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The '''heart''' is an important organ. It moves the blood around. For orthopods, it gets the Ancef (cefazolin) to the bones. When it stops for an extended time... people end-up in the morgue or being seen by a pathologist for an [[autopsy]]. | The '''heart''' is an important organ. It moves the blood around. For orthopods, it gets the Ancef (cefazolin) to the bones. When it stops for an extended time... people end-up in the morgue or being seen by a pathologist for an [[autopsy]]. | ||
An introduction to cardiovascular pathology is found in the ''[[cardiovascular pathology]]'' article. | |||
==Obscure anatomy== | |||
{{main|Heart anatomy}} | |||
==Heart dissection== | ==Heart dissection== | ||
===Pericardium=== | |||
If adhesions are present decide whether they are: | |||
#Fibrinous (recent) ''or'', | |||
#Fibrous (old). | |||
===Identifying hardware=== | |||
*Defibrillator - thick wires. | |||
*Pacer - thin wires. | |||
===General rule=== | ===General rule=== | ||
*Open along the lines of flow. | *Open along the lines of flow. | ||
Note: | Note: | ||
* | *Do '''not''' open right atrium (RA) SVC to IVC. | ||
**Why? A.: You cut through the territory of the SA node. | |||
===Coronary arteries=== | |||
*These are often done first, i.e. before the heart is opened. | |||
*They should be sectioned (axially) at ~2 mm intervals. | |||
**Longitudinally opening the coronaries does '''not''' allow accurate assessment of luminal stenosis.<ref>URL: [http://www.histopathology-india.net/CAEx.htm http://www.histopathology-india.net/CAEx.htm]. Accessed on: 7 July 2011.</ref> | |||
*A significant stenosis (defined by ''diameter'' narrowing) is 70-75%.<ref name=Ref_HospAuto147>{{Ref HospAuto|147}}</ref> | |||
Notes: | |||
*If calcified: | |||
**Dissect off the coronary tree + decal. | |||
===Right atrium=== | ===Right atrium=== | ||
*Open | *Open anteriorly ~ 1 cm above the tricuspid valve annulus. | ||
**Open right auricle at the same time. | **Open right auricle at the same time. | ||
===Examination of apex=== | |||
*Slice apex (perpendicular to the long axis of the heart), such that both ventricles can be seen. | |||
===Right ventricle=== | ===Right ventricle=== | ||
*Make cut | *Make cut through the apex (transverse/biventicular section). | ||
*Open along lateral edge (from RA cut). | *Open along lateral edge (from RA cut). | ||
Line 30: | Line 58: | ||
===Left ventricular outflow tract=== | ===Left ventricular outflow tract=== | ||
* | *Open LVOT with cut(s) from LV; stay close to intraventricular septum.<ref>{{Ref HospAuto|</ref> | ||
**Avoid cutting the pulmonary artery. | **Avoid cutting the pulmonary artery. | ||
** | **With luck you end-up between the left coronary cusp and right coronary cusp. | ||
***Check whether the aortic valve and coronary ostia are normal. | |||
==Standard measures== | ===Slicing=== | ||
*After the heart is opened it should be sliced at 5-10 mm intervals to the semilunar valves. | |||
==Standard measures of the heart== | |||
*Mass (weight). | *Mass (weight). | ||
*Left ventricle (LV) - 2 cm below the MV. | *Left ventricle (LV) - 2 cm below the MV. | ||
Line 42: | Line 74: | ||
*Pulmonic valve (PV) circumference. | *Pulmonic valve (PV) circumference. | ||
*Tricuspid valve (TV) circumference. | *Tricuspid valve (TV) circumference. | ||
===Normal measures=== | |||
====Younger adults (20-60 years)==== | |||
Based on ''Ludwig'':<ref name=Ref_Ludwig569>{{Ref Ludwig|569}}</ref> | |||
