PICTURES

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=22 BGCOLOR="#FFFFFF" TEXT="#080000" bgproperties="fixed" background="041000d2egerdp.png"> <div> </div> </td> </tr><tr> <td valign="top" width=145 BGCOLOR="#333399" TEXT="#080000" background="040a2c00erkjzj.png"> <div>  <img src="HTMLobj-206/aniGif.gif" border="0" align="bottom" width="113" height="101">  </div> </td> <td valign="top" height=458 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <FONT SIZE="5" COLOR="#336600" FACE="Times New Roman" ><I>cardio5</I></FONT><FONT SIZE="1" COLOR="#663399" FACE="Times New Roman" >    </FONT> |    <B> </B><FONT SIZE="2" COLOR="#0000BF" FACE="Times New Roman" ><A HREF="index.htm" TARGET="_top" TITLE="cardio5"><U><B>home</B></U></A></FONT></div> <div> <A HREF="id22.htm" TARGET="_top" TITLE="DEF"><U>DEF</U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE="ANATOMY REVIEW"><U>ANATOMY REVIEW</U></A>   |   <A HREF="id18.htm" TARGET="_top" TITLE="VALVULOPATHY"><U>VALVULOPATHY</U></A>   |   <A HREF="id25.htm" TARGET="_top" TITLE="mitral valve"><U>mitral valve</U></A>   |   <A HREF="id21.htm" TARGET="_top" TITLE="VALVULOPATHY2"><U>VALVULOPATHY2</U></A>   |   <A HREF="id20.htm" TARGET="_top" TITLE="HEART FAILURE"><U>HEART FAILURE</U></A>   |   <B>PICTURES</B>   |   <A HREF="id24.htm" TARGET="_top" TITLE="AORTA"><U>AORTA</U></A>   |   <A HREF="id17.htm" TARGET="_top" TITLE="Contact Me"><U>Contact Me</U></A></div> <div> <IMG SRC="04207040.png" border=0 width="263" height="4" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>PICTURES</B></div> <div> <FONT SIZE="2" COLOR="#000000" FACE="Arial" ><IMG SRC="0af82fe0.png" border=0 width="386" height="254" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT>Note the vegetations along the lines of closure of the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >valve</FONT> leaflets. This is one of the hallmarks of rheumatic endocarditis. In this slide, the vegetations are seen as bumps along the division between the trabeculae carnae below and the smooth endocardium above</div> <div> <IMG SRC="0b199140.png" border=0 width="409" height="276" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><FONT SIZE="2" COLOR="#0000FF" FACE="Arial" >left ventricular hypertrophy</FONT></div> <div> The hypertrophy in this case is due to an increase in the size of the individual muscle cells. More specifically it is an increase in the components of each cell. By contrast, hyperplasia is an increase in the number of cells. Hypertrophy of the left ventricle is defined as a wall thickness greater than 1.5 cm. There is an associated increase in the weight of the heart. Notice the immense thickening of the wall of the ventricle in this heart: use the ruler as a guide. When referring to an organ, hypertrophy means increased size of the organ and may be due to hypertrophy and/or hyperplasia (if the cells of the organ are capable of mitosis) of individual cells. Hypertrophy and hyperplasia are forms of adaptation and are thus reversible. </div> <div> <FONT SIZE="2" COLOR="#000000" FACE="Arial" ><IMG SRC="0d5aa330.png" border=0 width="426" height="307" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT>Bacterial endocarditis, heart, <FONT SIZE="2" COLOR="#800000" FACE="Arial" >mitral</FONT> <FONT SIZE="2" COLOR="#800000" FACE="Arial" >valve</FONT></div> <div> In this specimen a septic vegetation on the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >valve</FONT> leaflet can be seen. The vegetation is the large, reddish, elevated area on the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >valve</FONT> leaflet in the center of the slide. </div> <div> <FONT SIZE="2" COLOR="#000000" FACE="Arial" ><IMG SRC="0b3f2300.png" border=0 width="498" height="304" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT>left atrial <FONT SIZE="3" COLOR="#800000" FACE="Arial" >mitral</FONT> stenosis sometimes refered to as a third mogul. Determining left ventricle enlargement on a lateral view can be accomplished using Rigler's rule. A line is drawn from the point where the inferior vena cava meets the heart boarder up 2 cm and then a second line is drawn posteriorly from this point 2 cm. If the cardiac boarder is beyond this point than the posterior cardiac boarder is enlarged.