1. Heart
 OBJECTIVES
 Normal
 Effects of Aging on the Heart
 Pathology
Heart Failure
Left-sided heart failure
Right-sided heart failure
 Congenital Heart Disease
 Ischemic Heart Disease
 Hypertensive Heart Disease
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Dr. Krishna Tadepalli, MD, www.mletips.com

2. Heart
 OBJECTIVES
 Valvular diseases
 Valvular degeneration caused by calcification
 Myxomatous degeneration of the Mitral valve (Mitral
valve Prolapse- MVP)
 Rheumatic fever and rheumatic heart disease (RHD)
 Infective endocarditis (IE)
 Non-infected vegetations
 Complications of artificial valves
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Dr. Krishna Tadepalli, MD, www.mletips.com

3. Heart
OBJECTIVES
Carcinoid heart disease
Cardiomypathies
Myocarditis
Pericardial disease
Tumors of the heart
Cardiac transplantation
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Dr. Krishna Tadepalli, MD, www.mletips.com

4. Heart -Normal
 Weight
Male - 325 gm.
Female - 275 gm.
 Systole- ventricular contraction
 Diastole- ventricular relaxation
 Thickness
Thickness (cm)
LV
RV
Normal
1.5
0.5
Hypertrophy
>2
>0.7
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Dr. Krishna Tadepalli, MD, www.mletips.com

5. Heart -Normal
 Normal
 Hypertrophy =
pressure overload
 Dilation= volume
overload
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Dr. Krishna Tadepalli, MD, www.mletips.com

6. Heart -Normal
 Normal  Histology
 Specific Atrial Granules  Atrial Natriuretic Peptide
(ANP )
 Intercalated disks with Gap junctions
 Clinical significance
 Clinical significance
 Arrhythmias
 Arrhythmias
 Due to electromechanical dysfunction
 Due to electromechanical dysfunction
 Due to Abnormal distribution of gap junctions
 Due to Abnormal distribution of gap junctions
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Dr. Krishna Tadepalli, MD, www.mletips.com

7. Heart -Normal

Normal = Blood Supply
1. Left anterior descending (LAD)
2. Left circumflex (LCX) arteries
3. Right coronary artery (RCA)
 Clinical significance
 Clinical significance
 Most susceptible cardiac tissue to ischemic damage
 Most susceptible cardiac tissue to ischemic damage
Sub- endocardial myocardium
Sub- endocardial myocardium
 Cardiac chamber involved irrespective of specific vessel
 Cardiac chamber involved irrespective of specific vessel
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occlusion  Left Ventricle
occlusion  Left Ventricle
Dr. Krishna Tadepalli, MD, www.mletips.com

8. Heart -Normal
 Normal = Effects of Aging on the Heart
 Lambl excrescences = calcifications on aortic or
Mitral valves
 Atherosclerotic plaque
 Clinical significance
 Clinical significance
 Lambl excrescences = confuse with stenosis
 Lambl excrescences = confuse with stenosis
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Dr. Krishna Tadepalli, MD, www.mletips.com

9. Heart - Pathology
Heart Failure
 Cardiomegaly = increased size of heart
 Congestive Heart failure (CHF)
 Failure to pump blood = systolic dysfunction
 Compensatory hypertrophy & dilation
 Types = LVF, RVF
Cardiac
hypertrophy
2 times the size
(Left Ventricle)
3 times
4 times
Condition
pulmonary
HTN & IHD
Systemic HTN,
AS, MR, DCM
AR or HOCM
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Dr. Krishna Tadepalli, MD, www.mletips.com

10. Heart - Pathology
 Congestive Heart failure
(CHF) Compensatory
hypertrophy
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Dr. Krishna Tadepalli, MD, www.mletips.com

11. Heart - Pathology
LVF
 Causes = IHD, HTN, Valvular ( Aortic, Mitral) and
Myocardial diseases
 Pathology & Clinical features are due to
Pulmonary pooling of blood
Decrease in systemic arterial flow
 Morphology
 Heart
LV- hypertrophy
LA enlargement → Atrial fibrillation→ Thrombus
formation → Embolic stroke
 Lungs = Dyspnea  Earliest and the cardinal
congestion and edema-heavy, wet lungs
Kerley's B lines on x-ray
Siderophages or Heart failure cells
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Dr. Krishna Tadepalli, MD, www.mletips.com

12. Heart - Pathology
 Morphology
 Kidneys = prerenal azotemia
 Brain =Hypoxic encephalopathy
What are these cells ?
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Dr. Krishna Tadepalli, MD, www.mletips.com

13. Heart - Pathology
RVF
 Causes
MCC= left-sided heart failure
Rare =Pure right-sided heart failure ( seen in Pulmonary
HTN & Cor pulmonale)
 Morphology
Liver and Portal System = nutmeg
congestive hepatomegaly
centrilobular necrosis
cardiac sclerosis or cardiac cirrhosis
Congestive splenomegaly
Bowel - Chronic edema Ascites
Kidneys- Congestion→ peripheral edema →azotemia
Brain –like in LVF
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Dr. Krishna Tadepalli, MD, www.mletips.com

14. Heart - Pathology
 Clinically
 Atelectasis due to Pleural and Pericardial effusions
 Subcutaneous Tissue edema =Hallmark
Dependent pitting edema
Aanasarca -generalized massive edema
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Dr. Krishna Tadepalli, MD, www.mletips.com

15. Heart
– quick review
 Sub-endocardial myocardium (adjacent to the
ventricular cavities) - most susceptible to ischemic
damage
 Lambl excrescences – Due to aging
 Selective up-regulation or re-expression of
embryonic/fetal forms of contractile proteins in
Hypertrophy- β-myosin heavy chain, ANP, Collagen
 Compensatory changes in Hypertrophy
 Pressure overload – Hypertrophy
 Volume overload – Dilation & Hypertrophy
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Dr. Krishna Tadepalli, MD, www.mletips.com

16. Heart
– quick review
 Left-sided heart failure
 MCC - – IHD, HTN
 Lungs in LHF – heavy & wet
 Earliest and the cardinal complaint - Dyspnea
 Orthopnea &Paroxysmal nocturnal Dyspnea (PND) – Severe
forms of Dyspnea
 Renal effects are counteracted by – ANP
 Right-sided heart failure
 MCC- left-sided heart failure
 Liver in RHF
Nut Meg Liver (congestive hepatomegaly)
centrilobular necrosis
cardiac sclerosis or cardiac cirrhosis
 Hallmark of RHF - Subcutaneous Tissue edema
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Dr. Krishna Tadepalli, MD, www.mletips.com