{| class="wikitable sortable" | |||
! Measure | |||
! Men | |||
! Women | |||
|- | |||
|Aortic valve | |||
| 6.7 (6.0-7.4) | |||
| 6.3 (5.7-6.9) | |||
|- | |||
|Pulmonary valve | |||
| 6.6 (6.1-7.1) | |||
| 6.2 (5.7-6.7) | |||
|- | |||
|Mitral valve | |||
| 9.6 (9.4-9.9) | |||
| 8.6 (8.2-9.1) | |||
|- | |||
|Tricuspid valve | |||
| 11.4 (11.2-11.7) | |||
| 10.6 (10.2-10.9) | |||
|} | |||
Based on ''Ludwig'':<ref name=Ref_Ludwig569>{{Ref Ludwig|569}}</ref> | |||
{| class="wikitable sortable" | |||
! Feature | |||
! Measure | |||
|- | |||
|Left ventricle | |||
| 1.25 (1.00-1.50) | |||
|- | |||
|Right ventricle | |||
| 0.4 (0.25-0.50) | |||
|- | |||
|} | |||
====Older adults (>60 years)==== | |||
Based on ''Ludwig'':<ref name=Ref_Ludwig569>{{Ref Ludwig|569}}</ref> | |||
{| class="wikitable sortable" | |||
! Measure | |||
! Men | |||
! Women | |||
|- | |||
|Aortic valve | |||
| 8.3 (8.1-8.5) | |||
| 7.6 (7.3-7.9) | |||
|- | |||
|Pulmonary valve | |||
| 7.3 (7.2-7.5) | |||
| 7.1 (6.8-7.4) | |||
|- | |||
|Mitral valve | |||
| 9.5 (9.2-9.8) | |||
| 8.6 (8.2-9.0) | |||
|- | |||
|Tricuspid valve | |||
| 11.6 (11.4-11.8) | |||
| 10.5 (10.0-11.1) | |||
|} | |||
Based on ''Ludwig'':<ref name=Ref_Ludwig569>{{Ref Ludwig|569}}</ref> | |||
{| class="wikitable sortable" | |||
! Feature | |||
! Measure | |||
|- | |||
|Left ventricle | |||
| 1.15 (1.05-1.25) | |||
|- | |||
|Right ventricle | |||
| 0.38 (0.35-0.40) | |||
|- | |||
|} | |||
==Standard sections== | ==Standard sections== | ||
Minimalist approach: | Minimalist approach (Dr. C.): | ||
#LV and PPM (left ventricle and posterior papillary muscle). | #LV and PPM (left ventricle and posterior papillary muscle). | ||
# | #LV and APM (left ventricle and anterior papillary muscle). | ||
Compromise approach: | |||
#LV and PPM. | |||
#LV and APM. | |||
#LV lateral wall. | |||
#Intraventricular septum. | |||
#RV. | |||
Make the lab work hard approach: | Make the lab work hard approach (Dr. B.): | ||
#PRV (post. RV) with tricuspid valve. | #PRV (post. RV) with tricuspid valve. | ||
#ARV (ant. RV) with pulm. valve. | #ARV (ant. RV) with pulm. valve. | ||
Line 63: | Line 175: | ||
#LAD. | #LAD. | ||
#LCx. | #LCx. | ||
===Stock=== | |||
*One slice (close to apex). | |||
*+/-Region of SA node. | |||
*+/-Region of AV node. | |||
==Conducting system== | ==Conducting system== | ||
===Indications for examining the conducting system<ref>KC. 1 October 2010.</ref>=== | |||
#History of syncope. | |||
#History of [[cardiac arrhythmia|arrhythmia]]. | |||
#[[Autopsy#Negative autopsy|Negative autopsy]]. | |||
===Sinoatrial node=== | ===Sinoatrial node=== | ||
*Sinoatrial (SA) node is at the lateral aspect of ''sulcus terminalis''; lateral aspect of the superior vena cava and right atrium junction | *Sinoatrial (SA) node is at the lateral aspect of ''sulcus terminalis''; lateral aspect of the superior vena cava and right atrium junction.<ref name=virmani_p16>Virmani et al. Cardiovascular Pathology. 2nd Ed. 2001. P.16.</ref> | ||
** | **Cannot be identified grossly. | ||
**Artery of the SA (branch of RCA) may be a clue to where it lies. | **Artery of the SA (branch of RCA) may be a clue to where it lies. | ||
Line 80: | Line 202: | ||
*The SA Node is superficial to cardiac muscle, i.e. distant to the RA relative to the cardiac muscle. | *The SA Node is superficial to cardiac muscle, i.e. distant to the RA relative to the cardiac muscle. | ||
