GDPR brief comment

You will all be aware that your inboxes will have been filled with communications from various websites. The key issues to note are:

We have to send/receive data securely. (so please send anonymised data, eg the cases I post may have different ages/gender to the case and there is no patient identifier data)

We do not share data with other parties without permission. (so please use for teaching, but delete and do not use another formats/platforms)

We keep your data secure (the only data secured is your email contact data, apart from those listed as referral points). Please let me know if you wish me to remove you from the circulation list.

Any other thoughts do let me know, but I hope you will continue to use the forum for cases and information.

kind regards

Kim Suvarna

 

2018 cardiac EQA

hello

here are the digitised slides for the EQA, in case you have not seen the glass sections…. please copy and paste into your browser

Cardiac Pathology Network EQA

for those of you attending the meeting later this month, please have a look over the cases. please complete a return (word file attached) to dr goddard if you need a certificate for the EQA.

please email me or dr goddard if there any problems

2018 Cardiac EQA question and answer sheet

kind regards

kim suvarna

 

UK CPN training meeting 16th March 2018

The next UK CPN training meeting will take place on 16/03/2018.

It will be at:        The Circle, 33 Rockingham Ln, Sheffield S1 4FW  (www.thecirclesheffield.org.uk )

09.00 – 16.30

Trainees  – Free;    Consultants  – £70

5  CPD points

The programme and application form will be available in the New Year, to include :

Aortic disease, Valve pathology, Cardiac failure from the pathology perspective, Cardiac therapeutic medication overview, Case presentations, Cardiac EQA, Panel discussion of “What is normal”

 

A heart with fibrosis and some myocyte changes

Case history 46 year old female.

Past medical history of sharp pain in her chest for 3 years. Pain sharp, restricting full inspiration and associated with bilateral arm heaviness and aching. Attended chronic pain clinic, where ECG, CXR and bloods were performed, all said to be normal. Diagnosed with costochondritis and treated with celecoxib and pregabalin. Other past medical history includes anxiety and low BMI..

Out of hospital unwitnessed cardiac arrest recently. She had CPR and was in VF, a shock was given and there was spontaneous return of circulation. Subsequent ECG showed ST depression and no prolonged QTc interval. Two hour troponin was 76. Echo showed preserved biventricular function and mild mitral regurgitation.

Urine toxicology screen on admission was positive for cannabinoids and negative for opiates, ethanol, methadone, cocaine, benzodiazepines and amphetamines.

She was subsequently diagnosed with hypoxic brain injury and life support was withdrawn. She died 15/9/17.

At post mortem, the BMI was 17.1. There were features of recent medical intervention.

A heart with fibrosis and some myocye changes

On examination of the heart – Pericardial sac intact and appears normal. Heart weighed 320 g and showed a normal configuration. Normal arteries, with up to 20% occlusion of the LAD and RCA by atheromatous plaque, with no superimposed thrombi.

LV showed mild myocardial pallor circumferentially. LV 10mm thick. RV 4mm thick. No ventricular dilatation. Cardiac valves unremarkable, no vegetations present. Normal circumferences of the valves. Foramen ovale is closed.

No significant pulmonary artery atheroma. No PE. Lungs heavy and congested.

Other organs normal externally and on histology.

Micro from both lungs bases has grown strep pneumoniae.

On histo – cardiac conduction system appears normal.

Patchy established replacement fibrosis of the LV myocardium. No evidence of active myocarditis (multiple blocks examined). No features of acute ischaemia.

Some myocyte nuclear hypertrophy. Some myocytolysis and vacuolar change in the region of the fibrosis but elsewhere the myocardium appears normal. RV shows some fatty infiltration but not associated with fibrosis.

 

Questions

Has there has been previous myocardial damage (unknown cause, possibly previous myocarditis (viral or toxic) ?

Or is this ischaemia from microvascular cause, vasculitis) and these areas of fibrosis have acted as a substrate for the generation of an arrhythmia?

Whilst there are changes within the myocytes that can be seen in cardiomyopathy, these tend to be seen in the region of the fibrosis?

There is fat within the RV, this is not thinned and there is no discrete associated fibrosis. I would be very grateful for your opinion?