CARDIOVASCULAR PATHOLOGY

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rere_girl4ever
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298402
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CARDIOVASCULAR PATHOLOGY
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2015-03-15 14:09:36
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CARDIOVASCULAR PATHOLOGY
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CARDIOVASCULAR PATHOLOGY
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  1. The image below demonstrates a pathologic finding of the left ventricle. What is it and what diseases can cause it?
    • Concentric hypertrophy- caused by ⇧afterload
    • 1. Essential hypertension
    • 2. Pulmonary hypertension
    • 3. Aortic/ Pulmonary stenosis
    • 4. Hypertrophic cardiomyopathy
  2. What causes concentric hypertrophy of the left and right ventricles?
    • Concentric hypertrophy- caused by ⇧afterload
    • 1. Essential hypertension
    • 2. Pulmonary hypertension
    • 3. Aortic/ Pulmonary stenosis
    • 4. Hypertrophic cardiomyopathy
  3. In this type of cardiac hypertrophy, sarcomeres dilate parallel to the long axis of the cells causing the individual muscle fibers to be thicker.
    • Concentric hypertrophy
  4. In this type of cardiac hypertrophy, sarcomeres duplicate in series; muscle fiberes are longer and wider.
    • Eccentric hypertrophy
  5. Describe the findings of sarcomeres in eccentric hypertrophy.
    • Sarcomeres duplicate in series; muscle fiberes are longer and wider
  6. Describe the findings of sarcomeres in concentric hypertrophy.
    Sarcomeres dilate parallel to the long axis of the cells causing the individual muscle fibers to be thicker.
  7. The image below demonstrates a pathologic finding of the left ventricle. What is it and what diseases can cause it?
    • Eccentric hypertrophy⇧preload
    • 1. Dilated cardiomyopathy- Alcohol abuse, Wet Beri Beri, Cocksackie B virus myocarditis, chronic Cocaine use, Chagas disease, Doxorubicin, Hemochromatosis, Sarcoidosis
    • 2. MV, AV, Tricuspid, Pulmonary valve regurgitation
    • 3. L→R shunting e.g VSD
  8. Which conditions are associated with dilated cardiomyopathy?
    Alcohol abuse, Wet Beri Beri, Cocksackie B virus myocarditis, chronic Cocaine use, Chagas disease, Doxorubicin, Hemochromatosis, Sarcoidosis
  9. Which part of the heart is especially vulnerable to ischemia?
    Subendocardium
  10. Which heart sound is associated with ventricular hypertrophy?
    S4- atrial contraction against a stiff ventricle.
  11. When do coronary arteries fill?
    In early diastole
  12. What are the effects of tachycardia on the heart?
    Tachycardia shortens DIASTOLE due to ⇧heart rate→ less filling time (esp of coronary arteries)
  13. What causes less filling time of coronary arteries?
    Tachycardia - shortens DIASTOLE due to ⇧heart rate
  14. Chest pain accompanied by a transient ST segment elevation is diagnositic of?
    Variant (Prinzmetal) angina
  15. What are the clinical findings in Variant angina?
    • Variant (Prinzmetal)
    • ST segment elevation (transmural ischemia)
  16. What test is the most sensitive provocative diagnostic test for coronary vasospasm?
    • Ergonovine- ergot alkaloid
    • Low doses induce coronary spasm (vasoconstrictor), chest pain and ST segment elevation.
    • Aid in diagnosis of angina e.g. Variant (Prinzmetal)
  17. What is the use of Ergonovine?
    • Ergonovine- ergot alkaloid
    • Low doses induce coronary spasm (vasoconstrictor), chest pain and ST segment elevation.
    • Aid in diagnosis of angina e.g. Variant (Prinzmetal)
  18. What is the pathology in this myocardial biopsy?
    • Aschoff bodies - myocardial granulomas with giant cells.
    • Rheumatic fever carditis
  19. What are Aschoff bodies? In which disease is it found?
    • Aschoff bodies - myocardial granulomas with giant cells.
    • Rheumatic fever
  20. Myocardial granulomas with giant cells are characteristic of?
    • Aschoff bodies - myocardial granulomas with giant cells.
    • Rheumatic fever
  21. What are Antischkow/ caterpillar cells? In which disease is it found?
    • Enlarged macrophages with a central, round-ovoid, wavy, rod like nucleus and slender chromatin ribbons.
    • Rheumatic fever

  22. Describe the pathology in this myocardial biopsy.
    • Antischkow / caterpillar cells
    • Enlarged macrophages with a central, round-ovoid, wavy, rod like nucleus and slender chromatin ribbons.
    • Rheumatic fever


