Histopath - CVD

Question 1

Atherosclerosis

Answer 1

Atheromatous deposits in and fibrosis of the inner layer of the arteries

Question 2

Atherosclerosis RFs

Answer 2

• Age
• Genetics
• Hyperlipidaemia
• HTN
• Smoking
• DM

Question 3

Progression of atheroma

Answer 3

Raised lesion -> soft lipid core -> white fibrous cap

Question 4

Ischaemic heart disease

Answer 4

Groupd of conditions which result from myocardial ischaemia

Oxygen supply < demand

Question 5

Which conditions fall under ischaemic heart disease?

Answer 5

• Stable/unstable angina
• MI
• Chronic ischaemic heart disease w heart failure
• Sudden cardiac death

Question 6

Ischaemic heart disease plaque sites

Answer 6

• First few cm of LAD (left anterior descending artery) or LCX
• Entire length of RCA

Question 7

Angina

Answer 7

Critical stenosis (narrowing) when demand > supply

No muscle death -> no raised troponin/ECG changes generally

Question 8

Stable v unstable angina

Answer 8

Stable: occlusion around 70%

Unstable: occlusion >90% + chest pain at rest

Question 9

Prinzmetal angina

Answer 9

Uncommon, due to coronary artery spasm

Question 10

Myocardial infarction

Answer 10

Death of cardiac muscle due to prolonged ischaemia

Question 11

*Histopathology of MI at different times

• <6h
• 6-24h
• 1-4 days
• 5-10 days
• 1-2 weeks
• Weeks-months

Answer 11

• <6h: normal histology
• 6-24h: Flocculent densities form within mitochondria
• 1-4 days: Neutrophils begin to arrive at the area of coagulative necrosis
• 5-10 days: Macrophages begin to arrive at the area of coagulative necrosis
• 1-2 weeks: Granulation tissue begins to form
• Weeks-months: Collagen is deposited, forming a fibrous scar

Question 12

MI Complications

Answer 12

• Death
• Arrhythmia
• Rupture
• Tamponade
• Heart failure
• Valve disease
• Aaneurysm
• Dressler syndrome
• Embolism
• Reperfusion injury

Question 13

Right sided cardiac failure histopathology liver

Answer 13

Nutmeg liver

Question 14

Histology of cardiac failure

Answer 14

• Dilated heart
• Scarring and thinning of walls
• Fibrosis and replacement of ventricular myocardium

Question 15

Cardiomyopathy

Answer 15

Disease of muscle tissue

Question 16

3 types of cardiomyopathy

Answer 16

• Dilated
• Hypertrophic
• Restrictive

too thin, too thick, too stiff

Question 17

Dilated cardiomyopathy

Answer 17

Loss of myocytes

Question 18

Dilated cardiomyopathy casuses

Answer 18

• Idiopathic
• Infective
• Alcohol
• Thyroid disease

Question 19

Hypertrophic cardiomyopathy

Answer 19

Defect in beta myosin heavy chain

Question 20

What is hypertrophic cardiomyopathy associated with?

Answer 20

Sudden cardiac death

Question 21

Restrictive cardiomyopathy

Answer 21

Impaired compliance

Question 22

What is restrictive cardiomyopathy associated with?

Answer 22

Amyloid and sarcoid

Question 23

*Patient has abdominal pain radiating to his back and collapses and dies

Answer 23

Abdominal aortic aneurysm

Question 24

*Man has an MI 3 years ago. Now he comes into hospital and very unwell. Blood is aspirated from the pericardium.

Answer 24

Ventricular rupture

Question 25

\*Elderly man with atrial fibrillation with right flank pain

Answer 25

Renal infarct

Question 26

\*50 year old lady with memory issues/progressive amnesia, hypertension

Answer 26

Multiple cerebral infarcts

Question 27

\*Man, ex-smoker, with history of hypertension and MI, has sudden chest pain which radiates to the neck

Answer 27

Thrombus of the Left Anterior Descending artery

Question 28

\*Lady with Multiple myeloma and restrictive cardiomyopathy. What will you see on heart biopsy?

Answer 28

Amyloid depositions

Question 29

\*Man with uncontrolled hypertension and angina

Answer 29

?Left ventricular hypertrophy

Question 30

\*An 18 year old student collapses and dies whilst playing football. A postmortem finds asymmetric hypertrophy of the interventricular septum. Microscopic examination shows thickened and disorganized muscle fibres with hyperchromatic nuclei. What is the most likely diagnosis?

Answer 30

Hypertrophic cardiomyopathy (causing sudden cardiac death)