Cardiovascular Pathology

Normal Heart Note the firm smooth appearance. http://medlib.med.utah.edu/WebPath/CVHTML/CV001.html

Cardiomyopathy heart is flaccid and enlarged This very large heart has a globoid shape because all of the chambers are dilated. It felt very flabby, and the myocardium was poorly contractile. This is an example of a cardiomyopathy. This term is used to denote conditions in which the myocardium functions poorly and the heart is large and dilated, but there is no specific histologic finding. http://medlib.med.utah.edu/WebPath/CVHTML/CV117.html

Fibrinous Pericarditis http://medlib.med.utah.edu/WebPath/CVHTML/CV047.html The epicardial surface of the heart shows a shaggy fibrinous exudate. This is another example of fibrinous pericarditis. This appearance has often been called a "bread and butter" pericarditis, but you would have to drop your buttered bread on the carpet to really get this effect. The fibrin often results in the the finding on physical examination of a "friction rub" as the strands of fibrin on epicardium and pericardium rub against each other.

Pinpoint hemorrhages (epicardium of heart) http://www-medlib.med.utah.edu/WebPath/ATHHTML/ATH035.html Here are petechial hemorrhages seen on the epicardium of the heart. Petechiae (pinpoint hemorrhages) represent bleeding from small vessels and are classically found when a coagulopathy is due to a low platelet count. They can also appear following sudden hypoxia. Often due to low platelet count.

Coronary Artery Bypass Pacing wire http://medlib.med.utah.edu/WebPath/CVHTML/CV028.html Coronary Artery Bypass Bypass grafts

Interventricular Septal Defect Gross Interventricular septal defect, view from the right ventricle. The plastic rod has been inserted into the defect of the muscular interventricular septum. http://www-medlib.med.utah.edu/WebPath/ATHHTML/ATH014.html

Ventricular Aneurysm following MI http://www-medlib.med.utah.edu/WebPath/ATHHTML/ATH014.html There has been a previous extensive transmural myocardial infarction involving the free wall of the left ventricle. Note that the thickness of the myocardial wall is normal superiorly, but inferiorly is only a thin fibrous wall. The thinned area represents a ventricular aneurysm that has developed as a consequence of the healed infarct. Such an aneurysm represents non-contractile tissue that reduces stroke volume and strains the remaining myocardium. The stasis of blood in the aneurysm predisposes to mural thrombosis. Note: thin ventricular wall & fibrous scar tissue

The Aorta The largest artery in body Arises from left ventricle Transports blood to cells throughout the body

Normal Aorta (cut longitudinally) This is about as normal as an adult aorta in America gets. The faint reddish staining is from hemoglobin that leaked from RBC's following death. The surface is quite smooth, with only occasional faint small yellow lipid streaks visible. http://www-medlib.med.utah.edu/WebPath/ATHHTML/ATH015.html

Diseased Aortas These three aortas demonstrate mild, moderate, and severe atherosclerosis from bottom to top. At the bottom, the mild atherosclerosis shows only scattered lipid plaques. The aorta in the middle shows many more larger plaques. The severe atherosclerosis in the aorta at the top shows extensive ulceration in the plaques. http://www-medlib.med.utah.edu/WebPath/ATHHTML/ATH017.html

Severe Arteriosclerosis (aorta) This is severe atherosclerosis of the aorta in which the atheromatous plaques have undergone ulceration along with formation of overlying mural thrombus.

Aortic Aneurysm of Abdomen Aneurysm of the abdominal aorta The aorta is dilated and forms a fusiform bulging mass.

