Adventitia
Lumen
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Media (smooth muscles)
Intima
One/2 layers of endothelial cells
Neo-intima endothelial cells + New smooth muscle cells
during injury, inflammation, grafting.
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Atherosclerosis - Intimal based plaques...
Risk factors
Modifiable
-Obesity
-DM
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-HTN.
Infections-
CMV + Herpes + Chlamydia
Non-modifiable
age
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male
stress (Type-A)
Hyperhomocystinuria
Widely accepted Hypothesis - Endothelial injury
Intimal
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cytokines
Recruit Smooth muscles Inflammation (macrophages)
Oxidized LDL + macrophages ? Foam cells
Smooth muscles
Fibrous plaque
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Fatty streak (earliest feature visible)
m/c site - Abdominal aorta Least/c site - Cardiac willing
Aneurysm - Dilatation of Blood wall Heartucale
a) True aneurysm. All layers of Blood vessel wall
b) Pseudo Aneurysm - only one wall (intimal) Tear
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extravascular Hematoma
m/c Cause - Post myocardial .cardiac wall ruptures
c) Mycotic aneurysm - m/c a/w Staphylococcus
m/c site - Femoral Artery
Luetic aneurysm - Syphilis (Tertiary stage)
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Intimal wrinkling - Tree Bark appearance
m/c site - Ascending aorta (Root)
AR ? enlarged Heart chamber Cor bovinum
Ascending A
Arch
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Hypertension
Atherosclerosis
Descending
Aortic dissection- 40-60 years.
Dissection into T.media
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M/C Cause aortic dissection ? HTN
m/c Histology - cystic medial degeneration: (Marfan's, ORTA, EDS)
Vasculitis
Large
1) Giant cell arteritis
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2) Takayasu
Medium
1) PAN
NO ANCA
all stages of inflammation in all vessels
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Small
Wegener's
microscopic polyangitis
Churg-Strauss
Medium
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Giant cell arteritis
Kawasaki
Segmental Biopsy
granulationmatous
Fragmentation of internal elastic lamina
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anti endothelial Ab
Small
Churg-Strauss
eosinophilic granuloma
P-ANCA
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M/C Cause of vasculitis:
a) Pediatric - Henoch Schonlein purpura.
b) Adult - Giant cell arteritis.
c) m/c COD in ped - Kawasaki
II Takayasu arteritis - m/c site - Subclavian arteritis.
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m/c Cause of mononeuritis multiplex
Diabetes mellitus (Ind/world)
amongst Vasculitis- PAN.
Hairy cell leukemia - PAN.
Anti endothelial antibodies-Kawasaki.
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Coronary Artery disease
Significant Obstruction >75%
Risk factors
1) hs-CRP.
2) Total cholesterol
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HDL
3) ApoB/ApoA.
4) LDL
5) HDL.
m/c site
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Left anterior descending artery
MI (LV)
Gross - up to 12 Hrs no
fading/occasional microscopy
TTCAssay- Triphenyl Tetrazolium chloride assay
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Normal TTC
LDH
+
TTC
Dark red Colour
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Normal.
MI
all LDH Released into Serum.
(no LDH to combine)
Pale colour
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M.I
earliest myoglobin
m. sensitive/specific - Troponin I>T.
?2-4hrs-7-10 days.
Re-infarction- CK-MB.
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Flipping of LDH - Normal LDH2>1
Gross
12Hrs Occasional dark mottling
established dark mottling
1-3 days- yellow-tan-infarct
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3-7 days- Hyperaemic Borders
2 months- Scarring complete.
Jeep pattern. LDH1>2.
Microscopy
4Hrs-waviness of fibres.
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12-24Hrs- Coagulation necrosis. early neutrophilic infiltrate
1-3 days-max Neutrophilic infilt
7-10 days- early granulation tissue
10-14 days- max. granulation tissue
EM
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1st/2how-mitochondrial Swelling
1/2how-Large flocculent amorphous densities.
GABH: 1, 3, 5, 6, 18
Pharyngitis 3+ RHD
valve m/c mitral
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4c-pulmonary
Aschoff Bodies
Swollen Collagen
Plasma cells
Histiocytes. Caterpillar like nuclear chromatin
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Anitschow cells
No epitheloid cells
No Langhans giant cells
Diagnostic of RHD
Aschoff Bodies - myocardium (m/c)-Perivascular areas.
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Pericardium
endocardium
Acute RHD:
m/c - mitral Regurgitation.
Overall- mitral stenosis
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Chronic
mitral stenosis
Atrium posterior wall
Subendocardial patches Mac Callum plaques
Aschoff Bodies
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Commonly seen in Chronic RHD
Chronic RHD- myocarditis
Overall - myocarditis
RHD
Small
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sterile
along line of closure of wall
(Coagulase)
NBTE (malignancy, estrogen) LSE I.E)
Small NBTE>RHD
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more prone for embolisation.
sterile.
along lined of closure of wall
medium Large
Verrucous.
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flat
Sterile
either side of wall.
Lower Surface up. upper>
pocket fucalls.
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Non-sterile.
Both surfaces
layer
One liners-
Destructive. max embolization,
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most destructive
Related Cardiomyopathy- a/w Largest Fibrin (30,000).
wall
Arrhythmogenic @ventricular Cardiomyopathy.
ake plakoglobin protein mutation.
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Lv Hypertrophy: osteoglycan (CGN).
HOCM: m/c cause of Sudden death in athletes HOCM
m/c mutation - BmHcgene (myosin heavy chain) in...
- Banana like cavity
MED
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Disarray of myofibers
Helter Skelter disarray)
Myocarditis - Viral infections
m/c- Parvovirus-B19+ Herpes Coxsackie
Parasite-m/c - Trichinella Spiralis.
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m/c Cause of Hemorrhagic pericarditis malignancy
m/c Cause-Lung Ca.
m/c Bpleen tumor Benign Cavernous Hemangioma,
Rest all malignancies.
m/c Tumor of Heart metastasis
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m/c - lung
m/c site-pericardium
Cardiac tumors
Pediatric
m/c malignancy
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Rhabdomyosarcoma?
1° Benign Rhabdomyoma.
Adults
m/c malignancy
Angiosarcoma.
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m/c Benign - Cardiac
myxoma.
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