Histopath: CVD

Question 1

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?

Answer 1

Right sided heart failure –> Nutmeg liver

Question 2

Which of the following is NOT associated with infective endocarditis?

Splenomegaly 
Rose spots 
Hematuria 
Splinter Hemorrhages
Fever

Answer 2

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

Question 3

What is atherosclerosis?

Answer 3

Atheromatous deposits in and fibrosis of the inner layer of the arteries

Question 4

Describe the progression of atheroma?

Answer 4

Raised lesion

Soft lipid core

White fibrous cap

Question 5

What is IHD?

Answer 5

Group of conditions resulting frommyocardial ischaemia

O2 supply < demand

Question 6

How can IHD present?

Answer 6

Stable/ unstable angina, MI, Chronic ischaemic heart disease with heart failure, Sudden cardiac death

Question 7

Where are the most common plaque sites for IHD?

Answer 7

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

Question 8

What is angina?

Answer 8

Critical stenosis is whendemand > supply

Question 9

What are the different types of angina?

Answer 9

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

Question 10

What are the complications associated w angina?

Answer 10

Rupture
Erosion
Hemorrhage into plaque

Question 11

What is unstable angina caused by?

Answer 11

Due to disruption of the plaque with a superimposed thrombus

Warning of impending infarction

Question 12

What is MI?

Answer 12

Death of cardiac muscle due to prolonged ischaemia

Question 13

What is the pathogenesis of MI?

Answer 13

Sudden change in plaque
Platelet aggregation
Vasospasm
Coagulation
Thrombus evolves

Question 14

What histology is seen at <6h post MI?

Answer 14

Normal histology

Question 15

What histology is seen at 6-24h post MI?

Answer 15

Loss of nuclei, homogenous cytoplasm and necrotic cell death

Question 16

What histology is seen at 1-4d post MI?

Answer 16

Infiltration of polymorphs then macrophages (which clear up debris)

Question 17

What histology is seen at 5-10d post MI?

Answer 17

Further removal of debris

Question 18

What histology is seen at 1-2w post MI?

Answer 18

Has granulation tissue, new blood vessels, myofibroblasts and collagen synthesis

Question 19

What histology is seen weeks-months post MI?

Answer 19

Strengthening, decellularizing scar tissue

Question 20

What are the complications associated w MI?

Answer 20

DARTH VADER

Death
Arrhytmia
Rupture
Tamponade
HF

Valvular disease
Aneurysm
Dresslers syndrome
Embolism
Recurrance / regurgitation 

+ REPERFUSION INJURY

Question 21

What is reperfusion injury?

Answer 21

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

Question 22

What is congestive heart failure, LHF, RHF?

Answer 22

Congestive cardiac failure – both sides affected

Left-sidedcardiac failure –> SOB, pulmonary oedema

Right-sidedcardiac failure –> peripheral oedema, nutmeg liver

Question 23

What is nutmeg liver?

Answer 23

Nutmeg liver is the pathological appearance of the liver caused by chronic passive congestion of the liver secondary to right heart failure

Question 24

What are the complications associated w CF?

Answer 24

Sudden death

Arrhythmias

Systemic emboli

Pulmonary oedema with superimposed infection

Question 25

What is the histological appearance of HF?

Answer 25

Dilated heart

Scarring and thinning of the walls

Fibrosis and replacement of ventricular myocardium

Question 26

What are the 3 types of cardiomyopathy?

Answer 26

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

Question 27

How can pericardiits present?

Answer 27

Pleuritic chest pain - worse on sitting forward

Question 28

What are some causes of pericarditis?

Answer 28

Fibrinous (MI, uraemia)

Purulent (staph)

Granulomatous (TB)

Hemorrhagic (tumor, tb, uraemia)

Fibrous (constrictive and can come from any of the above)

Question 29

What ECG changes are seen w pericarditis?

Answer 29

widespread ST changes

Question 30

What is hemopericardium

Answer 30

Hemopericardium- myocardial rupture from MI or trauma.