**The SA nodal tissue abuts cardiac muscle. | **The SA nodal tissue abuts cardiac muscle. | ||
*It sits around the ''sinoatrial node artery'' - which should be seen on its lumen if the | *It sits around the ''sinoatrial node artery'' - which should be seen on its lumen if the sections were taken properly. | ||
*The SA node is deep to adipose tissue that covers that epicardial aspect of the heart. | *The SA node is deep to adipose tissue that covers that epicardial aspect of the heart. | ||
*Nerve fibres (from the vagus nerve) are typically found between that adipose tissue and SA nodal tissue. | *Nerve fibres (from the vagus nerve) are typically found between that adipose tissue and SA nodal tissue. | ||
Histologic characteristics: | Histologic characteristics: | ||
*Spindle cell morphology + wavy nucleus. | *Spindle cell morphology + wavy nucleus. | ||
* | *Cytoplasm stains lighter with eosin than cardiac muscle. | ||
*+/-Vacuoles. | *+/-Vacuoles. | ||
Image: | =====Images===== | ||
<gallery> | |||
Image:Sinoatrial_node_low_mag.jpg | SA node - low mag. - vignetting (WC) | |||
Image:Sinoatrial_node_2_low_mag.jpg | SA node - low mag. (WC) | |||
Image:Sinoatrial_node_high_mag.jpg | SA node - high mag.(WC) | |||
</gallery> | |||
===Atrioventricular node=== | ===Atrioventricular node=== | ||
Approach 1: | Approach 1 (Peter method): | ||
*Open the LVOT - if it hasn't been opened yet. | *Open the LVOT - if it hasn't been opened yet. | ||
*Cut a section of that includes the right coronary cusp (of the aortic valve) and about 1.5 cm below it (this has the membranous septum and the superior muscular septum).<ref>PF. August 21, 2009.</ref> | *Cut a section of that includes the right coronary cusp (of the aortic valve) and about 1.5 cm below it (this has the membranous septum and the superior muscular septum).<ref>PF. August 21, 2009.</ref> | ||
**This section should then be serially sectioned in the axis of the VLOT. | **This section should then be serially sectioned in the axis of the VLOT. | ||
Approach 2: | Approach 2 (Virmani method): | ||
#View from right atrium: AV node is between the ''coronary sinus'' and ''membranous septum''. | #View from right atrium: AV node is between the ''coronary sinus'' and ''membranous septum''. | ||
#View from LVOT: Inferior to the posterior (non-coronary) cusp of the aortic valve. | #View from LVOT: Inferior to the posterior (non-coronary) cusp of the aortic valve. | ||
Line 105: | Line 230: | ||
#**This section should then be serially sectioned in the axis of the VLOT. | #**This section should then be serially sectioned in the axis of the VLOT. | ||
Approach 3: | Approach 3 (Location by triangle of Koch): | ||
*Atrioventicular (AV) node is in the '' | *Atrioventicular (AV) node is in the ''triangle of Koch''. | ||
Triangle of Koch according to Virmani<ref name=virmani_p17>Virmani et al. Cardiovascular Pathology. 2nd Ed. 2001. P.17.</ref> is the ''floor of the RA'' and: | Triangle of Koch according to Virmani<ref name=virmani_p17>Virmani et al. Cardiovascular Pathology. 2nd Ed. 2001. P.17.</ref> is the ''floor of the RA'' and: | ||
Line 113: | Line 238: | ||
*Coronary sinus = "posterior". | *Coronary sinus = "posterior". | ||
Images: | |||
*[http://www.ctsnet.org/residents/ctsn/graphics/membsept.jpg Triangle of Koch (ctsnet.org)]. | |||
*[http://www.ctsnet.org/graphic/RAIanatomy.jpg Triangle of Koch (ctsnet.org)]. | |||
