Histopathology Cardiovascular Disease Flashcards Preview

Cardio > Histopathology Cardiovascular Disease > Flashcards

Flashcards in Histopathology Cardiovascular Disease Deck (41):
1

Ischaemic Heart Disease Definition

Definition

2

Ischaemic Heart Disease Factors that contribute to the reduction of coronary artery perfusion which results in myocardial ischemia

1. Atherosclerotic stenosis
2. Platelet aggregation
3. Coronary artery vasospasm
4. Non-atherosclerotic coronary artery disease
5. Systemic Haemodynamic derangement

3

Atherosclerotic Stenosis: Epi

• Over 90% of patients with ischaemic heart disease have significant (>75% of cross section of the vessel) stenosis of one or more of the three major coronary arteries.
• 30% have single vessel disease (left anterior descending- -LAD)/ Left circumflex/Right coronary.
• 30% → 2 vessels
• 40% triple vessel disease

4

Atherosclerotic Stenosis: Site of Stenosis

• Usually Proximal (within the first 4 cm) in the LCA (LAD or LC) and somewhat more distal in the RCA.

5

Platelet aggregation: Definition

Rupture and fissuring of atherosclerotic plaque seems to be the initiating factor in most acute cardiac events in IHD.

6

Platelet aggregation: The Exposure of the plaque content leads to

Platelet adherence and aggregation with the development of thrombus which may remain localised to occlude the vessel or may embolise downstream,

7

Vasospasm: Definition



Mechanisms unclear
Non-atheroscleroitc lesions of coronary arteries
• Coronary artery emboli
• Arteritis (Kawasaki’s syndrome, Polyarteritis nodosa)
Coronary artery dissection
Systemic haemodynamic derangements
Left ventricular failure

8

Vasospasm: Systemic haemodynamic derangements

A drop in blood pressure (shock, haemorrhage, operations etc) may severely reduce coronary artery perfusion in vessels which are already affected by fixed stenosis.

9

Myocardial infarction: Two classical patterns of infarction


• Localised transmural infarct in which the entire thickness of the wall is involved – definable occlusive disease.
• Subendocardial type where there is extensive infarction involving the inner third of the myocardium. Usually severe triple vessel disease but often-specific occlusive lesions are absent.

10

Myocardial infarction: LCA disease causes infarct in

Anterior wall, apex and anterior part of the interventricular septum

11

Myocardial infarction: LC disease causes infarct in

Lateral wall

12

Myocardial infarction: RCA disease causes infarct in

Posterior wall and posterior part of the septum?

13

Myocardial infarction: Complications in myocardial infarction

Sudden cardiac death – 25%
Arrhythmias – more than 75%
Mural (endocardial) thrombosis – 30% +. Clinically significant muscle – 1-5%
Cardiogenic shock – 10%
Pericarditis – 30%
Left ventricular failure- 60%

14

Cor pulmonale Definition


A right ventricular enlargement secondary to pulmonary hypertension caused by disorders that affect either the structure or function of the lungs.

15

Cor pulmonale Excluded in the definition

Right ventricular enlargement caused by diseases of the left side of the heart or by congenital heart disease are excluded by this definition.

16

Cor pulmonale Morphological terms

There is right ventricular dilation (as for instance in PE) and, in those disorders causing chronic cor pulmonale, right ventricular hypertrophy. (RV thickness > 0.5 cm).

17

Cor pulmonale Disorders which predispose to Cor Pulmonale

Diseases of the lungs
Diseases of pulmonary vessels
Diseases affecting chest moement

18

Cor pulmonale Diseases of the lungs

Chronic onstructive airways disease (COAD)
Pulmonary fibrosis
Cystic fibrosis

19

Cor pulmonale Disease of pulmonary vessels

Pulmonary embolism
Primary pulmonary hypertension

20

Cor pulmonale Diseases affecting chest movement

Kyphoscoliosis
Marked obesity (Pickwickian syndrome)
Neuromuscular disorders

21

Cardiac Valvular Disease → Definition

A relatively restricted number of conditions are responsible for disorders of the cardiac valves.

22

Cardiac Valvular Disease →Types

Mitral Valve disease
Aortic Valve disease
Aortic Valve disease
Cardiomyopathy

23

Cardiac Valvular Disease → Mitral Valve disease

Stenosis
Regurgitation

24

Cardiac Valvular Disease → Regurgitation intrinsic valve lesions

• Rheumatic heart disease
• Bacterial endocarditis
• Floppy mitral valve
• Calcification of valve ring (senile)

25

Cardiac Valvular Disease → Regurgitation extrinsic valve lesions

• Papillary muscle dysfunction
• Rupture
• Fibrosis
• Rupture of chordae

26

Cardiac Valvular Disease → Aortic Stenosis

• Calcific disease
• Bicuspid valve with calcification
• Tricuspid valve
• Rheumatic pattern of disease
• Rheumatic damage with mitral disease
• Rheumatic damage with normal mitral valve
• Congenital valve stenosis

27

Cardiac Valvular Disease → Aortic valve regurgitation

• Tricuspid (normal valve)
• Rheumatic
• Aortic root disease
• Aortitis
• Non-inflammatory medial degeneration
• Post bacterial endocarditis
• Bicuspid valve
• Post bacterial endocarditis
• Without bacterial endocaritis

28

Cardiomyopathy: Definition

Intrinsic myocardial disease which does not arise from inflammatory disorders or from IHD

29

Cardiomyopathy: Three morphological patterns

Dilated
Hypertrophic
Restricted

30

Cardiomyopathy: Dilated cardiomyopathy

A number of diverse conditions are described as resulting in dilated cardiomyopathy
• Alcohol
• Pregnancy associated nutritional deficiency
• Genetic defect
• Post-viral myocarditis

31

Cardiomyopathy: Hypertrophic pattern

Autosomally dominant pattern of inheritance giving rise to asymmetric left ventricular hypertrophy in young people.

32

Cardiomyopathy: Restricted pattern

Usually the result o amyloid infiltration of the myocardium in the elderly

33

Sites of atheroma formation

• Coronary arteries
• Carotid arteries
• Distal aorta
• Femoral arteries

34

Aneurysm: Definition

Localised abnormal dilation of any vessel. Aneurysms developed as a result of a localised weakness, usually acquired, in the vessel wall.

35

Aneurysm: Large aneurysmal structures

Atherosclerotic (fusiform) aneurysm
Dissecting aneurysm (Acute aortic dissection))
Syphilitic (saccular) aneurysm

36

Aneurysm: Medium sized aneurysmal structures

Saccular (Berry) aneurysm o Circle of Willis
Mycotic aneurysm
Traumatic aneurysm
Congenital Fibromuscular dysplasia

37

Aneurysm: Microaneurysms

Charcot-Bouchrd aneurysms
Diabetic microaneurysms
Cerebral amyloid angioopathy

38

Vasculitis: Definition

Inflammation and necrosis of blood vessel walls.

39

Vasculitis: Large vessels effects

Predominant effect larger vessels the predominant effect will be ischaemia as a result of thrombotic occlusion of the vessel at the site of the inflammatory focus. The ischaemia will usually manifest itself as tissue necrosis.

40

Vasculitis: Smaller vessels

While tissue necrosis may occur, haemorrhage is commonly the redominant manifestation (eg vasculitic purpura; gastrointestinal haemorrhage).

41

Vasculitis: Causes

Bacterial infection
Irradiation
Necrotising vasculitides.

Decks in Cardio Class (108):