Cardiovascular Pathology PDF Presentation - University of Alkafeel

Cardiovascular pathology Dr. Tuka Adil M.B.Ch.B F.I.C.M.S path. 1 alkafeel.edu.iq [email protected]...

Cardiovascular pathology Dr. Tuka Adil M.B.Ch.B F.I.C.M.S path. 1 alkafeel.edu.iq [email protected] 18 November 2024  Learning objectives: At the end of this presentation the student will be able to: ▲List two microscopic changes in atherosclerosis. ▲List two types of aneurysm. ▲Define aortic dissection & describe its microscopic feature. ▲List two difference between giant cell arteritis & poly arteritis nodosa. ▲List two microscopic changes in MI in day ( one & day 3)? 2 alkafeel.edu.iq [email protected] 18 November 2024  Normal arterial histology : 3 alkafeel.edu.iq [email protected] 18 November 2024  Normal venous histology : 4 alkafeel.edu.iq [email protected] 18 November 2024  5 alkafeel.edu.iq [email protected] 18 November 2024  Atherosclerosis: atherosclerosis: is a specific type of arteriosclerosis , it is the most common & clinically important vascular disease. it is primarily affect large elastic & medium sized muscular arteries. Morphology: Gross: They appear as white to yellow raised lesions except when ulcerated plaque superimposed by thrombus, it will appear as a red brown in color. Atherosclerosis is an intima-based lesion , so the important features are intimal thickening & lipid accumulation. The plaques are patchy , usually involve only a portion of any arterial wall , so on cross section they the lesions appear eccentric.. 6 alkafeel.edu.iq [email protected] 18 November 2024  7 alkafeel.edu.iq [email protected] 18 November 2024  Microscopic examination: Composed of a soft lipid cores covered by fibrous caps containing : SMCs , collagen , inflammatory cells , variable degree of neo- angiogenesis , lipid & necrotic debris. The media beneath the plaque may be attenuated & fibrotic with smooth muscle atrophy. Acute & chronic changes in atheroma can cause serious consequences: Ulceration or rupture , hemorrhage , embolism & aneurysm formation. 8 alkafeel.edu.iq [email protected] 18 November 2024  9 alkafeel.edu.iq [email protected] 18 November 2024  10 alkafeel.edu.iq [email protected] 18 November 2024  11 alkafeel.edu.iq [email protected] 18 November 2024  Aortic aneurysm: ▲ aneurysms are congenital or acquired dilatations of blood vessels or the heart that involve the entire wall thickness. ▲It typically occur in abdominal portion distal to the renal arteries. ▲In vast majority of cases extensive atherosclerosis is present with thinning & focal destruction of underlying media. ▲It can be classified by shape into. saccular ( discrete outpouching) & fusiform aneurysms (circumferential dilatation) Complication: rupture of the aneurysm. 12 alkafeel.edu.iq [email protected] 18 November 2024  13 alkafeel.edu.iq [email protected]  14 alkafeel.edu.iq [email protected] 18 November 2024  Atherosclerotic aneurysm of the aorta showing large ’bulge’ appears just above the aortic bifurcation 15 alkafeel.edu.iq [email protected] 18 November 2024  Aortic Dissections: It occur when arterial blood penetrates the intima & splays apart the media to form blood filled channel within the aortic walls. usually found in ascending aorta within 10 cm of the aortic valve Gross: Intimal tear with subsequent splitting of the aortic wall leading to massive hemorrhage into adventitia & surrounding soft tissue. 16 alkafeel.edu.iq [email protected] 18 November 2024  S/R opened aorta with a proximal dissection showing small , oblique intimal tear (identified by probe) associated with intramural hematoma (black arrow) & white arrow showing atherosclerotic area. The heart on the left. 17 alkafeel.edu.iq [email protected] 18 November 2024  S/R Dissecting aorta with two lumens : true lumen in the right while false lumen in the left 18 alkafeel.edu.iq [email protected] 18 November 2024  The false lumen (upper) showing irregular surface & blood clots while true lumen (low) with endothelial lining. 19 alkafeel.edu.iq [email protected] 18 November 2024  Mycotic aneurysm : Occur due to infection 20 alkafeel.edu.iq [email protected] 18 November 2024  Berry aneurysm : 21 alkafeel.edu.iq [email protected] 18 November 2024 Berry aneurysm: Gross: Ruptured Berry Aneurysm : S/R subarachnoid hemorrhage from a ruptured aneurysm. 