Pathology HCVD Duval

Question 1

Definition of aortic dissection (pathology)

Answer 1

• Dissection of blood along laminar planes of media
• Formation of blood-filled channel within aortic wall
• Usually leading to rupture

Question 2

Epidemiology of aortic dissection (pathology)

Answer 2

• Men 40-60 yo with HTN
• Connective tissue disorders (Marfan’s)
• Pregnancy (rare)

Question 3

90% of aortic dissection occur within:

Answer 3

10 cm of aortic valve

Type A - DeBakey I or II

Question 4

What is Type B/DeBakey III aortic dissection?

Answer 4

• Occurs descending thoracic aorta

- Distal to L subclavian artery

Question 5

Pathology of aortic dissection

Answer 5

• Primary intimal tear (95%)

- Longitudinal/oblique 1-5cm long

Question 6

Histology of aortic dissection

Answer 6

• Normal vascular wall (80%)

- Cystic medial necrosis (20%) - typical of Marfan’s

Question 7

How does an aortic dissection propagate (pathology)?

Answer 7

• Proximally to involve coronary arteries

- Distally to involve iliac/femoral arteries

Question 8

Definition of CHF (pathology)

Answer 8

• Multisystem derangement

- Heart no longer able to eject blood delivered to it by venous system

Question 9

Causes of L heart failure

Answer 9

• HTN
• Mitral valve disease
• Aortic valve disease
• IHD
• Primary myocardial diseases

Question 10

Causes of R heart failure

Answer 10

• L heart failure
• Cor pulmonale
• Pulm vascular disease
• Pulm valve disease
• Tricuspid valve disease
• Congenital (L to R shunt)

Question 11

Compensatory mechanisms of heart failure

Answer 11

• Increased sympathetic nervous system activity

- Hypertrophy

Question 12

Morphology of LV failure

Answer 12

• Dilated, hypertrophied heart
• Boggy lungs w/frothy fluid
• Pulm vascular congestion/edema
• Heart failure cells

Question 13

Morphology of RV failure

Answer 13

• Soft tissue edema
• Nutmeg liver (congestion)
• Cavity fluid
• Cardiac cirrhosis