what are weibel palade bodies?
vWF + Pselectin
63
Epidemiological types of KS?
```
Chronic/Classic/European KS:
elderly
men
Not ass. with HIV
red-purple plaques on LL
visceral involvement- rare
```
```
Endemic/Lymphoadenopathic/African KS:
Not ass. with HIV
cutaneous lesions- rare
Aggressive form
occasional- visceral involvement
MC- LN
```
Transient/Immunodeficiency ass. KS:
Transplant ass.
Chronic immunosuppression
Nodal, mucosal, visceral involvement- fatal & rare.
lesion regresses when immunosuppression is discontinued.
Epidemic/ AIDS ass. KS:
Skin, Mucous.M, LN, GIT, Viscera
wide visceral dissemination- early.
64
Cavernous lymphangioma neck seen in?
Turner's syndrome
65
Gloms tumor?
Gloms body - Specialised A-V structure - involved in thermoregulation.
Glomangioma
benign
Extremely painful
Modified smooth muscle cells arising from gloms body.
MC site - distal phalanges (under nail beds)
Excision - curative
66
Angiosarcoma?
```
Malignant endothelial neoplasma.
Common sites- skin, soft tissue, breast, liver.
Aggressive
early mets
all degrees of differentiation are seen
Diagnosis - Immunosaining for CD31, vWF.
```
67
Hepatic angiosarcoma are ass. with exposures to?
Arsenic (pesticides)
PVC (plastics)
Thorotrast (Radio-contrast agent)
68
Hemangiopericytoma?
tumors of pericyte (myofibroblast like cells ass. with capillaries and venules).
MC site- LL/ retroperitoneum.
painless
slow- growing.
69
MC congenital cardiac anomaly?
VSD
70
MC genetic cause of congenital heart disease?
Trisomy 21- Downs syndrome
71
what is the main mode of cardiac adaptation?
Hypertrophy
Never hyperplasia.
72
Cardiac Adaptations in pressure overload?
Increase in transverse diameter of myocyte.
length remains same.
concentric hypertrophy of LV.
seen in - HTN, AS.
73
Cardiac Adaptations in Volume overload?
Both transverse diameter & length of myocyte increase.
Eccentric hypertrophy- dilatation of LV chamber
increased thickness of ventricular wall.
seen in - AR, CCF.
74
Left Heart Failure features?
Wet lung- pulmonary congestion.
Kerly B & C lines - Perivascular & interstitial edema.
Siderophages - heart failure cells- hemosiderin laden macrophages - indicate current and previous episodes of pulmonary edema.
75
Right Heart failure features?
Nutmeg liver - Hepatomegaly with centrilobar congestion & atrophy - chronic passive congestion.
Cardiac cirrhosis.
Peripheral edema of dependent parts.
Pleural effusion.
76
Calcific Aortic Stenosis features?
Age related degeneration.
>70yrs.
MC R/f- Congenital bicuspid aortic valves.
Valve fibrosis + concentric LVH. (pressure overload).
77
Mitral Valve Prolapse?
```
Barlow syndrome.
young females.
Due to - Abnormal matrix synthesis - dysregualtion in TGF-beta signalling.
Ass with Marfan's . S
Mitral valve leaflets- myxomatous change
Prolapse back into atrium during systole.
thickened ventricular endocardium.
Asymptomatic
Mid- systolic click +
```
78
MC affected artery in atherosclerosis?
| LC affected artery in atherosclerosis?
LAD
LEft circumflex. A
79
Earliest enzymes to raise in MI?
Myoglobin
80
Most sensitive & specific marker in MI?
Troponin (I > T)
81
Best marker for reinfarctiron?
CK-MB
82
Flipping of LDH meaning?
Normally, LDH2 > LDH1
| in MI, LDH1 > LDH2.
83
Complications of MI?
Contractile dysfunction - Pul. edema, shock.
Arrhythmia
Myocardial rupture
-MC- ventricular free wall
-MC site- Anterolateral wall @ mid-vent. level.
-MC 2-4 days after MI.
Ventricular aneurysm- late - after 7days.
Dressler.S.
84
what is Dressler.S?
```
Fibrinous pericarditis.
a/k/a- Post-MI syndrome.
a/k/a- Post-cardiotomy pericarditis.
Auto immune rxn.
manifest after 2-3 weeks after MI
can be seen after 2-3days also- rare.
```
85
Dialated Cardiomyopathy (DCM)?
Gradual 4 chamber hypertrophy & dilation.
Systolic dysfunction
Progressive CCF.
MC aetiology- idiopathic.
Others- Genetic
Alcohol toxicity
Peri-partum
Myocarditis- flabby heart weighing 900g.
Diffuse myocyte hypertrophy with variable interstitial fibrosis.
86
Genetic causes of DCM?
20-50%- familial.
MC- AD
20%- have mutations in "TITIN".
87
which is X-linked Cardiomyopathy?
Duchenne & becker muscular dystrophy.
88
what is TITIN?