Aneurysm Abdominal Aorta Abdominal aneurysm just below the kidneys. Atherosclerosis may weaken the wall of the aorta such that it bulges out to form an aneurysm. An atherosclerotic aortic aneurysm typically occurs in the abdominal portion below the renal arteries, as shown here. Aortic aneurysms that get bigger than 6 or 7 cm are likely to rupture. http://www-medlib.med.utah.edu/WebPath/ATHHTML/ATH021.html

Dissecting aneurysm of aorta Dissecting aneurysm of the aorta, (Aortic dissection) The aortic wall has split (dissected) at the level of the media producing an outer false lumen running parallel to the central true lumen which is narrowed. splits in wall

Aortic Aneurysm Abdominal aorta iliac arteries This is an excellent gross specimen of the luminal surface of the abdominal aorta. The top 1/3 of the screen is the lumen of the aorta lined by fibro-fatty plaques--the yellowish shiny material. A fibro-fatty plaque is an atheroma. The bottom 2/3 of the field is occupied by the large thrombus which is seen to fill the saccular dilatation of this aorta--the aneurysm. The common iliacs are forming just distal to the aneurysm at the very bottom of the screen. iliac arteries

Hemopericardium (result of aortic dissection) An aortic dissection may lead to hemopericardium when blood dissects through the media proximally. Such a massive amount of hemorrhage can lead to cardiac tamponade. http://medlib.med.utah.edu/WebPath/CVHTML/CV155.html

Aortic Tear There is a tear (arrow) located 7 cm above the aortic valve and proximal to the great vessels in this aorta with marked atherosclerosis. This is an aortic dissection. http://medlib.med.utah.edu/WebPath/CVHTML/CV158.html

Limited Dissection of Aorta This aorta has been opened longitudinally to reveal an area of fairly limited dissection that is organizing. The red-brown thrombus can be seen in on both sides of the section as it extends around the aorta. The intimal tear would have been at the left. This creates a "double lumen" to the aorta. This aorta shows severe atherosclerosis which, along with cystic medial necrosis and hypertension, is a risk factor for dissection. thrombus http://medlib.med.utah.edu/WebPath/CVHTML/CV031.html

Compression--right Carotid (due to aortic dissection) The right carotid artery is compressed by blood dissecting upward from a tear with aortic dissection. Blood may also dissect to coronary arteries. Thus patients with aortic dissection may have symptoms of severe chest pain (for distal dissection) or may present with findings that suggest a stroke (with carotid dissection) or myocardial ischemia (with coronary dissection). http://medlib.med.utah.edu/WebPath/CVHTML/CV161.html

Coarctation of Aorta (aorta narrows to about 3mm) This portion of aorta was resected from a patient with a coarctation. The aorta narrows postductally here to about a 3 mm opening.

Coarctation of Aorta (longitudinally opened) The aorta is opened longitudinally here to reveal a coarctation. In the region of the narrowing, there was increased turbulence that led to increased atherosclerosis.

Infective Endocarditis In this case, the infective endocarditis demonstrates how the infection tends to spread from the valve surface. Here, vegetations can be seen on the endocardial surfaces, and the infection is extending into to underlying myocardium.

Acute Bacterial Endocarditis (destroying aortic valve) The more virulent bacteria causing the acute bacterial form of infective endocarditis can lead to serious destruction, as shown here in the aortic valve. Irregular reddish tan vegetations overlie valve cusps that are being destroyed. Portions of the vegetation can break off and become septic emboli. http://medlib.med.utah.edu/WebPath/CVHTML/CV040.html

Rheumatic Endocariditis

Small linear hemorrhages in finger in patient with infective endocarditis Seen here in the finger at the right are small splinter hemorrhages in a patient with infective endocarditis. These hemorrhages are subungual, linear, dark red streaks. Similar hemorrhages can also appear with trauma. http://medlib.med.utah.edu/WebPath/CVHTML/CV105.html

Calcified aortic stenosis-aortic valve An aortic valve need not be bicuspid to calcify. Sometimes in older adults, a normal tricuspid aortic valve will undergo calcification, a so-called "senile calcific aortic stenosis." Nodules of calcification are seen on the cusps here.

