INSTRUCTORS ONLY

Cardiovascular Laboratory 1
DISEASES OF BLOOD VESSELS

Areas of Concentration

• Atherosclerosis

• Arteriolosclerosis

• Polyarteritis nodosa

In particular:

1. Recognize the histopathologic features of atherosclerosis and understand their clinical consequences.

2. Recognize the arterial/arteriolar morphologic aspects of hypertensive disease as it affects the kidney.

3. Recognize the pathologic features of necrotizing arteritis, as exemplified by polyarteritis nodosa. Understand how the common clinical features of this disorder arise.

4. Distinquish between aortic dissection and aortic aneurysms.

PC USERS: Drive mapping is no long needed. Use the ImageScope links.

Slide 52 [WebScope] [ImageScope] and Slide 53 [WebScope] [ImageScope]

A 63-year-old woman complaining of chest pain was admitted to the hospital. Her clinical evaluation quickly led to the diagnosis of myocardial infarction, primarily involving the left ventricle. Shortly after admission, the patient developed cardiac failure and pulmonary edema. Despite aggressive management, the patient developed lethal arrhythmias and succumbed two days after admission. An autopsy was performed and Slides 52 and 53 were prepared from her aorta and coronary artery, respectively.

1. Please describe the pathologic features evident in the aorta. What accounts for the “clefts” in the aortic wall and what do the cells with the “foamy” cytoplasm represent? What has happened to the media of the aorta?

2. Some histologic sections of aorta might have actual bone in them, an infrequent finding. How is that possible?

3. Why does thrombus form on portions of the diseased intima? Blood may also be found in areas of the plaque itself. How can we explain the presence of this blood?

4. What complications might derive from the aortic disease manifested by this slide?

5. Slide 53 (coronary artery) shows similar pathologic features. In addition, a thrombus has formed in the lumen. How did the thrombus likely form and approximately how old is it?

6. If the patient had survived, what might have happened to the thrombus?

Slide 57 [WebScope] [ImageScope] and Slide 14 [WebScope] [ImageScope]

A 63-year-old man presents to the emergency department complaining of a severe headache. He rapidly becomes unconscious and dies shortly thereafter. The presumed cause of death is an acute cerebral hemorrhage. An autopsy was performed; a slide was prepared from one of his kidneys, where an incidental pathologic abnormality was noticed.

1. Based on the pathologic features exhibited by Slide 57, what systemic disorder was very likely present?

2. Note the pattern of sclerosis of the small renal arteries and arterioles. What other pathologic features can be exhibited by these vessels, in the context of the case presentation?

3. What might be the effects of these vascular changes on the rest of the kidney?

4. What would have been the gross appearance of the kidney at autopsy?

5. Slide 14 depicts the vascular changes encountered in another kidney. How do the afferent/efferent arterioles differ from those present in Slide 57? What clinical conditions may be associated with the vascular changes present in Slide 14?

Slide 56 [WebScope] [ImageScope]

A 48-year-old male sought medical attention because of abdominal pain, nausea, and vomiting. He had been well until one month earlier, when he developed generalized weakness, myalgias and headaches. Laboratory evaluation revealed an elevated erythrocyte sedimentation rate and a leukocytosis with a neutrophilic left shift. Renal failure and seizures developed during his hospitalization and two of his toes became gangrenous. A muscle biopsy was performed.

1. Describe the abnormalities exhibited by the arteries present in the muscle biopsy sample.

2. Based on the clinical and pathologic features, what is your diagnosis?

3. Assuming the patient responded to therapy, how might the arteries have appeared histologically three months later?

4. How could the vascular lesions account for the features of the clinical presentation?

5. Besides tissue biopsy, what other procedure can be used to establish the diagnosis?

6. What is the prognosis of this disease in both the treated and untreated patient?

Slide 55 [WebScope] [ImageScope]

A 45-year-old hypertensive male is brought to the E.R. because of the sudden onset of severe pain localized to the interscapular region. The patient was diaphoretic and hypotensive. He died in acute heart failure shortly after developing signs of aortic regurgitation. The slide is prepared from his aorta.

1. Based on the pathologic findings, explain why the patient developed aortic regurgitation.

2. What conditions predispose to this lesion? Describe the elastic and muscular tissue of the aortic wall.

3. What other signs and symptoms could have developed during the patient’s clinical course?

4. Recalling the slide of atherosclerosis of the aorta (Slide 52), how can atherosclerosis lead to aneurysm formation? Where and how do atherosclerotic aortic aneurysms present? What are the consequences of aneurysm formation?

5. How does syphilis lead to aneurysm formation? Compare and contrast atherosclerotic and syphilitic aneurysms.

The answers to the path lab questions will be posted approximately 48-72 hours after the lab sessions. These are abbreviated answers, not a full discussion of the topics. You can find them in the M2 CTools site resources. In the folder for each sequence the will be a folder called 'Path Lab Resources'