22 alkafeel.edu.iq [email protected] 18 November 2024  Vasculitis: ▲ vasculitis is a general term for vessel wall inflammation. ▲The two most common pathogenic mechanisms of vasculitis are : immune mediated inflammation & direct vascular invasion by infectious pathogens. 23 alkafeel.edu.iq [email protected] 18 November 2024  Giant cell arteritis: Is a chronic inflammatory disorder , typically with granulomatous inflammation , that principally affects large to medium-sized arteries in the head. Gross: (Tender & thickened) scalp veins. 24 alkafeel.edu.iq [email protected] 18 November 2024  25 alkafeel.edu.iq [email protected] 18 November 2024  26 alkafeel.edu.iq [email protected] 18 November 2024  Poly arteritis nodosa: It is a systemic vasculitis of medium sized muscular arteries that commonly involve renal & visceral vessels but usually spares the lung. Morphology: --acute lesions have fibrinoid necrosis of the vessel wall& infilterating neutrophils --where as older lesions are fibrotic & associated with chronic inflammation. --both acute & chronic inflammation may coexist. 27 alkafeel.edu.iq [email protected] 18 November 2024  28 alkafeel.edu.iq [email protected] 18 November 2024  Heart: Normal thickness of LV : average range 1.3 to 1.5 cm Normal thickness of RV : average range 0.3 to 0.5 cm 29 alkafeel.edu.iq [email protected] 18 November 2024  Heart failure: Right side heart failure result in chronic venous congestion of the liver. C/S showing alternating pale & dark areas with a nutmeg like appearance may be due to passive congestion of liver secondary to heart failure. 30 alkafeel.edu.iq [email protected] 18 November 2024  Heart failure: C/S showing hepatic paranchyma contain a faintly nodular pattern & nutmeg staining due to passive congestion of liver secondary to right side heart failure. 31 alkafeel.edu.iq [email protected] 18 November 2024  Heart failure: S/R the central portion of the liver lobules shows congestion & dilatation of central veins & blood sinusoids with atrophy & necrosis of liver cells. 32 alkafeel.edu.iq [email protected] 18 November 2024  Heart failure: Left side heart failure result in chronic venous congestion of the lung. this is gross photograph of lung that are distended & red. the reddish coloration of the tissue is due to congestion while some normal pink lung tissue is seen at the edges of the lungs(arrow) 33 alkafeel.edu.iq [email protected] 18 November 2024  Microscopic examination: The alveolar walls are thickened by dilated & engorged capillaries. *RBC present in alveolar spaces. 34 alkafeel.edu.iq [email protected] 18 November 2024  Myocardial infarction: ▲Definition: also commonly referred to as ‘heart block’ , is necrosis of the heart muscle resulting from ischemia. ▲Enzymes elevated in ischemia: a.troponin b.CK-MB(creatinine kinase) c.LDH(lactate dehydrogenase) d.Myoglobin ▲Complications that might occur in MI: --arrhythmia , ventricular rupture , papillary muscle rupture , aneurysm , heart failure & others. 35 alkafeel.edu.iq [email protected] 18 November 2024  Myocardial infarction Grossly: S/R soft hemorrhagic areas consistant with MI. 36 alkafeel.edu.iq [email protected] 18 November 2024  MI: Grossly: In this pictures cross section of left ventricle showing pale & irregular focal fibrosis with increased thickness. 37 alkafeel.edu.iq [email protected] 18 November 2024  Microscopic features of MI: Histology: One-day-old infarct showing coagulative necrosis & wavy fibers( left) compared with adjacent normal fibers(right), necrotic cells are separated by edema fluid. 38 alkafeel.edu.iq [email protected] 18 November 2024  Microscopic features of MI: Histology: Dense neutrophilic infilterate in the area of a 2-3 day old infarct. 39 alkafeel.edu.iq [email protected] 18 November 2024  Microscopic features of MI: Histology: Nearly complete removal of necrotic myocytes by phagocytic macrophages(7-10)days 40 alkafeel.edu.iq [email protected] 18 November 2024  Microscopic features of MI: Histology: granulation tissue characterized by loose connective tissue & abundant capillaries 41 alkafeel.edu.iq [email protected] 18 November 2024  Microscopic features of MI: Histology: Healed myocardial infarct consisting of a dense collagenous scar 42 alkafeel.edu.iq [email protected] 18 November 2024  ANY QUESTIONS? 43 alkafeel.edu.iq [email protected] 18 November 2024  Thank you for Listening 44 alkafeel.edu.iq [email protected] 18 November 2024