Transcript Cardiovascular Block

Cardiovascular practical Block
Shaesta Naseem
Part I
Normal anatomy and histology
NOTE:
- The heart serves as a mechanical pump to
supply the entire body with blood, both
providing nutrients and removing waste
products.
- The great vessels exit the base of the heart.
- Blood flow: body→vena cava→right
atrium→right ventricle→lungs→left
atrium→left ventricle→body
- The heart consists of 3 layers – the
endocardium, myocardium, and
epicardium. The epicardium (bottom left)
consists of arteries, veins, nerves,
connective tissue, and variable amounts of
fat.
- The myocardium contains branching,
striated muscle cells with centrally located
nuclei. They are connected by intercalated
disks (arrowheads).
Cardiovascular practical Block
1-Atheroma of aorta
These three aortas demonstrate mild, moderate, and severe atherosclerosis from bottom to
top.
At the bottom, the mild atherosclerosis shows only scattered lipid plaques.
The aorta in the middle shows many more larger plaques.
The severe atherosclerosis in the aorta at the top shows extensive ulceration in the plaques.
Cardiovascular Block
This is severe atherosclerosis of the aorta in which the atheromatous plaques have
undergone ulceration.
2-Coronary atherosclerosis
CORONARY ARTERY ATHEROSCLEROSIS
CORONARY ATHEROSCLEROSIS
Partial occlusion of the artery lumen by an atheromatous plaque.
CORONARY ATHEROSCLEROSIS
The plaque consists of dissolved, cholesterol clefts, hyaline fibrous tissue and
some blood capillaries.
ATHEROMATOUS PLAQUE WITH
CHOLESTEROL CLEFTS
Coronary atherosclerosis:
Cross section of a coronary artery shows:
Partial occlusion of the lumen by an atheromatous
plaque.
The plaque consists of dissolved, cholesterol
clefts, hyaline fibrous tissue and some blood
capillaries.
3-Aneurysm of abdominal aorta
An example of an atherosclerotic aneurysm of the aorta in which a large swelling is
seen just above the aortic bifurcation.
Aneurysmal dilatation of
the lower aorta with
evidence of rupture.
There is an intraluminal
thrombus with extensive
aortic atherosclerosis .
The causes of aneurysms are:
1. Advanced atherosclerosis (Usually abdominal aorta),
2. Fungal infection (mycotic)
3. Syphilis (thoracic aorta)
4. Congenital (Berry aneurysm in circle of willis) .
4-Myocardial infarction
Congested, hemorrhagic
and soft area in the left
ventricular wall
Acute Myocardial infarction
Myocardial infarction
Cross section of the left and right ventricles shows a pale and irregular focal
fibrosis and hemorrhagic/coagulative necrosis in the left ventricular wall with
increased thickness .
Coagulative necrosis is the type of cell injury which usually occurs as a result of
this lesion
MYOCARDIAL INFARCTION
(LATE STAGE)
Chronic ischemic fibrous scar replacing dead myocardial fibers . The remaining
myocardial fibers show enlarged nuclei due to ventricular hypertrophy .
Complications of MI:
1.
2.
3.
4.
5.
6.
7.
Arrhythmias,
Ventricular rupture and hemopericardium
Ventricular aneurysm
Heart failure.
Sudden death,
Pericarditis
ventricular aneurysm
The enzymes which are usually elevated in cases of MI
CKMB, Troponin I and LDH
5-Left ventricular hypertrophy
Heart from a hypertensive patient.
The left ventricle is very thick (over 2 cm). However the rest of the heart is fairly
normal in size as is typical for hypertensive heart disease.
 The hypertension creates a greater pressure load on the heart to induce the
hypertrophy
In cross section, this view of the heart shows the left ventricle in the center left of the
picture.
This heart is obtained from a severely hypertensive individual.
 The left ventricle is grossly thickened.
The myocardial fibers have undergone hypertrophy.
Heart, normal
Heart, left ventricular hypertrophy
6-Vegetations of rheumatic fever on
mitral and aortic valves
Rheumatic valvulitis or Endocarditis
The small verrucous vegetations seen along the closure line of this mitral valve
are associated with acute rheumatic fever over areas of endocardial
inflammation.
Vegetations of rheumatic fever on aortic valve
RHEUMATIC VALVULITIS (HEART)
Irregular endocardial surface, no endocardial lining , focal fibrin deposits.
