Temporal (Giant Cell) Arteritis
- Granulomatous Vasculitis often involving Branches of Carotid
- Thickened Tunica Intima
- Destruction of Elastic Lamina
- Presentations
- Headache
- Visual Disturbances
- Jaw Claudication
- Flu-Like Symptoms w/ Joint and Muscle Pain
- Elevated ESR
- Biopsy
- Inflamed Vessel Wall w/ Giant Cells and Intimal Fibrosis
- Negative biopsy DOES NOT r/o disease
- Treatment
- Corticosteroids
- Thickened Tunica Intima
- Destruction of Elastic Lamina
- Headache
- Visual Disturbances
- Jaw Claudication
- Flu-Like Symptoms w/ Joint and Muscle Pain
- Elevated ESR
- Inflamed Vessel Wall w/ Giant Cells and Intimal Fibrosis
- Negative biopsy DOES NOT r/o disease
- Corticosteroids
Takayasu Arteritis
- Granulomatous vasculitis often involving aortic arch at branch points
- Presents in younger adults (classically, Asian Females)
- Visual and Neurological Symptoms w/ weak and absent pulse in UE
- Elevated ESR
- Visual and Neurological Symptoms w/ weak and absent pulse in UE
- Elevated ESR
Polyarteritis Nodosa
- Necrotizing vasculitis involving multiple organs (Lungs Spared)
- Fibrinoid Necrosis
- Presents in Young Adults as
- Hypertension (Renal Artery Involvement)
- Abdominal pain w/ melena (Mesenteric Artery Involvement)
- Neurologic Disturbances
- Skin Lesions
- Associated w/ Serum HBsAg
- Fibrinoid Necrosis
- Hypertension (Renal Artery Involvement)
- Abdominal pain w/ melena (Mesenteric Artery Involvement)
- Neurologic Disturbances
- Skin Lesions
- Associated w/ Serum HBsAg
Kawasaki Disease
- Asian children <4 Years of Age
- Coronary Artery Involvment Common and Leads to:
- Risks for Thrombosis w/ MI
- Aneurysm w/ Rupture
- Presents w/
- Fever
- Conjunctivitis
- Erythematous Rash of Palms and Soles
- Enlarged Cervical Lymph Nodes
- Risks for Thrombosis w/ MI
- Aneurysm w/ Rupture
- Fever
- Conjunctivitis
- Erythematous Rash of Palms and Soles
- Enlarged Cervical Lymph Nodes
Microscopic Polyangitis
- Necrotizing vasculitis involving multiple organs, including lungs and kidney
- Similar to Wegener granulomatosis (granulomatosis w/ polyangitis)
- BUT nasopharyngeal involvement and granulomas absent
- Serum p-ANCA levels correlate w/ disease activity
- Tx = corticosteroids and cyclophosphamide
- BUT nasopharyngeal involvement and granulomas absent
Granulomatosis w/ Polyangitis (Wegener Granulomatosis)
- Necrotizing granulomatous vasculitis involving nasopharynx, lungs, and kidneys
- Presents in Middle-Aged Male w/ :
- Sinusitis
- Nasopharyngeal Ulceration
- Hemoptysis w/ bilateral nodular lung infiltrates
- Hematuria due to rapidly progressive glomerulonephritis
- Serum c-ANCA levels correlate w/ disease activity
- Biopsy reveals large necrotizing granulomas w/ adjacent necrotizing vasculitis
- Sinusitis
- Nasopharyngeal Ulceration
- Hemoptysis w/ bilateral nodular lung infiltrates
- Hematuria due to rapidly progressive glomerulonephritis
Buerger Disease
- Necrotizing vasculitis involving digits
- Presents w/
- Ulceration
- Gangrene
- Autoamputation of Fingers and Toes
- Raynaud Phenomenon often present
- Highly associated w/ heavy smoking
- Ulceration
- Gangrene
- Autoamputation of Fingers and Toes
- Raynaud Phenomenon often present
Reagent Test Strip
- Advantages
- Evaluate multiple physicochemical aspects of urine
- Results availabe in minutes
- Low complexity
- Disadvantages
- Medications/Other Compounds may interfere w/ test
- If there is discordance b/t clinical suspicion and test strip results microscopic eval is needed as well as backup chemistry tests
- Evaluate multiple physicochemical aspects of urine
- Results availabe in minutes
- Low complexity
- Medications/Other Compounds may interfere w/ test
- If there is discordance b/t clinical suspicion and test strip results microscopic eval is needed as well as backup chemistry tests
Hyaline Casts
- Hyaline Cast
- Composed of Tamm-Horsfall Protein
- Can be seen in:
- Normal Urine (0-2 Low Power Field)
- Following Strenuous Exercise and Dehydration
- All type of renal disease
- Composed of Tamm-Horsfall Protein
- Can be seen in:
- Normal Urine (0-2 Low Power Field)
- Following Strenuous Exercise and Dehydration
- All type of renal disease
- Cysteine crystals
- Cystinuria Disease
- Cystinuria Disease
- Tyrosine Crystals
- Severe Liver Disease
- Severe Liver Disease
- Leucine Crystals
- Liver Disease
- Liver Disease
- Cholesterol Crystals
- Nephrotic Syndrome
- Nephrotic Syndrome
- Bilirubin Crystals
- Liver Disease
- Liver Disease
Normal Blood Pressure
Less than 120/80 mmHg
Elevated Blood Pressure
Systolic b/t 120-129 and Diastolic less than 80
Stage 1 Hypertension
Systolic 130-139 and Diastolic 80-89
Stage 2 Hypertension
Systolic at least 140 or Diastolic at least 90
Hypertensive Crisis
Systolic Over 180 and/or Diastolic Over 120
Monckeberg's Medial Calcific Sclerosis