</div> <div> <FONT SIZE="2" COLOR="#000000" FACE="Arial" ><IMG SRC="0b7f84b0.jpg" border=0 width="504" height="331" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT>The heart has been sectioned to reveal the <FONT SIZE="4" COLOR="#800000" FACE="Arial" >mitral</FONT> <FONT SIZE="4" COLOR="#800000" FACE="Arial" >valve</FONT> as seen from above in the left atrium. The <FONT SIZE="4" COLOR="#800000" FACE="Arial" >mitral</FONT> <FONT SIZE="4" COLOR="#800000" FACE="Arial" >valve</FONT> demonstrates the typical "fish mouth" shape with chronic rheumatic scarring. <FONT SIZE="4" COLOR="#800000" FACE="Arial" >Mitral</FONT> <FONT SIZE="4" COLOR="#800000" FACE="Arial" >valve</FONT> is most often affected with rheumatic heart disease, followed by <FONT SIZE="4" COLOR="#800000" FACE="Arial" >mitral</FONT> and aortic together, then aortic alone, then <FONT SIZE="4" COLOR="#800000" FACE="Arial" >mitral</FONT>, aortic, and tricuspid together.</div> <div> <IMG SRC="0b8f84c0.jpg" border=0 width="504" height="332" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="504" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 132 WIDTH="500"><div> The small verrucous vegetations seen along the closure line of this <FONT SIZE="4" COLOR="#800000" FACE="Arial" >mitral</FONT> <FONT SIZE="4" COLOR="#800000" FACE="Arial" >valve</FONT> are associated with acute rheumatic fever. These warty vegetations average only a few millimeters and form along the line of <FONT SIZE="4" COLOR="#800000" FACE="Arial" >valve</FONT> closure over areas of endocardial inflammation. Such verrucae are too small to cause serious cardiac problems.</div> </tD> </tR> </TABLE></div> <div> <FONT SIZE="3" COLOR="#000000" FACE="Arial" ><IMG SRC="0b9f84b0.jpg" border=0 width="504" height="331" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT>Here are flat, pale tan, spreading vegetations over the <FONT SIZE="4" COLOR="#800000" FACE="Arial" >mitral</FONT> <FONT SIZE="4" COLOR="#800000" FACE="Arial" >valve</FONT> surface and even on the chordae tendineae. This patient has systemic lupus erythematosus. Thus, these vegetations that can be on any <FONT SIZE="4" COLOR="#800000" FACE="Arial" >valve</FONT> or even on endocardial surfaces are consistent with Libman-Sacks endocarditis. These vegetations appear in about 4% of SLE patients and rarely cause problems because they are not large and rarely embolize. Note also the thickened, shortened, and fused chordae tendineae that represent remote rheumatic heart disease.</div> <bR> <div> <FONT SIZE="2" COLOR="#000000" FACE="Arial" ><IMG SRC="0c180e00.jpg" border=0 width="640" height="480" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT>This specimen shows a heart opened to show the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >mitral</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >valve</FONT>, between the left atrium and ventricle. The <FONT SIZE="3" COLOR="#800000" FACE="Arial" >mitral</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >valve</FONT> has been infected by a virulent form of bacteria (infective endocarditis). The acute inflammation caused by the infection resulted in the formation of a "vegetation" on the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >valve</FONT>, comprised of a mixture of thrombus ("blood clot"), bacteria and inflammatory cells</div> <div> <FONT SIZE="2" COLOR="#000000" FACE="Arial" ><IMG SRC="0c2e0430.png" border=0 width="480" height="323" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT><B>Chronic Rheumatic </B><FONT SIZE="5" COLOR="#800000" FACE="New York" ><B>Mitral</B></FONT><B> </B><FONT SIZE="5" COLOR="#800000" FACE="New York" ><B>Valve</B></FONT></div> <div> Note thickening and fusion of chordae and thickening of <FONT SIZE="3" COLOR="#800000" FACE="New York" >valve</FONT> leaflets.</div> <bR> <div> <IMG SRC="0c3de430.png" border=0 width="478" height="323" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><FONT SIZE="5" COLOR="#000000" FACE="New York" ><B>Acute Rheumatic Valvulitis</B></FONT></div> <div> Note verrucae along lines of closure of the mitral valve</div> <div> <FONT SIZE="3" COLOR="#000000" FACE="Arial" ><IMG SRC="0d7d2380.png" border=0 width="466" height="312" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT><B>Mitral</B><FONT SIZE="5" COLOR="#000000" FACE="New York" ><B> </B></FONT><B>Valve</B><FONT SIZE="5" COLOR="#000000" FACE="New York" ><B> Prolapse</B></FONT></div> <div> Note reduplication and tenting of <FONT SIZE="3" COLOR="#800000" FACE="New York" >mitral</FONT> <FONT SIZE="3" COLOR="#800000" FACE="New York" >valve</FONT> leaflets with elongation of chordae</div> <bR> <div> <IMG SRC="0d6ce310.png" border=0 width="462" height="305" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><FONT SIZE="5" COLOR="#000000" FACE="New York" ><B>Normal </B></FONT><FONT SIZE="5" COLOR="#800000" FACE="New York" ><B>Valve</B></FONT></div> <bR> <bR> <bR> <bR> <bR> <bR> <bR> </td> </tr></table></body>