Cardiac pathology 2011 v2 (Med 2, 3) - Rated Medicine · Medium power view of recently infarcted myocardium. The infarcted area (yellow stars) undergoes coagulative necrosis and the

These presentations are to help you identify basic histopathological features. They do not containthe additional factual information that you need to learn about these topics.

This presentation contains images of basic histopathological features of ischaemic heart disease(mainly myocardial infarction), rheumatic fever and infective endocarditis.

Before viewing this presentation you are advised to review relevant histology, relevant sections of apathology textbook, histopathology atlas, relevant lecture notes and the histopathology powerpoint presentations on cell injury and necrosis, acute and chronic inflammation and healing.

Copyright University of Adelaide 2011 v2

Med 2 students do not need to know about rheumatic fever and infective endocarditis

Myocarditis and cardiomyopathy are also included as med 4 and 5 students should have someunderstanding of the histopathology of these topics.

Histopathology: Heart

Normal myocardium. Note nuclear features.

Low power view of recently infarcted myocardium. The infarcted area undergoes coagulative necrosisand the dead cells appear more eosinophilic than normal adjacent viable myocardium due to increasedbinding of eosin to denatured cytoplasmic proteins. Note also that some of the dead myocytes appearwavy.

Viable myocardium

Infarcted myocardium

Medium power view of recently infarcted myocardium. The infarcted area (yellow stars) undergoes coagulativenecrosis and the dead cells stain more intensely with eosin than adjacent viable cells (black star) due to increasedbinding of eosin to denatured cytoplasmic proteins. Some of the dead myocytes appear thin and wavy. Nuclei ofthe dead cells are undergoing karyolysis. No neutrophils can be seen in this section but a few are often present atthis early stage of around 8-24 hours old. The normal myocardium is paler (black star) and myocyte nuclei can beseen.

Medium power view of recently infarcted myocardium. The dead cells are very eosinophilic, some are thinned andwavy and nuclei are absent or faint in the dead cells. There is intercellular/interstitial oedema and many infiltratingneutrophils. The infarct is several days old.

Medium power view of a healing myocardial infarction. Granulation tissue has formed. Residual dead myocardial cells are present onthe right. The granulation tissue is well formed but is still fairly vascular. This infarct is probably around 1-2 weeks old.Black arrow: capillary. Green arrows: macrophages. Yellow arrows: fibroblast nuclei.Blue arrows: lymphocytes

Low power view of a fibrinous epicardialexudate (yellow star) over a healing myocardialinfarction.

Blue star: granulation tissue surrounding andinfiltrating area of necrosis.Black stars: necrotic myocardiumGreen star: adipose tissue in epicardium

Low power view of a healed myocardial infarction. Mature scar tissue has formed (black stars). Completehealing takes at least 6-8 weeks. Some residual viable myocardial cells are present (yellow stars).

Low power view of patchy microscopic subendocardial myocardial scarring (black stars) that occurs withchronic myocardial ischaemia due to severe atherosclerotic narrowing of coronary arteries. Theendocardial surface is indicated by the black arrow.

Pulmonary oedema. Alveoli filled with fluid (eosinophilic due to protein content) in pulmonary oedema inheart failure. Even transudates contain some protein.

Aschoff nodule in acute rheumatic fever.Green arrow: Aschoff cellBlack arrow: Anitschkow cellBlue star: degenerate connective tissueBlack star: adjacent myocardium

Acute rheumatic fever. Fibrinous vegetation (black star) formed over an area of denuded endocardium onthe margin of the mitral valve. Blue star: oedematous valve cusp with infiltrate of macrophages andlymphocytes.

Acute rheumatic fever. Fibrinous exudate(black star) on the epicardium withoedema of the underlying epicardium(yellow star).

What are some other causes of fibrinouspericarditis?

Chronic rheumatic valve disease. The valve cusp has become vascularised, fibrosed and thickened.Normal valve cusps do not contain vessels.

Infective endocarditis (very low power). Black stars: inflamed valve cusp.Yellow stars: thrombotic vegetation (predominantly fibrin and platelets)Green stars: inflammatory cells and bacteria intermixed in thrombusBlue star: myocardium

Myocyte disarray in hypertrophic cardiomyopathy. On low power, the overall impression is of myocytesarranged in a whorled cross pattern. (picture from Practical Cardiovascular Pathology by Sheppard andDavies (Arnold))

Viral myocarditis. There is an intense interstitial chronic inflammatory cell infiltrate, predominantlylymphocytes, with myocyte death. Some myocytes have been completely lost (between arrows).(Picture from Practical Cardiovascular Pathology by Sheppard and Davies (Arnold))