cvs lec 2.pdf, cardiovascular system and pathology

Cardiovascular system

1. Vasculitis

3. Causes
•Infections, such as hepatitis B and hepatitis C.
•Blood cancers.
•Immune system diseases, such as rheumatoid arthritis, lupus and
scleroderma.
•Reactions to certain drugs

4. Large vessel vasculitis
1.Giant cell arteritis
2.Takayasu

6. Giant cell arteritis

7. Pathogenesis
•Giant cell arteritis likely occurs as a result of a T cell–mediated
immune response to an as yet uncharacterized vessel wall antigen.
•Proinflammatory cytokines (especially TNF) and anti-EC antibodies
also contribute.
•There is characteristic granulomatous inflammation,
•the excellent therapeutic response to steroids all strongly support
an immune etiology.

8. Gross
Arteries involved
•1.branches of carotid
•2vertebral arteries
•3.aorta

9. •Thick cord like artery(patchy involvement)
•Reduced lumen

10. Microscopic features
Giants in the center;armyall around
•1.granuloma with giant cells in tunica media
•Fragmentation of internal elastic lamina
•2.Panarteritis(mixture of acute and chronic inflammatory cells

11. Late changes
•Intimal thickening
•fibrosis

12. Major hint
1.Elderly female
2.headache

13. •Headache(temporal artery involvement)
•Visual disturbance(ophthalmicartery
involvement)
•Jaw claudication
•ESRiselevated
•High risk of blindness without treatment

14. Takayasu arteritis

15. Gross
•Arteries involved: Aortic arch and branches
•Aortic root dilatation
•Narrowed vessel

16. Microscopic feature
•Same as giant cell arteritis
•Additionalpoint
inflammation can either occur in only adventitia or in
all layers

17. Clinical features

18. Imphints
1.Asian female
2.pulseless

19. Medium vessel vasculitis

20. Poly arteritis nodosa

21. Gross
•Strings on a baedappearance(nodule--fibrosis---
nodule)
•Affected arteries
Renal,coronary,hepaticand mesenteric

22. Microscopic(F.I.T)
•1.fibrinoid necrosis
•2.inflammatory cells(acute and chronic)
•3.thrombosis
Late changes:
•Intimal thickening
•fibrosis

23. •Systemic vasculitis of the small and medium-
sized vessels, which leads to tissue ischemia
•Most commonly involves skin, peripheral
nerves, muscles, joints, gastrointestinal tract,
and kidneys

24. Etiology(imp hint)
•associated with hepatitis Bor hepatitis C

25. Clinical features
•Nonspecific symptoms
•Fever, weight loss, malaise
•Muscle and jointpain
•hypertension, renal impairment
•myocardial infarction
•rash, ulcerations, nodules
•polyneuropathy(mononeuritis multiplex), stroke
•abdominal pain, melena
Usually spares the lungs
Classical case:HepB,renalfailure.nervedefect,skinnodule,purpura

26. Diagnostic
•Blood tests
•ANCA-negative
•Muscle biopsy
•Transmural inflammationof the arterial wall with leukocytic infiltration and fibrinoid
necrosis
•The inflammatory lesions are usually in various stages of development and regeneration.
•Angiography
[10]
•Numerous small aneurysmsand stenosis of small and medium-sized vessels of the
involved organs
•Most commonly seen in the renal arteries(pulmonary arteriesare usually not affected)

27. Things you need to remember in PAN
Usually spares the lungs
producing a 'string-of-pearls'
appearance on imaging

31. An angiogram is an X-ray
procedure that can be both
diagnostic and therapeutic. It
is considered the gold standard
for evaluating blockages in the
arterial system. An angiogram
detects blockages using X-rays
taken during the injection of a
contrast agent (iodine dye)

33. Kawasaki disease

36. Gross features
•Coronary arteries and mucocutaneous

37. Microscopic
•Same as PAN

38. Clinical hints
•Asian
•Child
•Red rash
•tongue

39. Small vessel vasculitis

44. Kaposi sarcoma

45. Etiology
•Caused by human herpesvirus 8(HHV8), a large DNAgamma herpes
virus
•Routes of transmission include
[1]
•Saliva
•Sexual contact
•Potentially via blood transfusionand IV drug use

47. Gross
•Patches
•Plaque
•nodule

56. MORPHOLOGY

58. Microscopic features
Chronic inflammatory cells
Irregular dilated vessels
Patch→linedby endothelial cell
Plaque→linedby plump spindle cells
Nodule→linedby proliferating layer of spindle

60. Angiosarcoma

62. Gross
•Red nodules or grey white masses

63. Microscopic features
•Atypical endothelial cells forming vascular
channels→undifferentiatedspindle cells without
discernible vessel
•Immunohistochemical staining
Endothelial cell markers(CD31 and von Willebrand factor)
•Negative staining for HHV-8