Histopath: CVD Flashcards
A coroner is conducting an autopsy on someone who has died within 24 hours of having a hip replacement. Examination of the liver shows the image on the right.
(NUTMEG LIVER)
What long standing condition is the patient likely to have suffered from?
Right sided heart failure –> Nutmeg liver
Which of the following is NOT associated with infective endocarditis?
Splenomegaly Rose spots Hematuria Splinter Hemorrhages Fever
Rose spots are associated with enteric fever (typhi and paratyphi)
Splenomegalyoccurs in 37% of patients with active infective endocarditis and in 64% of those with prosthetic valve endocarditis
It is most often due to congestion, hyperplasia, and infarction
What is atherosclerosis?
Atheromatous deposits in and fibrosis of the inner layer of the arteries
Describe the progression of atheroma?
Raised lesion
Soft lipid core
White fibrous cap
What is IHD?
Group of conditions resulting frommyocardial ischaemia
O2 supply < demand
How can IHD present?
Stable/ unstable angina, MI, Chronic ischaemic heart disease with heart failure, Sudden cardiac death
Where are the most common plaque sites for IHD?
LAD (Left anterior descending artery) - 50%, anterior wall, anterior septum, apex (MOST COMMON SITE)
RCA (Right coronary artery) - 40%, posterior wall, post-septum, post-RV
LCx (Left circumflex artery) - 10%, lateral LV not apex
What is angina?
Critical stenosis is whendemand > supply
What are the different types of angina?
Stable angina occurs at around70% occlusion(or diameter < 1 mm)
Prinzmetal - Uncommon, due to coronary artery spasm(can happen w cocaine use)
Unstable= occlusion > 90% + More frequent and longer lasting pain with onset after less exertion or at rest
NB - AGINA NEVER HAS MUSCLE DEATH
What are the complications associated w angina?
Rupture
Erosion
Hemorrhage into plaque
What is unstable angina caused by?
Due to disruption of the plaque with a superimposed thrombus
Warning of impending infarction
What is MI?
Death of cardiac muscle due to prolonged ischaemia
What is the pathogenesis of MI?
Sudden change in plaque Platelet aggregation Vasospasm Coagulation Thrombus evolves
What histology is seen at <6h post MI?
Normal histology
What histology is seen at 6-24h post MI?
Loss of nuclei, homogenous cytoplasm and necrotic cell death
What histology is seen at 1-4d post MI?
Infiltration of polymorphs then macrophages (which clear up debris)
What histology is seen at 5-10d post MI?
Further removal of debris
What histology is seen at 1-2w post MI?
Has granulation tissue, new blood vessels, myofibroblasts and collagen synthesis
What histology is seen weeks-months post MI?
Strengthening, decellularizing scar tissue
What are the complications associated w MI?
DARTH VADER
Death Arrhytmia Rupture Tamponade HF
Valvular disease Aneurysm Dresslers syndrome Embolism Recurrance / regurgitation
+ REPERFUSION INJURY
What is reperfusion injury?
This is the consequence of letting blood go back into an area of myocardial necrosis
The oxidative stress, calcium overload and inflammation can cause further injury
Arrhythmias are common
Biochemical abnormalities can last a few days
It can causestunned myocardium- reversible cardiac failure lasting several days(Pulomary + peripheral oedema) - reversible
What is congestive heart failure, LHF, RHF?
Congestive cardiac failure – both sides affected
Left-sidedcardiac failure –> SOB, pulmonary oedema
Right-sidedcardiac failure –> peripheral oedema, nutmeg liver
What is nutmeg liver?
Nutmeg liver is the pathological appearance of the liver caused by chronic passive congestion of the liver secondary to right heart failure
What are the complications associated w CF?
Sudden death
Arrhythmias
Systemic emboli
Pulmonary oedema with superimposed infection
What is the histological appearance of HF?
Dilated heart
Scarring and thinning of the walls
Fibrosis and replacement of ventricular myocardium
What are the 3 types of cardiomyopathy?
Too thin, too thick, too stiff
Dilated Cardiomyopathy:(MOST COMMON)
- Progressive loss of myocytes -> dilated heart
- Idiopathic, Infective, Alcohol, Thyroid Disease
Hypertrophic Cardiomyopathy:
- Defect in beta myosin heavy chain (AD, familal 50%)
- Associated with Sudden death
- Thickening of the septum narrows the left ventricular outflow tract
Restrictive Cardiomyopathy:
- Impaired compliance
- Amyloid and sarcoid
- Normal sized heart w big atria
How can pericardiits present?
Pleuritic chest pain - worse on sitting forward
What are some causes of pericarditis?
Fibrinous (MI, uraemia)
Purulent (staph)
Granulomatous (TB)
Hemorrhagic (tumor, tb, uraemia)
Fibrous (constrictive and can come from any of the above)
What ECG changes are seen w pericarditis?
widespread ST changes
What is hemopericardium
Hemopericardium- myocardial rupture from MI or trauma.