*[http://www.ipej.org/1007/asirvatham2.jpg Triangle of Koch (ipej.org)] from a paper by Macedo ''et al''.<ref>{{Cite journal | last1 = Macedo | first1 = PG. | last2 = Patel | first2 = SM. | last3 = Bisco | first3 = SE. | last4 = Asirvatham | first4 = SJ. | title = Septal accessory pathway: anatomy, causes for difficulty, and an approach to ablation. | journal = Indian Pacing Electrophysiol J | volume = 10 | issue = 7 | pages = 292-309 | month = | year = 2010 | doi = | PMID = 20680108 }}</ref> | |||
* | |||
* | |||
==Tamponade== | ==Tamponade== | ||
Line 124: | Line 247: | ||
The pathologist (like radiologists) can say... | The pathologist (like radiologists) can say... | ||
*Pericardial effusion. | *[[Pericardial]] [[effusion]]. | ||
**Hemopericardium. | **Hemopericardium. | ||
Image: [http://en.wikipedia.org/wiki/File:CT_pericardial_effusion.jpg Pericardial effusion - CT scan (wikipedia.org)]. | Image: [http://en.wikipedia.org/wiki/File:CT_pericardial_effusion.jpg Pericardial effusion - CT scan (wikipedia.org)]. | ||
==Fibrinous pericarditis== | |||
*[[AKA]] ''bread and butter pericarditis''. | |||
*Post-[[myocardial infarction]] this is known as ''Dressler's syndrome''.<ref name=Ref_PCPBoD8_293>{{Ref PCPBoD8|293}}</ref> | |||
===General=== | |||
Etiology: | |||
*Radiation.<ref name=pmid436483 >{{Cite journal | last1 = Schneider | first1 = JS. | last2 = Edwards | first2 = JE. | title = Irradiation-induced pericarditis. | journal = Chest | volume = 75 | issue = 5 | pages = 560-4 | month = May | year = 1979 | doi = | PMID = 436483 }}</ref> | |||
*Uremia. | |||
*[[Myocardial infarction]] (MI). | |||
**Classically occurs at 2-3 days following a MI.<ref name=Ref_PCPBoD8_293>{{Ref PCPBoD8|293}}</ref> | |||
Note: | |||
*Roberts suggests that ''pericardial heart disease'' may be a better term for this, as this isn't really an inflammatory process.<ref name=pmid16200146>{{Cite journal | last1 = Roberts | first1 = WC. | title = Pericardial heart disease: its morphologic features and its causes. | journal = Proc (Bayl Univ Med Cent) | volume = 18 | issue = 1 | pages = 38-55 | month = Jan | year = 2005 | doi = | PMID = 16200146 }}</ref> | |||
===Gross=== | |||
*Pericardium with a shaggy rough appearance. | |||
**Described as "buttered bread dropped-on-the-floor look".<ref name=pmid14991530>{{Cite journal | last1 = Cohen | first1 = MB. | last2 = Laennec | first2 = RT. | title = Cross your heart: Some historical comments about fibrinous pericarditis. | journal = Hum Pathol | volume = 35 | issue = 2 | pages = 147-9 | month = Feb | year = 2004 | doi = | PMID = 14991530 }}</ref> | |||
Image: | |||
*[http://library.med.utah.edu/WebPath/CVHTML/CV047.html Bread and butter pericarditis (utah.edu)]. | |||
===Microscopic=== | |||
Features: | |||
*Fibrin - pink amorphous material. | |||
Note: | |||
*Inflammation is not a strict requirement for the diagnosis.<ref name=pmid16200146>{{Cite journal | last1 = Roberts | first1 = WC. | title = Pericardial heart disease: its morphologic features and its causes. | journal = Proc (Bayl Univ Med Cent) | volume = 18 | issue = 1 | pages = 38-55 | month = Jan | year = 2005 | doi = | PMID = 16200146 }}</ref> | |||
Images: | |||
*[http://autopsy.stanford.edu/images/FibrinousPericarditis.jpg Fibrinous pericarditis (stanford.edu)].<ref>URL: [http://autopsy.stanford.edu/fellowships.html http://autopsy.stanford.edu/fellowships.html]. Accessed on: 21 January 2012.</ref> | |||
<gallery> | |||
Image:Pericarditis_fibrinosa.jpg | Fibrinous pericarditis. (WC) | |||
</gallery> | |||
===Sign out=== | |||
<pre> | |||
Pericardium, Excision: | |||
- Fibrinous pericardial heart disease. | |||
</pre> | |||
==Myocardial infarction== | ==Myocardial infarction== | ||