The valve is thickened by dense hyalinized fibrous tissue with vascularization and
chronic inflammatory cell infiltrate
Rheumatic valvulitis: Complications:
1.
2.
3.
4.
5.
Valvular stenosis and regurgitation
Chronic rheumatic carditis
Heart failure
Thrombo-emboli secondary to atrial fibrillation
Subacute endocarditis
7-Acute rheumatic myocarditis
Aschoff bodies /nodules
Aschoff bodies in the intermuscular fibrous septa.
They are oval in shape and seen in relation to blood vessels.
RHEUMATIC MYOCARDIITIS
(ASHOFF NODULE)
Each consists of a focus of fibrinoid necrosis, few lymphocytes,
macrophages and few small giant cells with one or several
nuclei (Aschoff giant cell).
Acute rheumatic myocarditis:
Section of cardiac muscle shows:
Aschoff bodies in the intermuscular fibrous
septa. They are oval in shape and seen in
relation to blood vessels.
Each consists of a focus of fibrinoid necrosis,
few lymphocytes, macrophages and few small
giant cells with one or several nuclei (Aschoff
giant cell).
8-Chronic venous congestion of the
liver
NUTMEG LIVER
Section of liver showing alternating pale and dark areas with a nutmeg like
appearance possibly due to passive congestion secondary to right sided heart
failure.
The central portion of liver lobules shows congestion and dilatation of
central veins and blood sinusoids, with atrophy and necrosis of liver cells.
Chronic venous congestion of the liver:
Section of liver shows:
The central portion of liver lobules shows
congestion and dilatation of central veins and
blood sinusoids, with atrophy and necrosis of liver
cells.
Kupffer cells contain few brown haemosiderin
pigment granules.
9-Chronic venous congestion of the
lung
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The alveolar walls are thickened by dilated and engorged capillaries.
The alveoli contain edema fluid, red blood cells and heart failure cells.
Chronic venous congestion of the lung:
Section of lung shows:
The alveolar walls are thickened by dilated and
engorged capillaries.
The alveoli contain edema fluid, red blood cells
and large alveolar macrophages (heart failure
cells), which are filled with haemosiderin
pigment derived from red cells breakdown.
In the late stage some fibrous tissue may also be
seen.
10-Thromboangitis oblitrans
(Buerger disease)
10-Thromboangitis oblitrans
(Buerger`s disease)
Thromboangiitis obliterans (Buerger disease). The lumen is occluded
by a thrombus containing abscesses (arrow), and the vessel wall is
infiltrated with leukocytes.
Thromboagitis obliterans (Buerger’s disease):
Section of the skin and subcutaneous tissue shows marked
hyperkeratosis with inflammatory exudate in epidermis:
Large number of small blood vessels in the dermis
show occlusive organized thrombi with
recanalization and fibrosis around blood vessels.
Some blood vessels show recent organizing
thrombi while others show infiltration of the wall
and surrounding tissue by chronic inflammatory
cells.
11-Giant cell ( temporal ) arteritis
Giant cell arteritis
Prominent and tortuous and thickened scalp veins (temporal area)
Serous complication that might occur as a result of this disease
include complete loss of vision and diplopia.
luminal stenosis
Circumferential involvement of the vascular media is present (vertical arrow pointing
downward). Also note the presence of chronic lymphocytic inflammation in the media and
adventitia.
Giant cells can be of Langhans type or foreign-body type (three arrows) and may show
fragments of disrupted internal elastic lamina
Giant cell (temporal) arteritis
Fragmentation of internal elastic lamina, Giant cell reaction and Chronic inflammation
12-Leukocytoclastic / hypersensitivity
vasculitis ( microscopic polyangitis )
Leukocytoclastic / hypersensitivity vasculitis ( microscopic polyangitis)
This condition might be complicated by glomerulonephritis leading to hematuria and
hemoptysis due to pulmonary capillaritis.
Leukocytoclastic vasculitis, foot.
Erythematous and purpuric eruption (Subcutaneous bleeding
patches)
 It tends to be most pronounced on dependent areas like the
foot.
in the wall of the dermal vessels
(Neutrophilic)
Fibrinoid necrosis of small dermal vessels is present, necessary to
establish the diagnosis of leukocytoclastic vasculitis.