Cardiovascular Pathology (modification of Dr. Veinot’s presentation) - PowerPoint PPT Presentation

1 / 99
About This Presentation
Title:

Cardiovascular Pathology (modification of Dr. Veinot’s presentation)

Description:

Cardiovascular Pathology (modification of Dr. Veinot s presentation) Michel Dionne MD FRCPC for John P. Veinot MD FRCPC Professor of Pathology – PowerPoint PPT presentation

Number of Views:259
Avg rating:3.0/5.0
Slides: 100
Provided by: medUottaw5
Category:

less

Transcript and Presenter's Notes

Title: Cardiovascular Pathology (modification of Dr. Veinot’s presentation)


1
Cardiovascular Pathology (modification of Dr.
Veinots presentation)
  • Michel Dionne MD FRCPC
  • for
  • John P. Veinot MD FRCPC
  • Professor of Pathology
  • University of Ottawa
  • Pathology and Laboratory Medicine
  • Ottawa Hospital

2
You may only access and use this PowerPoint
presentation for educational purposes. You may
not post this presentation online or distribute
it without the permission of the author.
3
Overview
  • Atherosclerosis
  • Aneurysms
  • Ischemic heart disease
  • Cardiomyopathies
  • Valvular heart disease
  • Hypertension

4
(No Transcript)
5
CVS Anatomy 101
6
Endothelium
7
muscular artery
intima
media
adventitia
8
Aorta
9
Media of aorta an elastic artery
10
Atherosclerosis
  • Disease of large and medium sized arteries
    (elastic and muscular), particularly
  • aorta, iliac, coronary, popliteal, carotid,
    circle of Willis
  • Develop intimal lesions called atheromas or
    atheromatous plaques which
  • protrude into the lumen resulting in stenosis
    (narrowing of lumen) and possibly occlusion
    (lumen blocked)
  • can weaken the underlying media, possibly leading
    to aneurysm formation

11
Atherosclerosis - risk factors
  • Hyperlipidemia
  • high LDL
  • low HDL
  • Hypertension
  • Smoking
  • Diabetes
  • Age
  • Male gender
  • Family history/ genetics

Other physical inactivity, diet, obesity etc.
12
Atherosclerosis - pathogenesis
  • Chronic endothelial injury resulting in
    endothelial dysfunction
  • increased permeability
  • increased adhesion of leukocytes (monocytes and
    lymphocytes) and platelets
  • accumulation of lipids in intima
  • Migration of monocytes into intima leading to
    formation of foam cells (lipid-laden macrophages)
  • Release of cytokines and growth factors result in
    smooth muscle cell migration into intima,
    proliferation of smooth muscle cells, deposition
    of extracellular matrix (e.g. collagen)
  • From hemodynamic forces, hyperlipidemia, HTN,
    smoking etc.

13
From Robbins and Cotran Pathologic Basis of
Disease, 8th Edition
14
Aorta fatty streaks
15
(No Transcript)
16
Aorta fibrofatty/atheromatous plaques
17
Aorta complicated plaques
18
Aortic arch vessels advanced plaques causing
severe stenosis
19
Coronary artery
20
Atheromatous material foam cells (lipid laden
macrophages) and cholesterol clefts
21
From Robbins and Cotran Pathologic Basis of
Disease, 8th Edition
22
Atherosclerosis - complications
  • Calcification
  • Plaque hemorrhage and rupture
  • Plaque erosion/ulceration
  • Thrombosis
  • Embolization of atheromatous material
    (atheroemboli)
  • Aneurysm formation and rupture

23
Renal infarct from embolization
24
Atherosclerosis - major consequences
  • Symptomatic disease most often affects the
    heart, brain, kidneys and lower extremities
  • Heart angina and myocardial infarction
  • Brain cerebral infarction (stroke)
  • Aorta (particularly abdominal)
  • Aneurysms
  • Stenosis of ostia of major branches leading to
    visceral ischemia
  • Lower extremities peripheral vascular (arterial)
    disease claudication, gangrene

