A 55 year old male comes to see you with a blood pressure of 165/90. He smokes, drinks and has high cholesterol. What is causing this blood pressure to go up?
He has hypertension from hyaline arteriolosclerosis.
What health condition could cause the hypertrophy seen below, other than hypertension?
Aortic stenosis can also cause concentric hypertrophy.
A 73 year old male comes to see you with a pulsatile mass in the mid-abdomen. He has a history of hypertension and has smoked for 60 years. What cells contribute to the pathogenesis of his disease?
Endothelium: expresses V-CAM and pulls in monocytes and T-lymphocytes (seen below). Monocytes: activated and become foam cells as they try to eat up cholesterol in clefts (seen below). Smooth muscle cells: come from media and circulating progenitor cells.
How do plaques develop to the point where they can obstruct blood flow?
Fatty streak -> small plaque (flat) -> grows to obstruct blood flow
Identify the different parts of this section of the wall of an aorta.
There is a new thrombus sitting on top of an old thrombus which sits on top of the atherosclerotic plaque (cleared out area) which is sitting on the tunica media.
What causes the condition seen here? When do you really worry about treating it and why?
This is a fusiform aneurism of the abdominal aorta. This is caused by hypertension and atherosclerotic plaque-induced atrophy of the vessel wall that allows it to balloon outwards. You worry about these when they reach 6cm because a burst aneurism has a mortality rate greater than 50%.
A 56 year old male comes to see you with sudden excruciating chest pain that is moving backwards and downward. He has a blood pressure of 170/120. Why might this patient be at risk for cardiac tamponade?
He is having an aortic dissection. If he has a type I or type II dissection, the aorta is dissecting on its ascending portion which is still inside the pericardial sac. If he is having a type III dissection it is going down the descending aorta and could possibly travel backwards towards the ascending portion.
What about this image makes you concerned about aneurism and aoritc dissection in this patient?
Cystic medial necrosis. Note elastin breakdown, making the vessel wall less resilient.
A 64 year old male comes to see you with fever and malaise. He also has a really bad headache. A biopsy of the vessel in his head is shown below. What is your diagnosis?
This patient has giant cell arteritis. Note formation of granuloma within the elastic media.
What are the different vasculitis you need to know?
Large vessels (giant cell and Takayasu). Medium vessels (Immune complex: Polyarteritis Nodosa and Antibodies: Kawasaki). Small vessels (ANCA = Microscopic polyangiitis, Wegener and Chrug-Strauss. Immune comples = SLE, Henoch-Schonlein (IgA), Cryoglobulin, Goodpasture).
On autopsy of the death of a 5 year old boy, the image below is seen from a section of the coronary arteries. What often causes this condition and what could have been done if the boy had made it to the ED in time for life-saving treatment?
This is Kawasaki's, a disease where anti-endothelial antibodies are produced after a viral infection (often Coxsackie's). It causes inflammation, hypercoagulation and thrombus formation in the coronary vessels. If the kid makes it to the ED in time, he needs to be immediately put on IV-Ig and anticoagulants before an MI occurs. Additionally, he would need to be on an anti-coagulant for many years to come.
A 32 year old HIV+ male comes to see you with skin lesions. Skin biopsy is seen below. What causes this condition?
Note the spindle cell proliferation with RBCs between the spindle cells. This is typically seen in Kaposi sarcoma, caused by HHV-8 infection in an immunosuppressed (HIV+) patient.
What organism causes the lesion seen below?
This is a benign skin lesion, bacillary angiomatosis. Note the satellite lesions, it's a vascular lesion. This is caused by bartonella seen on the silver stain image below.
What is your diagnosis?
Note vascular proliferations with cobblestone appearance around the proliferating vasculature. This is angiosarcoma. You could confirm your suspicions with a CD31 stain which will confirm that the lesion is endothelial in origin.
A 56 year old male died of an MI and section of his heart shortly after the MI is shown below. What would the section of his heart look like if he had lived for 2 or 3 more days?
There would be a lot more neutrophilic infiltrate, which typically occurs on days 1-3.
What serum markers do we look for in patients with possible myocardial infarctions?
If you do have an MI, what myocardium will die first?
The myocytes furthest away from blood (vessels and heart chambers)
What blood enzyme levels are useful to determine if a patient has had another MI since her MI a week ago?
CK-MB. They come down after 48 hours where troponins are elevated for 7-10 days.
How long after this patient's MI has it been?
7-10 days. Note the highly vascularized granulation tissue with hemosiderin-laiden macrophages coming in from the superior portion of the image.
What complications are people with a history of MI at risk for for the rest of their lives?
Embolism from mural thrombus, myocardial rupture, aneurism.
What kinds of heart conditions are people with the heart valve seen below at risk for?
This is mitral valve prolapse. You are at risk for regurgitation, mural thrombi, arrhythmia and panic attacks.
A 10 year old goes to the doctor with painful knee and ankle joints. She had pharyngitis a few weeks later. As her disease progresses and assuming she lives to 60 years old, what symptoms might occur then?
This sounds like rheumatic heart disease. Patients with rheumatic heart disease complain of orthopnea, dyspnea and a murmur. Fibrosis of the valve occurs over the years and you get the "fish mouth" deformity.
What non-genetic factors put you at risk for dilated cardiomyopathy?
Myocarditis, peri-partum and alcohol.
What are patients at risk for if endocarditis is not treated?
Embolization, sepsis and shock.
What congenital heart malformation is commonly associated with Down Syndrome?
What congenital heart conditions are commonly associated with Trisomy 13 and 18?
VSD, ASD and PDA.
What congenital heart conditions are commonly associated with Turner syndrome?
Bicuspid aortic valve and aortic coarctation
What congenital heart conditions are commonly associated with "CHARGE" (coloboma, heart, atresia choanae, retardation, genital and ear anomalies)?
VSD, ASD, PDA and tetralogy of Fallot.
What congenital heart conditions are commonly associated with "VATER" (vertebral/vascular, anal, trachea esophageal atresia, radial/renal anomalies)?
VSD, ASD, PDA and tetraology of Fallot.
What congenital heart conditions are commonly associated with congenital rubella?
PDA and peripheral pulmonic stenosis