View
617
Download
2
Category
Tags:
Preview:
DESCRIPTION
Citation preview
Heart Heart
OBJECTIVESNormal Effects of Aging on the HeartPathology
Heart Failure Left-sided heart failure Right-sided heart failure
Congenital Heart Disease Ischemic Heart Disease Hypertensive Heart Disease
OBJECTIVESNormal Effects of Aging on the HeartPathology
Heart Failure Left-sided heart failure Right-sided heart failure
Congenital Heart Disease Ischemic Heart Disease Hypertensive Heart Disease
Dr. Krishna Tadepalli, MD, www.mletips.com
1
Heart Heart
OBJECTIVESValvular diseases
Valvular degeneration caused by calcification Myxomatous degeneration of the Mitral valve (Mitral
valve Prolapse- MVP) Rheumatic fever and rheumatic heart disease (RHD)Infective endocarditis (IE) Non-infected vegetationsComplications of artificial valves
OBJECTIVESValvular diseases
Valvular degeneration caused by calcification Myxomatous degeneration of the Mitral valve (Mitral
valve Prolapse- MVP) Rheumatic fever and rheumatic heart disease (RHD)Infective endocarditis (IE) Non-infected vegetationsComplications of artificial valves
2Dr. Krishna Tadepalli, MD, www.mletips.com
Heart Heart
OBJECTIVESCarcinoid heart disease CardiomypathiesMyocarditis Pericardial disease Tumors of the heart Cardiac transplantation
OBJECTIVESCarcinoid heart disease CardiomypathiesMyocarditis Pericardial disease Tumors of the heart Cardiac transplantation
3Dr. Krishna Tadepalli, MD, www.mletips.com
Heart -NormalHeart -Normal
WeightMale - 325 gm.Female - 275 gm.
Systole- ventricular contractionDiastole- ventricular relaxationThickness
WeightMale - 325 gm.Female - 275 gm.
Systole- ventricular contractionDiastole- ventricular relaxationThickness
Thickness (cm) LV RV
Normal 1.5 0.5
Hypertrophy >2 >0.7
4Dr. Krishna Tadepalli, MD, www.mletips.com
Heart -NormalHeart -Normal
Normal
Hypertrophy = pressure overload
Dilation= volume overload
Normal
Hypertrophy = pressure overload
Dilation= volume overload
5Dr. Krishna Tadepalli, MD, www.mletips.com
Heart -NormalHeart -Normal
Normal HistologySpecific Atrial Granules Atrial Natriuretic Peptide
(ANP ) Intercalated disks with Gap junctions
Normal HistologySpecific Atrial Granules Atrial Natriuretic Peptide
(ANP ) Intercalated disks with Gap junctions
Clinical significance Arrhythmias
Due to electromechanical dysfunction Due to Abnormal distribution of gap junctions
Clinical significance Arrhythmias
Due to electromechanical dysfunction Due to Abnormal distribution of gap junctions
6Dr. Krishna Tadepalli, MD, www.mletips.com
Heart -NormalHeart -Normal
Normal = Blood Supply
1. Left anterior descending (LAD)
2. Left circumflex (LCX) arteries
3. Right coronary artery (RCA)
Normal = Blood Supply
1. Left anterior descending (LAD)
2. Left circumflex (LCX) arteries
3. Right coronary artery (RCA)
Clinical significanceMost susceptible cardiac tissue to ischemic damage
Sub- endocardial myocardium Cardiac chamber involved irrespective of specific
vessel occlusion Left Ventricle
Clinical significanceMost susceptible cardiac tissue to ischemic damage
Sub- endocardial myocardium Cardiac chamber involved irrespective of specific
vessel occlusion Left Ventricle 7Dr. Krishna Tadepalli, MD, www.mletips.com
Heart -NormalHeart -Normal
Normal = Effects of Aging on the Heart Lambl excrescences = calcifications on aortic or
Mitral valvesAtherosclerotic plaque
Normal = Effects of Aging on the Heart Lambl excrescences = calcifications on aortic or
Mitral valvesAtherosclerotic plaque
Clinical significanceLambl excrescences = confuse with stenosis
Clinical significanceLambl excrescences = confuse with stenosis
8Dr. Krishna Tadepalli, MD, www.mletips.com
Heart - Pathology Heart - Pathology
Heart Failure Cardiomegaly = increased size of heart Congestive Heart failure (CHF) Failure to pump blood = systolic dysfunction
Compensatory hypertrophy & dilation
Types = LVF, RVF
Heart Failure Cardiomegaly = increased size of heart Congestive Heart failure (CHF) Failure to pump blood = systolic dysfunction
Compensatory hypertrophy & dilation
Types = LVF, RVF
Cardiac hypertrophy
2 times the size
(Left Ventricle)
3 times 4 times
Condition pulmonary HTN & IHD
Systemic HTN, AS, MR, DCM
AR or HOCM
9Dr. Krishna Tadepalli, MD, www.mletips.com
Heart - PathologyHeart - Pathology
Congestive Heart failure (CHF) Compensatory hypertrophy
Congestive Heart failure (CHF) Compensatory hypertrophy
10Dr. Krishna Tadepalli, MD, www.mletips.com
Heart - PathologyHeart - PathologyLVF
Causes = IHD, HTN, Valvular ( Aortic, Mitral) and Myocardial diseases
Pathology & Clinical features are due to Pulmonary pooling of bloodDecrease in systemic arterial flow
MorphologyHeart
LV- hypertrophyLA enlargement → Atrial fibrillation→ Thrombus
formation → Embolic strokeLungs = Dyspnea Earliest and the cardinal
congestion and edema-heavy, wet lungsKerley's B lines on x-raySiderophages or Heart failure cells
LVFCauses = IHD, HTN, Valvular ( Aortic, Mitral) and
Myocardial diseasesPathology & Clinical features are due to
Pulmonary pooling of bloodDecrease in systemic arterial flow
MorphologyHeart
LV- hypertrophyLA enlargement → Atrial fibrillation→ Thrombus
formation → Embolic strokeLungs = Dyspnea Earliest and the cardinal
congestion and edema-heavy, wet lungsKerley's B lines on x-raySiderophages or Heart failure cells
Dr. Krishna Tadepalli, MD, www.mletips.com
11
Heart - PathologyHeart - Pathology Morphology
Kidneys = prerenal azotemiaBrain =Hypoxic encephalopathy
MorphologyKidneys = prerenal azotemiaBrain =Hypoxic encephalopathy
What are these cells ?
