Pathology
Cardiovascular System
Cardiovascular pathology for MBBS and NEET-PG: atherosclerosis, aneurysms, rheumatic heart disease, myocardial infarction, endocarditis and cardiomyopathies, mapped to NMC codes PA27.1 to PA27.10.
MedNext Academy | 3 min read
Cardiovascular System
Cardiovascular pathology for MBBS and NEET-PG: atherosclerosis, aneurysms, rheumatic heart disease, myocardial infarction, endocarditis and cardiomyopathies, mapped to NMC codes PA27.1 to PA27.10.
This chapter covers cardiovascular pathology. It includes atherosclerosis and arteriosclerosis, aneurysms and aortic dissection, heart failure, rheumatic fever and rheumatic heart disease, ischaemic heart disease, infective endocarditis, pericardial disease, cardiomyopathies and cardiovascular syphilis.
High-yield: Cardiovascular System
- Atherosclerosis affects large and medium arteries and is driven by endothelial injury, lipid deposition and inflammation.
- The fatty streak is the earliest atherosclerotic lesion, progressing to a fibrofatty plaque with a lipid core and fibrous cap.
- Arteriosclerosis is hardening of arteries in general; Monckeberg medial calcific sclerosis calcifies the media without narrowing the lumen.
- An aneurysm is an abnormal localised dilatation of a vessel; abdominal aortic aneurysms are usually atherosclerotic and infrarenal.
- Aortic dissection results from a tear in the intima with blood tracking through the media, often on a background of hypertension or cystic medial degeneration.
- Rheumatic fever follows group A streptococcal pharyngitis and is a type II hypersensitivity through molecular mimicry.
- The Aschoff body, with Anitschkow cells, is the pathognomonic myocardial lesion of rheumatic fever.
- Chronic rheumatic heart disease most often causes mitral stenosis with a fish-mouth valve.
- Myocardial infarction most often follows occlusion of the left anterior descending artery, causing an anterior infarct.
- The earliest reliable histological change of infarction is coagulative necrosis with wavy fibres, and neutrophils appear over the first day.
- Troponins are the most sensitive and specific biomarkers of myocardial infarction.
- Infective endocarditis produces friable vegetations on valves; acute disease is often due to Staphylococcus aureus and subacute to Streptococcus viridans.
- Libman-Sacks endocarditis is a sterile vegetation seen in systemic lupus erythematosus.
- Dilated cardiomyopathy causes a large poorly contracting heart; hypertrophic cardiomyopathy causes asymmetrical septal hypertrophy and sudden death in the young; restrictive cardiomyopathy stiffens the ventricle.
Key cardiovascular lesions
- **Aschoff body:** Pathognomonic of rheumatic fever; contains Anitschkow cells.
- **Myocardial infarction:** Usually left anterior descending occlusion; troponin is the key marker.
- **Endocarditis:** Acute Staphylococcus aureus; subacute Streptococcus viridans; Libman-Sacks in lupus.
- **Cardiomyopathy:** Dilated, hypertrophic (septal, sudden death) and restrictive types.
NMC competencies in this chapter
- **PA27.1:** Distinguish arteriosclerosis from atherosclerosis
- **PA27.2:** Aetiology, dynamics, pathology and complications of aneurysms
- **PA27.3:** Aetiology, types, stages, pathophysiology and complications of heart failure
- **PA27.4:** Aetiology, pathology and complications of rheumatic fever
- **PA27.5:** Epidemiology, risk factors, pathology and complications of ischaemic heart disease
- **PA27.6:** Pathology and complications of infective endocarditis
- **PA27.7:** Pathology and complications of pericarditis and pericardial effusion
- **PA27.8:** Cardiac function testing in acute coronary syndrome
- **PA27.9:** Classification and pathology of cardiomyopathies
- **PA27.10:** Pathology and complications of cardiovascular syphilis
Frequently Asked Questions
What is the earliest lesion of atherosclerosis?
The fatty streak, a flat lipid-laden lesion that can progress to a fibrofatty plaque with a lipid core and a fibrous cap.
What is the Aschoff body?
The pathognomonic myocardial lesion of rheumatic fever, containing Anitschkow cells with characteristic caterpillar nuclei.
Which artery is most often occluded in myocardial infarction?
The left anterior descending artery, producing an anterior wall infarct, confirmed by a rise in troponin.
How are cardiomyopathies classified?
Into dilated, hypertrophic and restrictive types, differing in ventricular size, wall thickness and contractile function.
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