*Abbreviated ''MI''. | |||
* | *[[AKA]] ''myocardial infarct''. | ||
* | {{Main|Myocardial infarction}} | ||
==Coronary artery atherosclerosis== | |||
* | {{Main|Atherosclerosis}} | ||
* | *[[AKA]] ''coronary artery disease'', abbreviated ''CAD''. | ||
* | *[[AKA]] ''atherosclerotic heart disease'', abbreviated ''ASHD''. | ||
*[[AKA]] ''atherosclerotic coronary artery disease''. | |||
===General=== | |||
*Greater than 75% (diameter) stenosis - considered significant.<ref>Chamberlain, D. March 7, 2008.</ref> | |||
*Leading cause of morbidity and mortality, esp. in the elderly. | |||
*''Left main coronary artery (LMCA) disease'' is particularly fatal.<ref name=pmid10580359>{{Cite journal | last1 = Kanjwal | first1 = MY. | last2 = Carlson | first2 = DE. | last3 = Schwartz | first3 = JS. | title = Chronic/subacute total occlusion of the left main coronary artery--a case report and review of literature. | journal = Angiology | volume = 50 | issue = 11 | pages = 937-45 | month = Nov | year = 1999 | doi = | PMID = 10580359 }}</ref> | |||
Clinical presentations: | |||
*Stable angina. | |||
*Unstable angina. | |||
*[[Myocardial infarction]]. | |||
* | *[[Sudden cardiac death]]. | ||
* | |||
* | |||
* | |||
Note: | |||
*''Coronary artery atherosclerosis'' is '''not''' the only type of ''coronary artery disease''... but it is by far the most common; thus, CAD is generally considered synonymous with ''coronary artery atherosclerosis''. | |||
Treatment: | |||
* | *Medical management (blood pressure control (antihypertensives), cholesterol control (e.g. statins, exercise), [[diabetes mellitus|diabetes]] control, smoking cessation). | ||
*[[Coronary artery bypass surgery]] (CABG). | |||
*Percutaneous coronary intervention (PCI). | |||
Stenosis definition (as per NASCET):<ref name="pmid9811916">{{cite journal |author=Barnett HJ, Taylor DW, Eliasziw M, ''et al.'' |title=Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators |journal=The New England Journal of Medicine |volume=339 |issue=20 |pages=1415–25 |year=1998 |month=November |pmid=9811916 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=9811916&promo=ONFLNS19}}</ref><br> | ====Stenosis definition==== | ||
<math>percent stenosis = ( 1 - ( minimal\ diameter ) / ( poststenotic\ diameter ) ) x 100%.</math> | Definition (as per NASCET):<ref name="pmid9811916">{{cite journal |author=Barnett HJ, Taylor DW, Eliasziw M, ''et al.'' |title=Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators |journal=The New England Journal of Medicine |volume=339 |issue=20 |pages=1415–25 |year=1998 |month=November |pmid=9811916 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=9811916&promo=ONFLNS19}}</ref><br> | ||
<math>percent\ stenosis = ( 1 - ( minimal\ diameter ) / ( poststenotic\ diameter ) ) x 100%.</math> | |||
With a bit of | With a bit of algebra one can show:<br> | ||
<math>A_x=x^2 A_o</math><br> | <math>A_x=x^2 A_o</math><br> | ||
Where: | Where: | ||
Line 180: | Line 335: | ||
*A 75% diameter reduction results in a 93.75% area reduction. | *A 75% diameter reduction results in a 93.75% area reduction. | ||
*A 90% diameter reduction results in a 99% area reduction. | *A 90% diameter reduction results in a 99% area reduction. | ||
===Microscopic=== | |||
:See ''[[Atherosclerosis]]''. | |||
==Abnormal hearts== | ==Abnormal hearts== | ||
===Cardiac hypertrophy=== | |||
Can be by: | |||
