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Case No: 1

Case No: 1. A 50 years old businessman, hypertensive and obese, experiences severe chest pain on learning about his huge financial loss. He is rushed to the hospital where his ECG was done and some blood tests were taken. What is the likely cause for his condition?

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Case No: 1

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  1. Case No: 1 A 50 years old businessman, hypertensive and obese, experiences severe chest pain on learning about his huge financial loss. He is rushed to the hospital where his ECG was done and some blood tests were taken. • What is the likely cause for his condition? • Discuss the pathogenesis of underlying pathology • What blood tests would be useful in this patient? • If the treatment was delayed in this patient then what morphological changes do you expect to find in his heart at 24 hours, 01 week and 02 weeks?

  2. Case No: 2 20 years old girl is brought with joint pains, Palpitations & shortness of breath. On examination she is pale with weak heart sounds and tachycardia. Her knee and ankle joints are inflammed. • How will you proceed to reach a diagnosis? • What is the pathogenesis of this condition? • What are the complication associated with it? • How can this condition be differentiated from Infective Endocarditis?

  3. CARDIOVASCULAR SYSTEM CARDIOMYOPATHIES: Intrinsic disease of myocardium Primary Secondary • Dilated cardiomyopathy (DCM) • Hypertrophic cardiomyopathy (HCM) • Restrictive cardiomyopathy (RCM) • Left ventricular noncompaction (rare) • MC - ion channel dysfunction • Arrhythmogenic right ventricular dysplasia

  4. CARDIOVASCULAR SYSTEM Conditions associated with CM: Infections Toxins Metabolic Neuromuscular disease Storage disorders Infiltrative Immunological Genetic

  5. DILATED CARDIOMYOPATHY Congestive CM Progressive cardiac dilation & Hypertrophy Hypocontracting heart Contractile dysfunction (systolic) Pathogenesis: Genetic (20-50%) Myocarditis Alcohol & toxins (alcoholic CM) Childbirth (peripartum CM) Hemochrmatosis, sarcoidosis Idiopathic

  6. DILATED CARDIOMYOPATHY Secondary: IHD Valvular heart disease Hypertensive heart disease Congestive heart disease

  7. DILATED CARDIOMYOPATHY Morphology: Dilated, heavy, flabby heart Mural thrombosis Valvular defects Hypertrophied cells with large nuclei Interstitial & endocardial fibrosis

  8. HYPERTROPHIC CARDIOMYOPATHY Myocardial hypertrophy Poor compliance Diastolic dysfunction Intermittent outflow obstruction Genetic mutations (100%) Hypercontracting heart

  9. HYPERTROPHIC CARDIOMYOPATHY Morphology: Thickened septum Banana like ventricular cavity Endocardial thickening/mural plaque (subaortic region) • Outflow obstruction Extensive myocyte hypertrophy myofiber disarray Interstitial fibrosis

  10. RESTRICTIVE CARDIOMYOPATHY D/D: Endomyocardial fibrosis Loeffler endomyocarditis Endocardial fibroelastosis

  11. CARDIOVASCULAR SYSTEM

  12. CARDIOVASCULAR SYSTEM

  13. CARDIOVASCULAR SYSTEM MYOCARDITIS: Infections: Viruses (coxsackie, ECHO, influenza, HIV) Chlamydia Rickettsiae Bacteria Fungi Protozoa Helminths

  14. CARDIOVASCULAR SYSTEM Immune mediated post viral post streptococcal (RF) SLE Drugs Transplant rejection Unknown sarcoidosis giant cell myeloma

  15. CARDIOVASCULAR SYSTEM Morphology: Hypertrophy, dilated, flabby Diffuse/patchy Mottled (hges) Mural thrombi Interstitial inflammatory infiltrate (mononuclear) Focal myocyte necrosis

  16. CARDIOVASCULAR SYSTEM Hypersensitivty MC perivascular lymphocytes Macrophages, eosinophils Giant cell myocarditis giant cells, lympho, eos plasma cells, macrophages Chagas disease  parasite in myofibers, inflammatory cells

  17. CARDIOVASCULAR SYSTEM PERICARDITIS: Acute Serous Fibrinous Purulent Haemorrhagic Caseous

  18. CARDIOVASCULAR SYSTEM Chronic: Adhesive mediatinopericarditis Constrictive pericarditis CAUSES: Infectious (viruses, bacteria, TB, fungi) Immunologic (RF, SLE, scleroderma, post MI, (dresslers syndrome) drugs Miscellaneous (MI, uremia, cardiac surgery, neoplasia, trauma, radiation)

  19. CARDIOVASCULAR SYSTEM TUMORS OF HEART: Primary (rare) Secondary/metastatic (5% dying patients) Benign: Myxoma Fibroma Lipoma Papillary fibroelastoma Rhabdomyomas Malignant: Angiosarcoma & other SAs

  20. CARDIOVASCULAR SYSTEM MYXOMA: Commonest primary tumor 90% in atria  Atrial Myxoma Left : right = 4 : 1 Single Near fossa ovalis <1 – 10 cm Sessile / pedunculated  wrecking ball effect  embolize

  21. CARDIOVASCULAR SYSTEM Hard – soft gelatinous Stellate cells (lepidic cells, myxoma cells) Endothelial cells, SMCs Undifferentiated cells Mucopolysaccharide ground substance ++ Endothelial covering Inflammatory cells, hges

  22. CARDIOVASCULAR SYSTEM CONGENITAL HEART DISEASE: Ventricular septal defects Atrial septal defects Pulmonary stenosis Patent ductus arteriosis Coarctation of aorta AV septal defects Transposition of great arteries Truncus arteriosis Tricuspid atresia

  23. CARDIOVASCULAR SYSTEM TETROLOGY OF FALLOT: • VSD • Sub-pulmonary stenosis • Overriding aorta over pulmonary stenosis • Right ventricular hypertrophy

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