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QPR-Atherosclerosis

Quick Review of Pathology for clinicians and senior students. Atherosclerosis, myocardial infarction

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QPR-Atherosclerosis

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  1. QPR-Atherosclerosis Quick Pathology Review Shashidhar Venkatesh Murthy A/Prof.& Head of Pathology School of Medicine & Dentistry James Cook University Australia. Pathology of Atherosclerosis System : CVS Class : Disorders of Blood Vessels. Topic : Diseases of Arteries. *Requires knowledge of CVS,Vascular anatomy & physiology.

  2. Atherosclerosis - Pathology <ul><li>Aetiology: </li></ul><ul><li>Hypercholesterolemia – Cong, Acquired(life style). </li></ul><ul><li>DM, HPTN, Smoking, Ageing, Homocystinemia*. </li></ul><ul><li>Pathogenesis: </li></ul><ul><li>Intima  injury  Inflam.  Fat/chol.  necro, fibrosis, Ca+ </li></ul><ul><li>Morphology: </li></ul><ul><li>Gross: Streak  Plaque (soft, hard)  Complications. </li></ul><ul><li>Micro: Necrosis, cholesterol, Infl. cells, SMC, Fibrosis, </li></ul><ul><li>Complications: </li></ul><ul><li>Sclerosis, Obstruction, ulceration, thrombosis, aneurysm*, rupture. </li></ul><ul><li>Ischemia – Infarction – Haemorrhage. </li></ul><ul><li>Clinical: </li></ul><ul><li>Chronic progressive obstruction – claudicaton, dysfunction, atrophy. </li></ul><ul><li>Acute changes – Spasm, embolism, rupture. </li></ul> Atherosclerosis - Pathology <ul><li>Aetiology: </li></ul><ul><li>Hypercholesterolemia – Cong, Acquired(life style). </li></ul><ul><li>DM, HPTN, Smoking, Ageing, Homocystinemia*. </li></ul><ul><li>Pathogenesis: </li></ul><ul><li>Intima  injury  Inflam.  Fat/chol.  necro, fibrosis, Ca+ </li></ul><ul><li>Morphology: </li></ul><ul><li>Gross: Streak  Plaque (soft, hard)  Complications. </li></ul><ul><li>Micro: Necrosis, cholesterol, Infl. cells, SMC, Fibrosis, </li></ul><ul><li>Complications: </li></ul><ul><li>Sclerosis, Obstruction, ulceration, thrombosis, aneurysm*, rupture. </li></ul><ul><li>Ischemia – Infarction – Haemorrhage. </li></ul><ul><li>Clinical: </li></ul><ul><li>Chronic progressive obstruction – claudicaton, dysfunction, atrophy. </li></ul><ul><li>Acute changes – Spasm, embolism, rupture. </li></ul>

  3. ? <ul><li>Aneurysm Aorta, Thrombosis, wall Ca+. </li></ul><ul><li>RIA aneurysm, mural thrombosis, ca+. </li></ul><ul><li>Aneurysm, Rupture of RIA with hematoma. </li></ul><ul><li>Large atheromatous plaque in RIA. </li></ul><ul><li>Berry aneurysm RIA + calcification. </li></ul> ? <ul><li>Aneurysm Aorta, Thrombosis, wall Ca+. </li></ul><ul><li>RIA aneurysm, mural thrombosis, ca+. </li></ul><ul><li>Aneurysm, Rupture of RIA with hematoma. </li></ul><ul><li>Large atheromatous plaque in RIA. </li></ul><ul><li>Berry aneurysm RIA + calcification. </li></ul>

  4. Diagnosis ? <ul><li>Atherosclerosis of RIA </li></ul><ul><li>Aneurysm of lower end of Aorta. </li></ul><ul><li>Dissecting aneurysm Aorta. </li></ul><ul><li>Aneurysm with thrombosis of RIA </li></ul><ul><li>Fusiform aneurysm of RIA. </li></ul> Diagnosis ? <ul><li>Atherosclerosis of RIA </li></ul><ul><li>Aneurysm of lower end of Aorta. </li></ul><ul><li>Dissecting aneurysm Aorta. </li></ul><ul><li>Aneurysm with thrombosis of RIA </li></ul><ul><li>Fusiform aneurysm of RIA. </li></ul>

  5. ? <ul><li>Hypercholesterolemia, diabetes. </li></ul><ul><li>Intimal injury, cholesterol deposits. </li></ul><ul><li>Inflammation, Proteases, destruction. </li></ul><ul><li>Obstruction, Ischemia, Infarction. </li></ul><ul><li>Streak, soft plaque, hard plaque. </li></ul> ? <ul><li>Hypercholesterolemia, diabetes. </li></ul><ul><li>Intimal injury, cholesterol deposits. </li></ul><ul><li>Inflammation, Proteases, destruction. </li></ul><ul><li>Obstruction, Ischemia, Infarction. </li></ul><ul><li>Streak, soft plaque, hard plaque. </li></ul>

  6. ? <ul><li>Hypertension. </li></ul><ul><li>Atherosclerosis. </li></ul><ul><li>Diabetes. </li></ul><ul><li>Burgers disease. </li></ul><ul><li>Familial Hypercholesterolemia. </li></ul> ? <ul><li>Hypertension. </li></ul><ul><li>Atherosclerosis. </li></ul><ul><li>Diabetes. </li></ul><ul><li>Burgers disease. </li></ul><ul><li>Familial Hypercholesterolemia. </li></ul>