*Mass criteria described in a couple of articles from the ''Mayo Clinic Proceedings''.<ref name=pmid3276973>{{cite journal |author=Scholz DG, Kitzman DW, Hagen PT, Ilstrup DM, Edwards WD |title=Age-related changes in normal human hearts during the first 10 decades of life. Part I (Growth): A quantitative anatomic study of 200 specimens from subjects from birth to 19 years old |journal=Mayo Clin. Proc. |volume=63 |issue=2 |pages=126–36 |year=1988 |month=February |pmid=3276973 |doi= |url=}}</ref><ref name=pmid3276974>{{cite journal |author=Kitzman DW, Scholz DG, Hagen PT, Ilstrup DM, Edwards WD |title=Age-related changes in normal human hearts during the first 10 decades of life. Part II (Maturity): A quantitative anatomic study of 765 specimens from subjects 20 to 99 years old |journal=Mayo Clin. Proc. |volume=63 |issue=2 |pages=137–46 |year=1988 |month=February |pmid=3276974 |doi= |url=}}</ref> | |||
*Thickness criteria. | |||
Rules of thumb:<ref>KC. 14 October 2010.</ref> | |||
*>400 g is ''often'' abnormal. | |||
*>500 g is abnormal. | |||
*>1.5 cm left ventricle thickness. | |||
*>0.5 cm right ventricle thickness. | |||
===Common patterns=== | |||
====Dilated hearts==== | |||
Dilated pattern DDx:<ref name=Ref_PBoD602>{{Ref PBoD|602}}</ref> | Dilated pattern DDx:<ref name=Ref_PBoD602>{{Ref PBoD|602}}</ref> | ||
*Hypertensive heart disease. | *Hypertensive heart disease. | ||
Line 187: | Line 358: | ||
*[[Amyloidosis]]. | *[[Amyloidosis]]. | ||
==Cardiomyopathy== | ====Concentric left ventricular hypertrophy==== | ||
Concentric left ventricular hypertrophy is a common gross pathologic finding. | |||
The main DDx is: | |||
*[[Hypertension]]. | |||
*[[Valvular heart disease|Aortic stenosis]]. | |||
Other considerations: | |||
*Hypertrophic [[cardiomyopathy]] (usually eccentric). | |||
<gallery> | |||
Image: Heart_left_ventricular_hypertrophy_sa.jpg | Concentric LVH. (WC) | |||
</gallery> | |||
====Eccentric left ventricular hypertrophy==== | |||
*[[Hypertrophic cardiomyopathy]], includes [[hypertrophic obstructive cardiomyopathy]] (HOCM). | |||
==Detail articles== | |||
===Cardiomyopathy=== | |||
{{main|Cardiomyopathy}} | {{main|Cardiomyopathy}} | ||
In the land of cardiology... there is a thing called cardiomyopathy. | In the land of cardiology... there is a thing called cardiomyopathy. This article deals with it. | ||
It includes discussion of ''dilated cardiomyopathy'', ''hypertrophic cardiomyopathy'' and ''arrhythmogenic right ventricular cardiomyopathy''. | |||
==Congenital heart disease== | ===Congenital heart disease=== | ||
{{main|Congenital heart disease}} | {{main|Congenital heart disease}} | ||
Congenital heart disease... a domain of pediatric cardiac surgery and occasionally adult cardiac surgery. | |||
The article covers shunts, both left-to-right and right-to-left. | |||
==Tumours== | ===Tumours=== | ||
{{main|Tumours of the heart}} | {{main|Tumours of the heart}} | ||
These are rare buggers. | These are rare buggers. | ||
==Valvular disease== | ===Valvular disease=== | ||
{{main|Valvular heart disease}} | {{main|Valvular heart disease}} | ||
This is the domain of cardiac surgery... only seen in hospitals with cardiac surgery. | This is the domain of cardiac surgery... only seen in hospitals with cardiac surgery. | ||
==Endocarditis== | ===Endocarditis=== | ||
{{Main|Infective endocarditis}} | |||
= | |||
==Cardiac sarcoidosis== | ==Cardiac sarcoidosis== | ||
{{main|Sarcoidosis}} | |||
===General=== | ===General=== | ||