25
Aneurysm - definition
  • a localized abnormal dilatation of a vessel

26
Aneurysm types
Atherosclerotic aneurysms are the most common,
but there are other types!
27
Aneurysms - complications
  • Stasis of blood
  • Thrombosis
  • obstruction
  • embolism
  • Mass effect
  • Rupture

28
Abdominal Aortic Aneurysm (AAA)
thrombus
29
Aneurysm rupture
blood
lumen
tear
thrombus
vessel wall
30
AAA rupture
Hemorrhage into surrounding tissue
31
Dissecting aneurysm
32
Coronary artery aneurysms secondary to vasculitis
(inflammation of blood vessels)
33
Left lung
SVC
Aorta
Left atrium
Pericardium
Right atrium
Right lung
Left ventricle
Right ventricle
34
Left atrium
Right atrium
Left ventricle
Right ventricle
Interventricular septum
35
Coronary artery anatomy
http//www.drchander.com/diagnoseCAD.html
36
Coronary artery atherosclerosis
  • affects the epicardial arteries tends to be more
    pronounced in the proximal portion of these
    vessels
  • can involve 1, 2 or all 3 of the main vessels /-
    their large branches
  • if degree of obstruction is significant, can
    result in angina (pain from myocardial ischemia)
  • an atherosclerotic plaque can become unstable
    (acute plaque lesion)
  • intraplaque hemorrhage
  • plaque rupture or erosion resulting in thrombosis
  • acute plaque lesions can result in an acute
    coronary syndrome (unstable angina, myocardial
    infarct)

37
(No Transcript)
38
(No Transcript)
39
Myocardial infarct terminology
40
(No Transcript)
41
(No Transcript)
42
(No Transcript)
43
(No Transcript)
44
Recent MI - about 24 hours old
45
Contraction band necrosis
46
Recent MI - about 3 days old
47
Recent MI - interstitial infiltrate of neutrophils
48
Recent MI - 5-7 days old
49
Recent MI - 7-10 days old
Residual necrotic myocytes
Phagocytosis of dead cells at margin of infarct
Sick myocytes bordering the infarct
50
Remote myocardial infarcts
51
(No Transcript)
52
Transmural rupture
53
Infarct rupture and tamponade
54
Papillary muscle rupture
55
Left ventricle aneurysm
56
Ischemic heart disease - interventions
  • Non-surgical
  • thrombolysis
  • PTCA / stenting
  • atherectomy
  • rotablation
  • Surgical
  • Coronary Artery Bypass Grafting (CABG)
    typically using saphenous vein grafts and/or
    internal thoracic arteries
  • endarterectomy

57
Atherectomy device
58
PTCA balloon
59
(No Transcript)
60
Angiogram pre/post PTCA
61
(No Transcript)
62
(No Transcript)
63
(No Transcript)
64
Aortic valve - normal
65
Mitral valve - normal
66
Aortic stenosis - causes
67
Aortic stenosis causing LVH
68
Mitral stenosis - rheumatic
69
Floppy mitral valve - mitral valve prolapse (MVP)
70
Hypertension
  • PRIMARY (ESSENTIAL)
  • Genetic and environmental factors
  • Defects in sodium homeostasis, vascular smooth
    muscle structure, regulation of vascular tone
  • SECONDARY
  • renal disease
  • vascular disease
  • endocrinopathies
  • drugs
  • neurogenic etc

71
Reno-vascular hypertension
72
Hypertension - complications
  • enhance other diseases (risk factor)
  • small vessel changes
  • scarring/sclerosis
  • microaneurysms
  • large vessel changes
  • ectasia / aneurysms / aortic regurgitation
  • dissection
  • vessel rupture
  • cardiac hypertrophy
  • etc