Note long, thin chordae tendinae Prolapse Mitral Valve Note long, thin chordae tendinae The leaftlets of the mitral valve are redundant, and the one on the far left is ballooned upward. This is characteristic of floppy mitral valve with mitral valve prolapse. The chordae tendineae that hold the leaflets become long and thin. The characteristic finding on physical exam is a mid-systolic click. http://medlib.med.utah.edu/WebPath/CVHTML/CV033.html

Opened coronary artery demonstrates thrombosis Note dark red color: (consistent with myocardial infarction) The anterior surface of the heart demonstrates an opened left anterior descending coronary artery.Within the lumen of the coronary can be seen a dark red recent coronary thrombosis. The dull red color to the myocardium as seen below the glistening epicardium to the lower right of the thrombus is consistent with underlying myocardial infarction. http://www-medlib.med.utah.edu/WebPath/ATHHTML/ATH008.html

Normal Coronary Artery This is a normal coronary artery. The lumen is large, without any narrowing by atheromatous plaque. The muscular arterial wall is of normal proportion.

Narrowing of luman in coronary artery Abnormal coronary with narrowing of luman due to plaque buildup.

Coronary Artery Thrombosis

Thrombus in lumen of coronary plaques At high magnification, the dark red thrombus is apparent in the lumen of the coronary. The yellow tan plaques of atheroma narrow this coronary significantly, and the thrombus occludes it completely. plaques http://www-medlib.med.utah.edu/WebPath/ATHHTML/ATH009.html

Narrowed Coronary Artery

Severe Atherosclerosis (with calcification)

Due to transmural myocardial infarction Myocardial Rupture Due to transmural myocardial infarction One complication of a transmural myocardial infarction is rupture of the myocardium. This is most likely to occur in the first week between 3 to 5 days following the initial event, when the myocardium is the softest. The white arrow marks the point of rupture in this anterior-inferior myocardial infarction of the left ventricular free wall and septum. Note the dark red blood clot forming the hemopericardium. The hemopericardium can lead to tamponade.

Myocardial Rupture (due to MI that occured 3 days earlier) In cross section, the point of rupture of the myocardium is shown with the arrow. In this case, there was a previous myocardial infarction 3 weeks before, and another myocardial infarction occurred, rupturing through the already thin ventricular wall 3 days later.

Ventricular Aneurysm A cross section through the heart reveals a ventricular aneurysm with a very thin wall at the arrow. Note how the aneurysm bulges out. The stasis in this aneurysm allows mural thrombus, which is present here, to form within the aneurysm.

Thrombus in Femoral Vein Thrombi on the venous side of the circulation are often called red thrombi, because the low velocity flow of blood enables them to trap many RBCs within the developing fibrin network of the thrombus. This is well-shown in this photograph of a thrombus within the femoral vein. The deep veins of the leg are the most likely site for the formation of venous thrombi.

Carotid Artery Surgery

normal heart enlarged heart (cardiomegaly)

Radiograph Right Heart Pulmonary artery Vena cavae

Radiograph Left Heart

Congestive Heart Failure Enlarged heart (cardiomegaly) (should be width of one lung field) Pulmonary edema (white areas are indicative of fluid) Chest x-ray - Congestive heart failure This PA chest radiogram shows an enlarged heart (it should be the width of one lung field) and pulmonary edema. This is the typical radiologic picture seen in prolonged congestive heart failure. Congestive Heart Failure

Dextrocardia

Enlarged Heart

Summary aneurysm arteriosclerosis dissection Bulging segment of vessel is called: aneurysm 2. Abnormal condition of lipid plaques is called: arteriosclerosis 3. When wall of artery splits and pulls away from vessel, this is called: dissection

myocardial infarction 4. The largest great vessel is the: aorta 5. Area of heart tissue that died as result of blood clot is a: myocardial infarction 6. A clot that forms in a vessel & stays at site of formation is called a: thrombus

embolus cardiomegaly coarctation 7. A mass that floats in the blood stream & gets lodged in a vessel is an: embolus 8. The medical term that means enlarged heart is: cardiomegaly 9. Narrowing of a great vessel is called: coarctation