*Can be in | *Can be in isolation or part of systemic sarcoidosis.<ref name=pmid9608713>{{cite journal |author=Veinot JP, Johnston B |title=Cardiac sarcoidosis--an occult cause of sudden death: a case report and literature review |journal=J. Forensic Sci. |volume=43 |issue=3 |pages=715–7 |year=1998 |month=May |pmid=9608713 |doi= |url=}}</ref> | ||
*May mimic hypertrophic [[cardiomyopathy]] clinically.<ref name=pmid10981852>{{cite journal |author=Matsumori A, Hara M, Nagai S, ''et al.'' |title=Hypertrophic cardiomyopathy as a manifestation of cardiac sarcoidosis |journal=Jpn. Circ. J. |volume=64 |issue=9 |pages=679–83 |year=2000 |month=September |pmid=10981852 |doi= |url=}}</ref> | *May mimic hypertrophic [[cardiomyopathy]] clinically.<ref name=pmid10981852>{{cite journal |author=Matsumori A, Hara M, Nagai S, ''et al.'' |title=Hypertrophic cardiomyopathy as a manifestation of cardiac sarcoidosis |journal=Jpn. Circ. J. |volume=64 |issue=9 |pages=679–83 |year=2000 |month=September |pmid=10981852 |doi= |url=}}</ref> | ||
*Clinical: associated with heart block.<ref name=pmid9608713/> | *Clinical: associated with heart block.<ref name=pmid9608713/> | ||
Line 256: | Line 413: | ||
*Anterior LV - 18.0%. | *Anterior LV - 18.0%. | ||
*RV - 17.9%. | *RV - 17.9%. | ||
**RV involvement may lead to confusion with arrhythmogenic right ventricular cardiomyopathy (ARVC). | **RV involvement may lead to confusion with [[arrhythmogenic right ventricular cardiomyopathy]] (ARVC). | ||
*Lateral LV - 14.1%. | *Lateral LV - 14.1%. | ||
Line 262: | Line 419: | ||
*Advanced lesions are fibrotic and may mimic old infarcts (grossly) due to coronary artery atherosclerosis. | *Advanced lesions are fibrotic and may mimic old infarcts (grossly) due to coronary artery atherosclerosis. | ||
=== | ===Microscopic=== | ||
Features:<ref name=pmid19660614/> | Features:<ref name=pmid19660614/> | ||
*Non-caseating granulomas. | *Non-caseating [[granulomas]]. | ||
*Subepicardial predominance. | *Subepicardial predominance. | ||
*+/-Fibrosis - old lesions are fibrotic. | *+/-Fibrosis - old lesions are fibrotic. | ||
Line 273: | Line 430: | ||
Notes: | Notes: | ||
*Myocyte necrosis and | *Myocyte necrosis and [[eosinophil]]s are features of ''granulomatous myocarditis''.<ref name=pmid19660614/> | ||
==Myocarditis== | ==Myocarditis== | ||
{{Main|Myocarditis}} | |||
==Idiopathic granulomatous myocarditis== | |||
*[[AKA]] ''giant cell myocarditis''<ref name=emedicine1612533>[http://emedicine.medscape.com/article/1612533-overview http://emedicine.medscape.com/article/1612533-overview]</ref> and less ambiguously ''idiopathic giant cell myocarditis''. | |||
===General=== | ===General=== | ||
* | *Unknown etiology.<ref name=upmc175>URL: [http://path.upmc.edu/cases/case175/dx.html http://path.upmc.edu/cases/case175/dx.html]. Accessed on: 8 January 2012.</ref> | ||
=== | ===Microscopic=== | ||
Features:<ref name=pmid19660614/> | Features:<ref name=pmid19660614/> | ||
* | *[[Granuloma]]s. | ||
*Myocyte necrosis. | *Myocyte [[necrosis]]. | ||
*Eosinophils. | *Eosinophils. | ||
Note: | Note: | ||
*Eosinophils and myocyte necrosis differentiate this entity from ''cardiac sarcoidosis''. | *Eosinophils and myocyte necrosis differentiate this entity from ''[[cardiac sarcoidosis]]''. | ||
**Granulomas in sarcoidosis are well formed and also involve the fat.<ref name=upmc175>URL: [http://path.upmc.edu/cases/case175/dx.html http://path.upmc.edu/cases/case175/dx.html]. Accessed on: 8 January 2012.</ref> | |||
DDx: | |||
*Infectious granulomatous myocarditis, e.g. [[tuberculosis]]. | |||
*[[Rheumatic myocarditis]]. | |||