- Calcific deposits in muscular arteries in people over age 50
- Typically do not involve the lumen
- Typically do not involve the lumen
Arteriolosclerosis
- Disease of small arteries and arterioles associated w/ hypertension and diabetes
Atherosclerosis
- Arteriosclerosis characterized by fatty and atheromatous plaques w/in arterial lumina
- Most frequent and clinically important pattern of ateriosclerosis
- Most frequent and clinically important pattern of ateriosclerosis
Hyaline Arteriolosclerosis
- Arteriolar wall is thickened w/ increased plasma protein deposition and narrowed lumen
- Chronic Hypertension
- Diabetes Mellitus
- Chronic Hypertension
- Diabetes Mellitus
Hyperplastic Arteriolosclerosis
- Onion-skinning causing lumenal obliteration
- Severe (Malignant) HTN
- Laminations composed of smooth muscle cells w/ reduplicated, thickened basement membranes
- Severe (Malignant) HTN
Most frequent causes of aortic stenosis
- Wear and Tear
- RHD
Most frequent cause of aortic insufficiency
- Dilation of Aortic Arch (Due to Hypertension and Aging)
- RHD
Most frequent cause of mitral stenosis
- Post-Inflammatory Scarring of RHD
Most frequent cause of mitral insuffiency
- Myxomatous Degeneration
- RHD
Congenital Bicuspid Aortic Valve
- 1.4% of Live Births
- Asymptomatic Early
- Predisposes to Early Calcific Stenosis
- Often Diagnosed in Young Adulthood
- Larger Cusp Often has Midline Raphe
- Proteoglycans Deposited in Spongiosa
- Collagen and Elastin Loose and Disorganized
- Collagen and Elastin Loose and Disorganized
Mitral Valve Prolapse (Myxomatous Valve)
- Midsystolic Click
- Ballooning/Parachute-Like Leaflets
*More common in women than men*
Bread and Butter Pericarditis
Acute Rheumatic Heart Disease
Most Common of All Valvular Diseases
Aortic Stenosis
- Angina
- Syncope During Exertion
- Congestive Heart Failure
- Heart Palpitations
- Sudden Cardiac Death from Arryhthmia
Aortic Stenosis
- Dyspnea on Exertion
- Fatigue
- Decreased Exercise Tolerance
- Sensation of Forceful Heartbeat w/ HBP
Aortic Regurgitation/Insufficiency
- Dyspnea w/ Exertion at First and at Rest Later (With increased severity)
- Fatigue
- Pulmonary Hypertension
- Right Sided Heart Failure
Mitral Stenosis
Use of Fen-Phen
Mitral Regurgitation
Anitschkow Cells "Caterpillar Cells"
Rheumatic Heart Disease
What valve disease is pretty much universal in Chronic Rheumatic Heart Disease?
Mitral Stenosis
Acute Infective Endocarditis
- Explosive, Rapidly Progressive Illness
- High Fever
- Shaking Chills
- Staph aureus commonly
- Often arises in previously normal heart valves
- High Fever
- Shaking Chills
Subacute Infective Endocarditis
- Low-Grade Fever, often w/ nonspecific constitutional symptoms
- Strep viridans most common w/ native valves
- Epidermidis most common w/ prosthetic valves
- Typically arise in damaged/congenitally abnormal heart valves
- Intravenous Drug Abuse
- May be complicated by pulmonary emboli and infarcts
- Pneumonia
- Lung abscesses
- May result in CHF
- Pneumonia
- Lung abscesses
Right-Sided Endocarditis
- Sterile, small vegetations of platelets and fibrin, loosely adherent to valve leaflets along closure lines w/o significant inflammation or valve damage
- Setting of cancer of prolonged chronic illnesses
Non-Bacterial Thrombotic Endocarditis
- Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome
- Valve Scarring
- Small/Medium-Sized Fibrinous, Sterile Vegetations on Either or Both Sides of the Valve Leaflets
Libman-Sachs Disease
Fusion of Commisure of Aortic Valve
Post-Rheumatic Heart Disease
- Occur in Skin, Subcutaneous Tissues, Mucous Membranes, Liver, Spleen, and Kidneys
- Bright Red to Blue, Vary from a few millimeters to several centimeters in size
- Microscopically are unencapsulated aggregates of closely packed, thin walled capillaries
- Vessels separated by scant connective tissue stroma
- Vessels separated by scant connective tissue stroma
Capillary Hemangioma
- Composed of larger vessels than seen in capillary hemangiomas
Cavernous Hemangioma
- Rapidly growing pedunculated red nodule on the skin of mucus membrane
- Bleeds easily, often ulcerated
- Usually reach 1-2 cm in size within a few weeks
- May develop after trauma
- Microscopically are composed of closely packed small capillaries in a lobular configuration w/ stromal edema
Lobular Capillary Hemangioma
- Predominantly in head and neck region, and axillary subcutaneous tissues
- Look like hemangioma, except vessels do not contain blood
Simple Capillary Lymphangioma
- Typically found in head and neck region or axilla of children
- May be enormous, up to 15 cm
- Not encapsulated. Composed of large, dilated vessels, w/o blood in the lumen
Cavernous Lymphangioma
Malignant Primary Cardiac Tumors
- Angiosarcoma
- Rhabdomyosarcoma
- Leiomyosarcoma
- Kaposi Sarcoma
- Fibrosarcoma
- Lymphoma
Most Common Metastatic tumors to Heart