  7. ? <ul><li>Plaques and Dissecting aneurysm. </li></ul><ul><li>Aneurysm, thrombosis, wall calcification. </li></ul><ul><li>Ruptured aneurysm and hematoma. </li></ul><ul><li>Circular large soft plaque & aneurysm. </li></ul><ul><li>Multiple plaques, ulcerations, calcifications. </li></ul> ? <ul><li>Plaques and Dissecting aneurysm. </li></ul><ul><li>Aneurysm, thrombosis, wall calcification. </li></ul><ul><li>Ruptured aneurysm and hematoma. </li></ul><ul><li>Circular large soft plaque & aneurysm. </li></ul><ul><li>Multiple plaques, ulcerations, calcifications. </li></ul>

  8. ? <ul><li>Hypertension. </li></ul><ul><li>Atherosclerosis. </li></ul><ul><li>Diabetes. </li></ul><ul><li>Smoking  Burgers. </li></ul><ul><li>Multiple conditions. </li></ul> ? <ul><li>Hypertension. </li></ul><ul><li>Atherosclerosis. </li></ul><ul><li>Diabetes. </li></ul><ul><li>Smoking  Burgers. </li></ul><ul><li>Multiple conditions. </li></ul>

  9. ? <ul><li>Intestinal Haemorrhage. </li></ul><ul><li>Thrombosed Intestines. </li></ul><ul><li>Gangrene of small intestine. </li></ul><ul><li>Atherosclerosis of Abdominal arteries. </li></ul><ul><li>Large aneurysm of Aorta. </li></ul> ? <ul><li>Intestinal Haemorrhage. </li></ul><ul><li>Thrombosed Intestines. </li></ul><ul><li>Gangrene of small intestine. </li></ul><ul><li>Atherosclerosis of Abdominal arteries. </li></ul><ul><li>Large aneurysm of Aorta. </li></ul>

  10. . ? <ul><li>Unstable angina. </li></ul><ul><li>Myocardial infarction. </li></ul><ul><li>Stable Angina </li></ul><ul><li>Atherosclerosis of CA. </li></ul><ul><li>Prinzmetal angina. </li></ul>

  11. . ? <ul><li>Smooth muscle cells </li></ul><ul><li>Neutrophils. </li></ul><ul><li>Fibroblasts </li></ul><ul><li>T lymphocytes. </li></ul><ul><li>Macrophages </li></ul>

  12. . ? <ul><li>High LDL </li></ul><ul><li>Low HDL. </li></ul><ul><li>Raised CRP. </li></ul><ul><li>High Homocystine. </li></ul><ul><li>Raised Factor VII. </li></ul>

  13. . ? <ul><li>Life style modification. </li></ul><ul><li>Treat Diabetes </li></ul><ul><li>Thrombolysis / Stent. </li></ul><ul><li>Folate and Vitamins. </li></ul><ul><li>Platelet inhibitors (aspirin). </li></ul>

  14. . “ Difficulties and problems give us the opportunity to grow. When your hopes and dreams are dashed, search among the wreckage, you may find a golden opportunity hidden in the ruins!” - Wings of Fire : An Autobiography of Dr. APJ Abdul Kalam (1999)

  15. . Quick Pathology Review Shashidhar Venkatesh Murthy A/Prof.& Head of Pathology School of Medicine & Dentistry James Cook University Australia. Pathology of Myocardial Infarction System : CVS Class : Heart. Topic : Diseases of Myocardium. *Requires knowledge of Cardiac anatomy & physiology.

  16. . MI - Pathology <ul><li>Aetiology: </li></ul><ul><li>Atherosclerosis. (all others rare) </li></ul><ul><li>Pathogenesis: </li></ul><ul><li> coronary flow, Ischemia, infarction, Inflam, clearing, fibrosis. </li></ul><ul><li>Morphology: </li></ul><ul><li>Gross: N(12h),  LDH(3h), red(24h), Central yellow (2wk), white. </li></ul><ul><li>Micro: 12h necrosis, karyolysis, inflam(1-3d), macro (3-7d), Fibr(wk) </li></ul><ul><li>Complicaitons: </li></ul><ul><li>Acute: Arrhythmia, conduction defects, rupture, tamponade. </li></ul><ul><li>Chronic: Failure (CCF), Aneurysm, thrombosis, embolism. </li></ul><ul><li>Clinical: </li></ul><ul><li>Rupture – 3-7 days - tissue lysis. </li></ul>

  17. . MI - Complications 1d 2-3d 7d 10d old

  18. . MI - Microscopy 1d 2-3d 7d 10d old

  19. . ? <ul><li>Acute Infarction (MI new) </li></ul><ul><li>Acute Rheumatic fever. </li></ul><ul><li>Viral Myocarditis. </li></ul><ul><li>Old Infarction (MI old). </li></ul><ul><li>Atheroclerotic changes. </li></ul>

  20. . ? <ul><li>Mitral stenosis. </li></ul><ul><li>Mitral regurgitation. </li></ul><ul><li>Myocardial rupture. </li></ul><ul><li>Ventricular aneurysm. </li></ul><ul><li>Cardiac tamponade. </li></ul>

  21. . ? <ul><li>Mitral stenosis. </li></ul><ul><li>Mitral regurgitation. </li></ul><ul><li>Myocardial rupture. </li></ul><ul><li>Ventricular aneurysm. </li></ul><ul><li>Cardiac tamponade. </li></ul>

  22. 23. “ Each individual creature on this beautiful planet is here to fulfill a particular role. We are all born with a divine fire in us. Our efforts should be to give wings to this fire and fill the world with the glow of its goodness. - Wings of Fire : An Autobiography of Dr. APJ Abdul Kalam (1999)

  23. 24. Be content with what you have; rejoice in the way things are. When you realize there is nothing lacking, the whole world belongs to you. Lao Tzu

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