73
Arteriolo-nephrosclerosis
74
Brain hypertensive bleed
75
Hypertensive brain stem bleed
76
LVH (look familiar?)
77
Cardiomyopathy - definition
  • Heterogenous group of diseases of the myocardium
    associated with mechanical or electrical
    dysfunction that usually (but not invariably)
    exhibit inappropriate ventricular hypertrophy or
    dilation and are due to a variety of causes that
    frequently are genetic.
  • Cardiomyopathies are either confined to the heart
    or are part of generalized systemic disorders
    often leading to cardiovascular death or
    progressive heart failure related disability.
  • Circulation 2006 1131807-1816

78
Cardiomyopathy types(clinical/functional/morphol
ogic patterns)
  • Dilated (DCM) 90
  • Hypertrophic (HCM)
  • Restrictive

79
Primary cardiomyopathy (confined to the heart) -
etiology
  • Genetic
  • e.g. HCM, ARVC, mitochondrial defects,
    channelopathies (e.g. LQTS)
  • Acquired
  • e.g. due to myocarditis (inflammation of the
    myocardium)
  • Mixed
  • Idiopathic

80
Secondary cardiomyopathy (part of generalized
systemic disorder) examples of etiologies
  • Amyloidosis
  • Hemochromatosis
  • Sarcoidosis
  • Medication/Toxin induced - e.g. cancer
    chemotherapy, alcoholism
  • Autoimmune diseases - e.g. SLE, rheumatoid
    arthritis
  • Infections
  • Endocrine disorders - e.g. hypothyroidism
  • Neuromuscular diseases - e.g. muscular
    dystrophies
  • Storage diseases - e.g. glycogen storage disease
  • Nutritional deficiencies - e.g. thiamine

81
Primary dilated cardiomyopathy
  • Primary myocardial abnormality
  • NO SIGNIFICANT
  • coronary artery disease
  • valve disease
  • systemic arterial hypertension
  • systemic disorder, history of toxin exposure etc.

82
(No Transcript)
83
(No Transcript)
84
(No Transcript)
85
(No Transcript)
86
Non-specific myocardial degenerative changes
87
DCM - clinical presentation
  • Progressive heart failure
  • systolic dysfunction
  • 4 chamber dilatation
  • hypokinesis
  • Arrhythmias
  • Thromboembolism
  • Sudden death

88
Familial (genetic) DCM
  • About 30 of DCM
  • Often asymptomatic LV dilatation at detection -
    minority progress
  • Examples
  • muscular dystrophy
  • mitochondrial defects - maternal inheritance
  • inherited metabolic disorders

89
Cardiomyopathy genetic abnormalities
  • Dilated - cytoskeletal elements largely affected
  • dystrophin - X-linked, some muscular dystrophies
  • lamin
  • desmin
  • actin
  • etc
  • mitochondrial genes
  • Hypertrophic - contractile elements affected
    (sarcomeric genes)
  • myosin
  • troponin
  • tropomyosin
  • myosin binding protein C
  • etc

90
(No Transcript)
91
Viral myocarditis and DCM
  • Enteroviral protease cleaves dystrophin
  • Disrupted dystrophin / sarcoglycan complex
  • Similar to primary genetic defects found in DCM

92
(No Transcript)
93
Hypertrophic cardiomyopathy
  • a genetic disease autosomal dominant, variable
    penetrance
  • phenotype variations even with same mutation - ?
    environmental influences
  • myocardial hypertrophy (thickened myocardium)
  • diastolic dysfunction
  • sub-aortic obstruction
  • sudden death (60 of deaths are sudden)

94
Hypertrophic cardiomyopathy
Disproportionate thickening of the
interventricular septum
95
Myocyte disarray and hypertrophy and interstitial
fibrosis
96
HCM - diastolic dysfunction
  • ventricular hypertrophy
  • myocyte disarray
  • interstitial fibrosis
  • myocardial microinfarcts

97
(No Transcript)
98
(No Transcript)
99
Cardiomyopathy - summary
  • Gross and histopathologic findings are non-
    specific but may be diagnostic
  • Most require clinicopathological correlation
  • Many mimics and secondary diseases
  • Molecular diagnosis / genetics developing
Write a Comment
User Comments (0)
About PowerShow.com