Professional Documents
Culture Documents
Heart: Exam 2
Heart: Exam 2
Exam 2
Just as we said the Blood Vessel chapter was 1) atherosclerosis and 2) everything else
We can now say the heart chapter is 1) ischemic heart disease and 2) everything else
Remember 1.5 cm is considered to be the
AVERAGE LV wall thickness, RV is 1/3 that,
and atria are ½ RV.
This is a section from “Shotgun Histology”, in other words, the terms on the left describe the entire myocardium. Atrial
natriuretic peptide (ANP), atrial natriuretic factor (ANF), atrial natriuretic hormone (ANH), or atriopeptin, is a powerful
vasodilator, and a protein (polypeptide) hormone secreted by heart muscle cells. It is involved in the homeostatic control of
body water, sodium, potassium and fat (adipose tissue). It is released by muscle cells in the upper chambers (atria) of the
heart (atrial myocytes), in response to high blood pressure. ANP acts to reduce the water, sodium and adipose loads on the
circulatory system, thereby reducing blood pressure.
STRIATIONS
NUCLEUS
DISCS
SARCOLEMMA
SARC. RETIC.
MITOCHONDRIA
ENDOTHELIUM
FIBROBLASTS
GLYCOGEN
A.N.P.
S.A. NodeAV NodeBundle of HIS L. Bundle, R. Bundle
The specialized myocytes of the heart’s conduction system, Purkinje fibers, running sub-
endocardially, have this unique appearance.
I do not recall any pathologist ever pinpointing an EKG abnormaility to a specific histopathologic
abnormality of a Purkinje fiber.
Whichever artery winds up
supplying the posterior
interventricular septum is
said to be “DOMINANT”.
A thrombosis of WHICH
coronary artery would
usually result in sudden
death? Ans: MAIN left
coronary artery.
AX Anterior
Lateral
Posterior
Septal
VLA
The myocardial
perfusion is a
good test of
HLA coronary artery
and myocardial
function.
VALVES
• AV:
– TRICUSPID 13 cm
– MITRAL 11 cm
• SEMILUNAR:
– PULMONIC 8 cm
– AORTIC 6 cm
Note: R>L
Atherosclerotic plaque
< - BROWN
ATROPHY, HEART
LIPOFUCSIN
The pigment which accumulates with age is called lipofucsin, and caused the heart to appear “browner” than
normal. This is called “brown” atrophy of the heart. Lipofucsin is another typical example of a golden brown,
slightly refractile, INtrinsic pigment, which looks like hemosiderin, melanin, or bile, but accumulates, as a rule, on
opposite poles of the myocyte nucleus. It is also called, appropriately, AGING pigmernt.
It appears to be the product of the oxidation of unsaturated fatty acids.
LVH, how do you know this is probably NOT a
cardiomyopathy? Ans: Thickening limited to LV
AVSD
TGA (TRANSPOSITION of GREAT ARTERIES
In TRUNCUS ARTERIOSUS,
the embryological structure known
as the truncus arteriosus fails to
properly divide into the pulmonary
trunk and aorta
Tricuspid Atresia ->
Why does the necrosis spread from the endocardium to the pericardium (i.e., epicardium)? Ans: Because the
subendocardium is the LEAST well perfused by the subepicardial arteries. The “furthest away” theory, BOTH furthest away
from the artery and furthest away from the base.
The APEX of the myocardium is like the FOOT of a human being, it is the most likely to receive the brunt of ischemic and
infarctive phenomena, no matter WHERE along the course of the artery the disease occurs. The apex therefore the most
common site of wall motion abnormalities, logically.
NOTE: In ischemia, NO
gross or microscopic
findings are seen, visible
changes are seen only
with INFARCTION. You
cannot see ISCHEMIA!!!
When might myocardial
rupture occur? Why?
Coagulative necrosis is PALE early. Or
purple.
Yellow when macrophages chew up
the dead tissue.
Sometimes red and soft again with
organization or neovascularation.
White and firm with fibrosis.
Pneumoconioses
Cystic fibrosis
A reasonably logical way of looking at COR
Bronchiectasis PULMONALE, or RIGHT HEART FAILURE
Idiopathic
“Myxomatous” degeneration? Describe it.
CHRONIC:
THICKENED VALVES
Granuloma:Giant Cell::Aschoff
COMMISURAL FUSION
Body:Anitschkow Cell
THICK, SHORT, CHORDAE
TENDINAE
CLINICAL FEATURES
• Migratory Polyarthritis
• Myocarditis
• Subcutaneous nodules
• Erythema marginatum
• Sydenham chorea
Artificial Valves
A “restrictive” cardiomyopathy is a wall which
is NOT thickened or dilated necessarily, but
RIGID in diastolic relaxation, i.e., loss of
“compliance”. EF=1/EDV
DCM
(Dilated Cardiomyopathy)
Path:
4 chamber dilatation
Hypertrophy, also 4 chambers
Interstitial Fibrosis
Arrhythmogenic Right Ventricular Cardiomyopathy
(Arrhythmogenic Right Ventricular Dysplasia)
So is NAXOS syndrome.
A genetic disease
LYMPHOCYTIC INFILTRATES are the USUAL pattern of ALL myocarditis, but eosinophils,
giant cells, and even trypanosomes can be seen occasionally
The “bread and butter” pericarditis is
classically and most often described in uremia
or pericardial infections.
What is the exudate? Ans: Fibrin
“Bread and butter” pericarditis = fibrinous
pericarditis.
FIBROELASTOMAS (valvular,
usually papillary)
RHABDOMYOMA (Most
common cardiac tumor in
children)
MYXOMA
Left atrium most common
CARDIAC TRANSPLANT
HVG
PATHOLOGY (heart and great vessels)