Case 1

A 55-year-old man presents to the emergency room with chest pain radiating to his left arm and dyspnea for two hours. He rates the intensity of the chest pain at 10/10 and describes it as “crushing”. For several months prior to presentation he has had a few episodes of mild chest pain which developed while climbing stairs. The pain resolved within several minutes after resting. The patient smokes and has been told that his cholesterol is “on the high side”. On exam, the patient is obese. He is diaphoretic and is grabbing his chest.

As part of his evaluation the ER physician orders an EKG, as well as serum myoglobin and troponin levels.

Myoglobin 106 (0-75ng/mL)
Troponin 1.37 (<0.1ng/mL)

a. Identify the organs: Heart/Coronary artery

b. Describe the characteristic pathologic features in each organ. Section of the left ventricle reveals transmural ischemic necrosis (emphasize staining difference between infarct and normal myocardium). The necrotic fibers have lost nuclei and cross striations. The interstitium contains neutrophils and congested blood vessels with some extravasation of RBCs.A cross section of the coronary artery reveals occlusion by a recent thrombus. The vessel wall shows modest atherosclerotic changes, including initimal fibrosis, few cholesterol clefts, focus of calcification and infiltrating macrophages.

c. Diagnosis: Acute Myocardial Infarct. Coronary Atherosclerosis/Thrombosis.

d. Correlate the clinical findings with the pathology. Typical clinical feature of acute myocardial infarction is crushing substernal pain with radiation. The several transient episodes of chest pain after walking up stairs represent angina.

e. What are major risk factors associated with this diagnosis?
Risk factors for atherosclerosis/ischemic heart disease Nonmodifiable Increasing age Male gender Family History Genetic abnormalities Potentially controllable Hyperlipidemia Hypertension Cigarette smoking Diabetes Mellitus C-reactive protein

f. What hereditary disorders are associated with this diagnosis?

Usually they are multifactorial The also include familial hyperlipidemias

Case 2

A 37-year-old Mexican male presents with fever and flank pain. Several weeks ago, he received treatment from a dentist for severe periodontal disease. He was not prescribed any medication for that procedure. His past medical history is significant for an episode of joint pains and fever when he was 10-years-old and still living in Mexico. He received some medication at that time but did not follow-up with any doctor after that. Physical exam revealed a low grade fever and a heart murmur.

a. Identify the structure (organs): Cardiac valve/kidney

b. Describe the characteristic pathologic changes in each organ. Section of cardiac valve with attached vegetation. The valve is distorted (thickened) by fibrosis and chronic inflammation. Acute inflammation (necrosis) is superimposed on the old pathology. A large attached vegetation is composed of fibrin, RBC’s inflammatory cells and masses of blue bacteria. Section of the kidney demonstrates an ischemic infarct.

c. List the potential manifestations of this disorder and correlate them with the pathology. indings in patients who have aortic or mitral

Your Diognosis Please !


TOTAL 5 Cases


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