Largest known human protein with 30,000 AA.
89
Hypertrophic CM?
MC- AD
MC mutation- beta- myosin heavy chain (beta-MHC).
Poor diastolic relaxation- heavy, muscular, hyper contractile heart.
Asymmetrical inter ventricular septal hypertrophy.
Banana-shaped - LV
HOCM.
Myofiber hypertrophy with helter-skelter pattern.
MCC of sudden death in young athletes.
90
Arrhythmogenic RV CM?
AD.
predominantly RHF and arrhythmia.
MCC- defective adhesive molecules in desmosomes.
RV- wall - severely thinned out with myocyte loss, fatty infiltration.
91
Gene involved in LVH?
Osteoglycin (OGN)
92
Restrictive CM?
Impaired ventricular filling - Diastolic dysfunction.
Ventricle size- normal.
Dialation of both atrium.
Non-specific interstitial myocardial fibrosis.
causes- Amyloidosis, radiation, hemochromatosis, sarcoidosis, scleroderma, neoplasm.
93
Myocarditis?
Inflammation of myocardium.
MCC - viral - Herpes.V > Coksackie.V
MC helminth - Trichinella spiralis.
94
MCC of constrictive pericarditis?
TB
95
MCC of hemorrhagic pericarditis?
Malignancy - MC - lungs.
96
Cardiac tumors are?
Myxoma
| Rhabdomyoma
97
MC tumors of heart?
secondries.
98
MC primary of cardiac secondaries?
MC primary tumors of heart?
lung cancer> breast cancer (MC involve pericardium)
Myxomas.
99
Myxomas
MC site- left atrium (fossa ovale)
arise from- primitive multipotent mesenchymal cells.
MC- females >60yrs.
100
Types of myxomas?
Sporadic - MC type, mostly solitary.
Familial myxomas- B/l, multi centric, affects young ppl.
- ass. with mutations in GNAS1 gene
(McCune Albright.S).
Microscopy- stellate multi potential mesenchymal myxoma cells (Lepidic cells)- in an acid mucopolysaccharide matrix.
10% myxoma are ass. with AD Carney.S :
* Cardiac & extra- cardiac myxomas.
* Pigmented skin lesions.
* Endocrine hyperactivity.
101
MC primary heart tumor in children?
Rhabdomyoma.
102
Rhabdomyoma
most are harmatomas ass. with tuberous sclerosis- defects in TSC1, TSC2 tumor suppressor genes.
Microscopy - large rounded-polygonal cells rich in glycogen containing myofibrils.
Spider cells are seen- artefacts seen on histology- cytoplasmic stranding radiating from central nucleus to plasma membrane.
103
Carcinoid syndrome
Systemic disorder.
Flushing, diarrhoea, dermatitis, bronchoconstriction.
caused by serotonin released by carcinoid tumors.
MC- right heart
MC cardiac manifestation- TR.
Left heart lesions- uncommon, as serotonin is metabolised in lungs, and left heart is supplied by pulmonary circulation.
104
When is left heart affected in carcinoid?
Primary/ metastatic carcinoid - lung.
ASD & Right to left flow.
Drugs with ergotogenic activity - Ergotamine, Fenfluramine, Phenteramine, Methylsergide.
105
Morphology of carcinoid?
Glistening white intimal plaque like thickening of - endocardial surfaces - cardiac chambers & valve leaflets.
composed of- smooth muscles, few collagen fibres in acid mucopolysaccharide matrix.
Severity- correlates with
* Plasma levels of serotonin.
* Urinary excretion of metabolite (5-HIAA).
106
Serous pericarditis
Unkown etiology.
Non- bacterial
seen in - RF, SLE, tumors, uraemia, primary viral infections.
107
Fibrinous & serofibrinous pericarditis
MC type
serous fluid + fibrinous exudates.
seen in- MI, Dressler.S, cardiac surgery, uraemia, irradiation, RF, SLE, trauma.
108
Purulent (supparative) pericarditis
due to - bacterial, fungal, parasitic infection reaching pericardium.
109
Hemorrhagic pericarditis
cardiac surgery
| ass. with TB/ malignancy.
110
Caseous pericarditis
TB
less commonly mycotic infections.
precedes fibrocalcific constrictive pericarditis.
111
Milk spots/ soldier's plaque
seen in healing pericarditis.
| Pericardial fibrosis- thick, pearly, non- adherent epicardial plaque.
112
Cardiac polyp
Not a tumor.
| Postmortem fibrinous clot.
113
De Bakey's classification of aortic dissection ?
DeBakey 1 - from root of aorta to its bifurcation
DeBakey 2 - from root of aorta to its 1st branching
DeBakey 3 - beyond subclavian. A
114
Stanford's classification?
DeBakey 1 & 2 - Stanford's type A
DeBakey 3 - Stanford type B
type A- worse prognosis
type B - better prognosis
115
D/D for aortic dissection?
Acute Pancreatitis (pain in lower abdomen radiating to the back).