  23. What is the pathology seen below? What will happen to the tumor over time?
    • Strawberry/ Juvenille hemangioma
    • Benign capillary hemangioma of infancy.
    • Grows rapidly and regresses spontaneously by 5-8 years.
  24. What is the pathology seen below? What will happen to the tumor over time?
    • Strawberry/ Juvenille hemangioma
    • Benign capillary hemangioma of infancy.
    • Grows rapidly and regresses spontaneously by 5-8 years.
  25. What are the effects of left atrial enlargement?
    • Hoarseness - due to compression of left recurrent laryngeal nerve, a branch of the vagus nerve.
    • Ortner syndrome
    • Dysphagia- due to compression of the esophagus
  26. What is Ortner syndrome?
    Hoarseness - due to compression of left recurrent laryngeal nerve, a branch of the vagus nerve by an enlarged left atrium as a result of MITRAL STENOSIS
  27. Describe the course of the left recurrent laryngeal nerve.
    • Loops behind the ligamentum arteriosum, underneath and around the aortic arch, and ascends to the larnyx to which it supplies.
  28. Describe the course of the right recurrent laryngeal nerve.
    • Enters the thorax between the right common carotid artery and right subclavian artery
  29. Describe the histologic findings of a cardiac myxoma.
    Are composed of scattered cells within a mucopolysaccharide stroma, abnormal blood vessels (due to ⇧VEGF) and hemorraging (hemosiderin deposition).
  30. Describe the clinical manifestations of a cardiac myxoma.
    • Dyspnea, shortness of breath
    • Weight loss, fever (due to ⇧IL-6)
    • Tumor blocks diastolic filling of ventricle, stimulating Mitral stenosis (mid-diastolic rumbling murmur near apex)
  31. What is the pathology seen below?
    Myxoma
  32. What is the pathology seen below?
    "Ball valve" obstruction in the left atrium
  33. Describe the pathology seen below. What causes it?
    • Janeway lesions- small, painless erythematous or hemorragic macules that may appear on the palms and soles of the feet.
    • Caused by septic microemboli to cutaneous blood vessels.
    • The emboli are fragments of infected vegetations.
    • Characteristic of BACTERIAL ENDOCARDITIS
  34. Describe the pathology seen below. It is characteristic of?
    • Janeway lesions- small, painless erythematous or hemorragic macules that may appear on the palms and soles of the feet.
    • Caused by septic microemboli to cutaneous blood vessels.
    • The emboli are fragments of infected vegetations.
    • Characteristic of BACTERIAL ENDOCARDITIS
  35. Describe the pathology seen below. It is characteristic of?
    • Osler nodes- painful raised/ palpulopustile lesions on finger or toe pads 
    • Characteristic of BACTERIAL ENDOCARDITIS
  36. Describe the pathology seen below. It is characteristic of?
    • Osler nodes- painful raised/ palpulopustile lesions on finger or toe pads 
    • Characteristic of BACTERIAL ENDOCARDITIS
  37. In this pathology, what does the blue arrow point to?
    • Roth spot- round white spots on retina surrounded by hemorrage
    • Characteristic of BACTERIAL ENDOCARDITIS
  38. Round white spots on the retina surrounded by hemorrage is characteristic of?
    • Roth spot
    • Bacterial endocarditis
  39. This pathological finding is characteristic of?
    • Splinter hemorrages on nail bed
    • Bacterial endocarditis
  40. Splinter hemorrages on fingernails are characteristic of?
    Bacterial endocarditis
  41. What is the pathology seen below?
    Aortic dissection
  42. Enlarged macrophages with a ovoid/ round nuclei is characteristic of?
    Antischkow cells
  43. What is the major cause of an abdominal aortic aneurysm?
    Atherosclerosis- INTIMAL (FATTY) STREAK
  44. Atherosclerosis is a major cause of which type of aneurysm?
    Abdominal aortic aneurysm
  45. Where are aortic aneurysms usually located?
    • Below renal artery orifices
  46. What is the pathology seen below? What causes it?
    • Abdominal aortic aneurysm
    • Caused by atherosclerosis- intimal (fatty) streak
  47. What are the risk factors associated with abdominal aortic aneurysm?
    • Tobacco use
    • ⇧age
    • Males
    • Family history
  48. Describe the presentation of an abdominal aortic aneurysm.
    • Vague abdominal discomfort.
    • Palpitation reveals a centrally-located/ epigastic pulsatile mass. 
    • Bruit (harsh sound) is heard if renal artery stenosis is present.
  49. Patient presents with vague abdominal discomfort. Palpitation reveals a centrally-located pulsatile mass. What is the pathology?
    Abdominal aortic aneurysm
  50. What complication can arise from an abdominal aortic aneurysm? Describe the clinical presesntaion and findings.
    • Ruputre is the most common complication
    • Sudden onset of severe left flank pain (bleed is initally retroperitoneal) followed by hypotension from blood loss; and presence of a pulsatile mass on physical examination.
  51. What is the pathology seen below?
    Abdominal aortic aneurysm
  52. What is a major cause of aortic dissection?
    Tear in the intima 
  53. Which diseases/ conditions are associated with aortic dissection?
    • Hypertension
    • Bicuspid aortic valve (leaky)
    • Connective tissue disorders (Marfans, Ehlers-Danlos)
  54. What is the most common cause of death in Marfans/ Ehler-Danlos syndrome?
    Aortic dissection
  55. Describe the presentation of an aortic dissection.
    • Acute onset severe retrosternal chest pain radiating to the back, which may extend distally/ proximally as the dissection progresses. 
    • Blood pressure in left arm may be different in right arm.
  56. What complications can result from an aortic dissection?
    • Can result in ruputure.
    • Rupture sites include pericarcial sac ⇨CARDIAC TAMPONADE and death
  57. What  type of Aortic dissection is this? How do we treat?
    • Stanford type A (proximal)
    • De bakey Type I
    • Involves the ascending aorta and extends to aortic arch and descending aorta.
    • Tx: surgery
  58. This type of aortic dissection involves the ascending aorta and extends to aortic arch and descending aorta.
    • Stanford type A (proximal)
    • De bakey Type I
  59. What type of Aortic dissection is this? How do we treat?
    • Stanford type A (proximal)
    • De bakey Type I
    • Involves the ascending aorta
    • Tx: Surgery
  60. This type of aortic dissection involves the ascending aorta.
    • Stanford type A (proximal)
    • De bakey Type II
  61. What  type of Aortic dissection is this? How do we treat?
    • Stanford type B (distal)
    • De bakey Type III
    • Involves descending aorta and/ or aortic arch. 
    • No ascending aorta involvement.
    • Tx- β-blockers then vasodilators
  62. Which arrow points to the true/ false lumen?
    • Yellow arrow: FALSE LUMEN (darker and bigger)
    • Pink arrow: TRUE LUMEN (lighter and smaller)

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