Transcript Cardiovascular Pathology I

Cardiovascular Pathology I
Cardiovascular Pathology I
Case 1
Normal coronary artery
H&E stain
Elastin stain
High power
Q1. Describe the histology of a normal coronary
artery.
Be sure to describe all of the layers of the artery
in your discussion.
What is the arrow pointing to on the high power
image?
Case History
A 57-year old man has experienced chest pain
with exertion for the past year. For example,
when he walks up a flight of 10 or more stairs he
develops a pain in his chest which subsides
within several minutes when he sits down and
rests.
Q1. Develop a clinical differential diagnosis.
The image is that of the patient’s left
anterior descending coronary artery
Q2. Describe the histologic findings in this
coronary artery.
Q3. What is your pathologic diagnosis?
Q4. Name at least 3 modifiable and 3 nonmodifiable risk factors for the development of
this condition.
Q5. Correlate the clinical history with the
pathology.
Cardiovascular Pathology I
Case 2
History
A 67-year old man presented to the emergency
department with 10/10 crushing substernal
chest pain. The pain was greatest over his left
chest and radiated down his left arm.
Q1. List 5 life-threatening causes of chest pain.
*represents normal myocardium
Cross sections of coronary artery
Q2. Describe the gross morphologic findings of
the heart. Be specific when describing the area
to which the large arrow is pointing. What
chambers of the heart are labeled A and B?
Q3. What is your diagnosis?
Q4. Based on the gross findings, when did this
event occur? Discuss your rationale.
Q5. Clinically, what lab tests would confirm the
diagnosis? Why?
Q6. Discuss potential complications of this
disease process.
Cardiovascular Pathology 1
Case 3
History
A 45-year old woman with diabetes mellitus,
type 1 complained of “not feeling well” for
several days. She collapses from a cardiac arrest
and cannot be resuscitated. An autopsy is
performed. The light microscopic appearance of
the left ventricle anterior wall and left anterior
descending coronary artery are shown in the
figures
normal
Low power
High power
Q1. Describe the histologic findings of the
myocardium. Compare to normal.
Q2. Describe the histologic findings of the
coronary artery.
Q3. What is your diagnosis?
Q4. Based on the histologic findings, when did
this event occur? Discuss your rationale.
Q5. Are the patient’s symptoms typical of this
disease process? Provide a rationale to your
answer.
Q6. Define the term “vulnerable plaque”.
Cardiovascular Pathology
Case 4
History
A 27-year old man presents with shortness of
breath which developed 7 days prior and has
been steadily worsening. He has no known
medical problems and takes no medications.
Physical exam reveals jugular venous distention,
bilateral basilar lung crackles and lower
extremity edema.
Q1. Develop a clinical differential diagnosis.
An endomyocardial biopsy is performed
Low power
.
High power
Q2. Describe the histologic findings.
Q3. What is your pathologic diagnosis?
Q4. What is the most common cause of this
entity in the United States?
Q5. Correlate the clinical with the pathologic
findings.
Cardiovascular I
Case 5
History
A 78-year-old man presents with sudden onset
of low mid-back pain. His past history is
significant for coronary artery disease and
coronary artery bypass surgery. He has a 60pack year smoking history. On examination, a
pulsatile mass can be felt in the lower abdomen.
On auscultation of the mass a bruit is
appreciated.
Q1. Describe the characteristic pathologic
features of this specimen.
Q2. Correlate the clinical findings with the pathology
Q3. What is your diagnosis?
Q4. What is/are risk factors for the
development of this condition? How do they
contribute to its development?