*Lymphocytic myocarditis. | |||
Images: | |||
*[http://path.upmc.edu/cases/case175.html Giant cell myocarditis (upmc.edu)]. | |||
===Stains=== | |||
*[[Ziehl-Neelsen stain]] -ve. | |||
*[[GMS stain]] -ve. | |||
==Chagas disease== | |||
*[[AKA]] ''American trypanosomiasis''. | |||
{{Main|Chagas disease}} | |||
==Cardiac amyloidosis== | ==Cardiac amyloidosis== | ||
{{main| | {{main|Amyloidosis}} | ||
===General=== | |||
*Amyloid in the heart. | *Amyloid in the heart. | ||
* | *Common in the elderly - see ''[[senile systemic amyloidosis]]''. | ||
=== | ===Microscopic=== | ||
Features (H&E stain): | Features ([[H&E stain]]): | ||
* | *Acellular fluffy pink material. | ||
Special stains: | Special stains: | ||
Line 309: | Line 481: | ||
*Thioflavin-T stain<ref name=pmid18175051>{{cite journal |author=Nishi S, Alchi B, Imai N, Gejyo F |title=New advances in renal amyloidosis |journal=Clin. Exp. Nephrol. |volume=12 |issue=2 |pages=93-101 |year=2008 |month=April |pmid=18175051 |doi=10.1007/s10157-007-0008-3 |url=}}</ref> | *Thioflavin-T stain<ref name=pmid18175051>{{cite journal |author=Nishi S, Alchi B, Imai N, Gejyo F |title=New advances in renal amyloidosis |journal=Clin. Exp. Nephrol. |volume=12 |issue=2 |pages=93-101 |year=2008 |month=April |pmid=18175051 |doi=10.1007/s10157-007-0008-3 |url=}}</ref> | ||
Images (amyloidosis cardiac): | |||
*[http://commons.wikimedia.org/wiki/File:Cardiac_amyloidosis_very_high_mag_he.jpg Cardiac amyloidosis - H&E (WC)]. | |||
Images (amyloidosis - non-cardiac): | Images (amyloidosis - non-cardiac): | ||
*[http://en.wikipedia.org/wiki/File:Small_bowel_duodenum_with_amyloid_deposition_congo_red_10X.jpg Amyloid - congo red stain] | *[http://en.wikipedia.org/wiki/File:Small_bowel_duodenum_with_amyloid_deposition_congo_red_10X.jpg Amyloid in small bowel - congo red stain (WC)]. | ||
*[http://commons.wikimedia.org/wiki/File:Small_bowel_duodenum_with_amyloid_deposition_20X.jpg Amyloid - H&E | *[http://commons.wikimedia.org/wiki/File:Small_bowel_duodenum_with_amyloid_deposition_20X.jpg Amyloid in small bowel - H&E (WC)]. | ||
Notes: | |||
*ABCs of pink on H&E = '''a'''myloid, '''b'''lood (fibrin), '''c'''ollagen, '''s'''mooth muscle. | |||
==Mesothelial/monocytic incidental cardiac excrescence== | |||
*[[AKA]] ''Cardiac MICE''. | |||
===General=== | |||
*Very rare. | |||
*Benign. | |||
*May be confused with a tumour.<ref name=pmid12879644>{{Cite journal | last1 = de Gouveia | first1 = RH. | last2 = Ramos | first2 = S. | last3 = Ribeiro | first3 = MA. | last4 = Ferreira | first4 = M. | last5 = Martins | first5 = AP. | title = Cardiac MICE--tumor or thrombus? | journal = Rev Port Cardiol | volume = 22 | issue = 4 | pages = 523-9 | month = Apr | year = 2003 | doi = | PMID = 12879644 }}</ref> | |||
===Microscopic=== | |||
Features:<ref name=pmid12879644/> | |||
*Mesothelial cells. | |||
==Cocaine toxicity== | |||
{{Main|Cocaine toxicity}} | |||
No distinctive pathologic findings. May appear older than one would expect, e.g. advanced [[atherosclerosis]] in a young man. | |||
==Heart transplant pathology== | |||
{{Main|Heart transplant pathology}} | |||
Comes in different flavours... cellular, acute vascular chronic. | |||
==See also== | ==See also== | ||
*[[Basics]]. | *[[Basics]]. | ||
*[[Cardiovascular pathology]]. | *[[Cardiovascular pathology]]. | ||
*[[Pulmonary hypertension]] | *[[Forensic pathology]]. | ||
*[[Medical lung disease]]. | |||
*[[Pulmonary hypertension]]. | |||
==References== | ==References== |
edits