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    • Pericardium
    • Upper figure depicts from left to right: epicardium (E) with its mesothelial lining (arrow), pericardial space (*), fibrous pericardium (F) with its mesothelial lining (arrow).
    • The lower figure shows the epicardium with its mesothelial lining (M). The asterisk (*) indicates the pericardial space. Note the presence of fibrous tissue (F) and adipose tissue (A). The hole on the left side of the image is a blood vessels. The bottom most structure is the myocardium adjacent to the epicardium.
    • -know the parietal pericardium
    • -epicardium- ala visceral serous pericardium
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    • Myocardium
    • This figure shows an H&E photomicrograph of normal cardiac myocytes. Note the branching pattern, the cross striations (vertical lines perpendicular to long axis of myocytes), and central nuclei. Intercalated disks attach myocytes to one another, usually end-to-end, but occasionally side-to-side (not shown). IDs = intercalated disks; N = myocyte nucleus; asterisks (*) = representative branching points
    • -myocytes are striated, branching; many are bi-nucleated
    • -intercalated discs- junctions through which electrical activity & nutrients pass; responsible for electrophysiologic properties of the heart that allow conduction
    • orderly conduction in a standardized manner is the way that the heart contracts normally; problems cause conduction problems and arrhythmia
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    • Myocardium Dc Granules
    • This ultrastructural photomicrograph of an atrial cardiac myocyte shows multiple, scattered dense core (DC) granules, which contain atrial natriuretic peptide, within the cytoplasm. N = nucleus of atrial cardiac myocyte.
    • -conduction system of the heart is made up of modified myocytes
    • -basic atrial natriuretic peptide- a useful test; goes up when blood pressure rises
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    • Myocardium Conductors
    • The top figure illustrates bundle of His as it bifurcates into the right and left bundle branches. Note the interventricular septal myocardium (M) between the bundle branches. The conductive cardiac myocytes appear smaller and paler (due to less myofibril content in the cytoplasm). It is associated with more collagenous (fibrous) tissue.
    • The lower figure depicts a cluster of Purkinje cells (P) within the subendocardium. “E” indicates the endocardium and “M” indicates the myocardium. Note the larger size of the Purkinje cells in addition to its pallor and prominent cytoplasmic vacuolization. The panel on the right is a higher power view of Purkinje cells.
    • -specialized cells w more glycogen and less contractile elements; function in conduction of electrical activity
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    • Endocardium
    • shows an elastic van Gieson (EVG) stained section of endocardium. As can be inferred from the name, the EVG stain highlights elastic tissue, which is black with this particular stain. Note the loose elastic framework. The pink bundles represent the collagen. The black block arrow is pointing to the endothelium, the innermost layer of the endocardium. The bottom of this figure shows myocardium.
    • -endothelial layer, then connective tissue that abuts the myocardium
    • -endocardium is very important to prevent thrombis formation; once there is damage to any endothelial surface, thrombogenesis (clot formation) occurs; intact endothelium is very important
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    • Endothelium
    • prothrombic properties in certain conditions, although generally antithrombotic
    • -inflammatory cells pass through endothelium to get to tissues
    • -neovascularization- in wound healing, there is chronic inflammation and new blood vessel formation, eventually replaced by scar formation
    • red scar because of neovascularization; scar eventually becomes white as blood vessels disappear
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    • Semilunar Valves
    • This figure is an elastic Van Gieson stain which highlights elastic tissue in black. The pink portion represents
    • -aortic & pulmonary valves have 3 leaflets/cusps, with dense fibrosa, spongiosa, and ventricularis (don’t need to know these details)
    • -when there are diseases involving heart valves, this structure bcs obliterated
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    • AV valves
    • This figure is a Movat pentachrome which highlights elastic tissue in black, collagen in pink, and proteoglycans in blue-green. As you can see, the fibrosa layer is mostly collagen and the atrialis is rich in elastic fibers. The spongiosa contains abundant proteoglycans.
    • -tricuspid on right, mitral on left; also have fibrosa, spongiosa, and atrialis (connective tissue layer facing the atria)- don’t need to know these layers
    • -most important thing abt valves- there are diseases where valves are damaged or scarred, causing malfunction
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    • Dilated Cardiomyopathy Gross
    • This gross photograph exhibits a heart with dilated cardiomyopathy. First, the heart is markedly enlarged and all the 4 chambers are dilated (only the right ventricle, left ventricle, and left atrium are well seen in this photograph). Second, there is eccentric hypertrophy in which there is hypertrophy (due to volume overload) with a proportional increase in the chamber size so that the thicknesses of both the ventricles are not increased and may be decreased as compared to normal hearts.
    • -chambers are dilated, larger than normal; heart weight is increased (due to hypertrophy of fibers)
    • -for chronic injury, heart deals with damage by getting larger
    • -bc the heart is not contracting vigorously but weakly, there are blood clots forming in the chambers (thrombi), which increases chance of stroke or heart attack as clots move to different areas of body
    • -cardiomyopathy means there is nothing else wrong with heart
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    • Dilated Cardiomyopathy Micro
    • This photomicrograph is from a histologic section of a heart with dilated cardiomyopathy. The section has been stained with Masson trichrome that stains collagen blue and myocytes red. There is an increased amount of interstitial collagen.
    • -trichrome stain- showing extensive muscle scarring, bc there has been injury in the past
    • -myocarditis may have been contracted in the past, so it may still be seen
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    • Arrhythmogenic right ventricular Cardiomyopathy
    • Above image is a gross image of a cross section of a heart with arrhythmogenic right ventricular cardiomyopathy. Note the significant encroachment of the myocardium by fibrofatty tissue in both the left and right ventricles. It is more prominent in the right ventricle.
    • The bottom figure is a H&E photomicrograph shows mostly fibrofatty tissue (white = fat, pink = collagen) with scattered residual myocytes (magenta).
    • -heart muscle is replaced by fat; fat gets into muscle & fibrous tissue
    • -usually, these pts die of severe arrhythmia before they have heart failure
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    • Hypertrophic Cardiomyopathy
    • S = interventricular septum
    • FW = lateral free wall
    • Asterisk = anterolateral papillary muscle
    • Arrow is pointing to fibrous plaque in left ventricular outflow tract
    • Overall, this heart is markedly enlarged with an increased heart weight. This is due to marked hypertrophy of the myocardium. In this particular case, there is disproportionate increase in the thickness of the septum as compared to the free wall and is consistent with the asymmetric form of hypertrophic cardiomyopathy.
    • -cause of young athletes dying on the field; arrhythmias related to stress and exercise
    • -septum thicker than free wall, which can cause obstruction in left ventricular outflow track
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    • Hypertrophic Cardiomyopathy Micro
    • The upper and lower panels are photomicrographs of sections of a hypertrophic cardiomyopathy heart.
    • The upper panel illustrates two things: 1 – the myocytes are disorganized and 2 – there is considerable disarray of the myofibrils which are crisscrossing one another.
    • The lower panel shows significant fibrointimal thickening of the intramyocardial arteries which is a fairly common finding and may result in ischemic changes in the myocardium.
    • -myocyte disarray- fibers are not parallel like usual, but are disorganized; histological hallmark of this disease
    • -thickening & obstruction of vessels- cause ischemia & infarctions, which can contribute to heart failure
Card Set:
2012-02-13 05:34:21
Fishbein Sytems1

Fishbein 1 Sytems1
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