12Dr. Krishna Tadepalli, MD, www.mletips.com
Heart - PathologyHeart - Pathology
RVFCauses
MCC= left-sided heart failureRare =Pure right-sided heart failure ( seen in Pulmonary
HTN & Cor pulmonale)Morphology
Liver and Portal System = nutmegcongestive hepatomegalycentrilobular necrosis cardiac sclerosis or cardiac cirrhosis
Congestive splenomegalyBowel - Chronic edema AscitesKidneys- Congestion→ peripheral edema →azotemiaBrain –like in LVF
RVFCauses
MCC= left-sided heart failureRare =Pure right-sided heart failure ( seen in Pulmonary
HTN & Cor pulmonale)Morphology
Liver and Portal System = nutmegcongestive hepatomegalycentrilobular necrosis cardiac sclerosis or cardiac cirrhosis
Congestive splenomegalyBowel - Chronic edema AscitesKidneys- Congestion→ peripheral edema →azotemiaBrain –like in LVF 13
Dr. Krishna Tadepalli, MD, www.mletips.com
Heart - PathologyHeart - Pathology
Clinically Atelectasis due to Pleural and Pericardial effusions Subcutaneous Tissue edema =Hallmark
Dependent pitting edemaAanasarca -generalized massive edema
Clinically Atelectasis due to Pleural and Pericardial effusions Subcutaneous Tissue edema =Hallmark
Dependent pitting edemaAanasarca -generalized massive edema
14Dr. Krishna Tadepalli, MD, www.mletips.com
Heart – quick reviewHeart – quick review
Sub-endocardial myocardium (adjacent to the ventricular cavities) - most susceptible to ischemic damage
Lambl excrescences – Due to aging Selective up-regulation or re-expression of
embryonic/fetal forms of contractile proteins in Hypertrophy- β-myosin heavy chain, ANP, Collagen
Compensatory changes in HypertrophyPressure overload – HypertrophyVolume overload – Dilation & Hypertrophy
Sub-endocardial myocardium (adjacent to the ventricular cavities) - most susceptible to ischemic damage
Lambl excrescences – Due to aging Selective up-regulation or re-expression of
embryonic/fetal forms of contractile proteins in Hypertrophy- β-myosin heavy chain, ANP, Collagen
Compensatory changes in HypertrophyPressure overload – HypertrophyVolume overload – Dilation & Hypertrophy
15Dr. Krishna Tadepalli, MD, www.mletips.com
Heart – quick reviewHeart – quick review
Left-sided heart failure MCC - – IHD, HTN Lungs in LHF – heavy & wet Earliest and the cardinal complaint - Dyspnea Orthopnea &Paroxysmal nocturnal Dyspnea (PND) – Severe
forms of Dyspnea Renal effects are counteracted by – ANP
Right-sided heart failure MCC- left-sided heart failure Liver in RHF
Nut Meg Liver (congestive hepatomegaly)centrilobular necrosis cardiac sclerosis or cardiac cirrhosis
Hallmark of RHF - Subcutaneous Tissue edema
Left-sided heart failure MCC - – IHD, HTN Lungs in LHF – heavy & wet Earliest and the cardinal complaint - Dyspnea Orthopnea &Paroxysmal nocturnal Dyspnea (PND) – Severe
forms of Dyspnea Renal effects are counteracted by – ANP
Right-sided heart failure MCC- left-sided heart failure Liver in RHF
Nut Meg Liver (congestive hepatomegaly)centrilobular necrosis cardiac sclerosis or cardiac cirrhosis
Hallmark of RHF - Subcutaneous Tissue edema16
Dr. Krishna Tadepalli, MD, www.mletips.com
Recommended