Histopath - CVD Flashcards
Atherosclerosis
Atheromatous deposits in and fibrosis of the inner layer of the arteries
Atherosclerosis RFs
- Age
- Genetics
- Hyperlipidaemia
- HTN
- Smoking
- DM
Progression of atheroma
Raised lesion -> soft lipid core -> white fibrous cap
Ischaemic heart disease
Groupd of conditions which result from myocardial ischaemia
Oxygen supply < demand
Which conditions fall under ischaemic heart disease?
- Stable/unstable angina
- MI
- Chronic ischaemic heart disease w heart failure
- Sudden cardiac death
Ischaemic heart disease plaque sites
- First few cm of LAD (left anterior descending artery) or LCX
- Entire length of RCA
Angina
Critical stenosis (narrowing) when demand > supply
No muscle death -> no raised troponin/ECG changes generally
Stable v unstable angina
Stable: occlusion around 70%
Unstable: occlusion >90% + chest pain at rest
Prinzmetal angina
Uncommon, due to coronary artery spasm
Myocardial infarction
Death of cardiac muscle due to prolonged ischaemia
*Histopathology of MI at different times
- <6h
- 6-24h
- 1-4 days
- 5-10 days
- 1-2 weeks
- Weeks-months
- <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
MI Complications
- Death
- Arrhythmia
- Rupture
- Tamponade
- Heart failure
- Valve disease
- Aaneurysm
- Dressler syndrome
- Embolism
- Reperfusion injury
Right sided cardiac failure histopathology liver
Nutmeg liver
Histology of cardiac failure
- Dilated heart
- Scarring and thinning of walls
- Fibrosis and replacement of ventricular myocardium
Cardiomyopathy
Disease of muscle tissue
3 types of cardiomyopathy
- Dilated
- Hypertrophic
- Restrictive
too thin, too thick, too stiff
Dilated cardiomyopathy
Loss of myocytes
Dilated cardiomyopathy casuses
- Idiopathic
- Infective
- Alcohol
- Thyroid disease
Hypertrophic cardiomyopathy
Defect in beta myosin heavy chain
What is hypertrophic cardiomyopathy associated with?
Sudden cardiac death
Restrictive cardiomyopathy
Impaired compliance
What is restrictive cardiomyopathy associated with?
Amyloid and sarcoid
*Patient has abdominal pain radiating to his back and collapses and dies
Abdominal aortic aneurysm
*Man has an MI 3 years ago. Now he comes into hospital and very unwell. Blood is aspirated from the pericardium.
Ventricular rupture
*Elderly man with atrial fibrillation with right flank pain
Renal infarct
*50 year old lady with memory issues/progressive amnesia, hypertension
Multiple cerebral infarcts
*Man, ex-smoker, with history of hypertension and MI, has sudden chest pain which radiates to the neck
Thrombus of the Left Anterior Descending artery
*Lady with Multiple myeloma and restrictive cardiomyopathy. What will you see on heart biopsy?
Amyloid depositions
*Man with uncontrolled hypertension and angina
?Left ventricular hypertrophy
*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?
Hypertrophic cardiomyopathy (causing sudden cardiac death)
