Ruptured Papillary Muscle

Question 1

Consequences of severe regurgitation from LV to LA?

Answer 1

1. decreased CO -> shock 2. increased pulmonary blood pressure -> pulmonary edema -> hypoxia 3. left atrial dilation 4. and eventually….right ventricular hypertrophy and failure

Question 2

coagulative necrosis presentation for ruptured papillary muscle?

Answer 2

1. collagen of chordae stains = blue in trichrome stain 2. Abnormal purple staining of myocytes 3. subendocardial myocytes are normal because rx nutrients from luminal blood (although not enough to function normally) 4. congested blood vessels, inflammatory cells, disappearance of visible nuclei (karyolysis)

Question 3

What molecular changes result in hypereosinophilia in coagulative necrosis?

Answer 3

1. Denaturation of cellular proteins (coagulation) increases eosin staining 2. decreased levels of cellular RNA reduce normal basophilia (cytoplasmic staining with hematoxylin)

Question 4

What recruits neutrophils?

Answer 4

IL-8, C5a, C3a, LTB4, platelet activating factors

Question 5

Pyknosis

Answer 5

nuclear shrinkage with hyperchromasia

Question 6

Karyolysis

Answer 6

loss of nuclear basophilia (hypochromasia)

Question 7

Karyorrhexis

Answer 7

fragmentation of nuclear material