5. Heart -Normal
Normal
Hypertrophy =
pressure overload
Dilation= volume
overload
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6. Heart -Normal
Normal Histology
Specific Atrial Granules Atrial Natriuretic Peptide
(ANP )
Intercalated disks with Gap junctions
Clinical significance
Clinical significance
Arrhythmias
Arrhythmias
Due to electromechanical dysfunction
Due to electromechanical dysfunction
Due to Abnormal distribution of gap junctions
Due to Abnormal distribution of gap junctions
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7. Heart -Normal
Normal = Blood Supply
1. Left anterior descending (LAD)
2. Left circumflex (LCX) arteries
3. Right coronary artery (RCA)
Clinical significance
Clinical significance
Most susceptible cardiac tissue to ischemic damage
Most susceptible cardiac tissue to ischemic damage
Sub- endocardial myocardium
Sub- endocardial myocardium
Cardiac chamber involved irrespective of specific vessel
Cardiac chamber involved irrespective of specific vessel
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occlusion Left Ventricle
occlusion Left Ventricle
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8. Heart -Normal
Normal = Effects of Aging on the Heart
Lambl excrescences = calcifications on aortic or
Mitral valves
Atherosclerotic plaque
Clinical significance
Clinical significance
Lambl excrescences = confuse with stenosis
Lambl excrescences = confuse with stenosis
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9. 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
Cardiac
hypertrophy
2 times the size
(Left Ventricle)
3 times
4 times
Condition
pulmonary
HTN & IHD
Systemic HTN,
AS, MR, DCM
AR or HOCM
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11. Heart - Pathology
LVF
Causes = IHD, HTN, Valvular ( Aortic, Mitral) and
Myocardial diseases
Pathology & Clinical features are due to
Pulmonary pooling of blood
Decrease in systemic arterial flow
Morphology
Heart
LV- hypertrophy
LA enlargement → Atrial fibrillation→ Thrombus
formation → Embolic stroke
Lungs = Dyspnea Earliest and the cardinal
congestion and edema-heavy, wet lungs
Kerley's B lines on x-ray
Siderophages or Heart failure cells
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12. Heart - Pathology
Morphology
Kidneys = prerenal azotemia
Brain =Hypoxic encephalopathy
What are these cells ?
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13. Heart - Pathology
RVF
Causes
MCC= left-sided heart failure
Rare =Pure right-sided heart failure ( seen in Pulmonary
HTN & Cor pulmonale)
Morphology
Liver and Portal System = nutmeg
congestive hepatomegaly
centrilobular necrosis
cardiac sclerosis or cardiac cirrhosis
Congestive splenomegaly
Bowel - Chronic edema Ascites
Kidneys- Congestion→ peripheral edema →azotemia
Brain –like in LVF
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14. Heart - Pathology
Clinically
Atelectasis due to Pleural and Pericardial effusions
Subcutaneous Tissue edema =Hallmark
Dependent pitting edema
Aanasarca -generalized massive edema
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15. Heart
– 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 Hypertrophy
Pressure overload – Hypertrophy
Volume overload – Dilation & Hypertrophy
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16. Heart
– 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
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