new_n_lost
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A 55-year-old man had been in good health since receiving a heart transplant for severe atherosclerotic disease. Five years after transplantation, the patient died suddenly, without any premonitory symptoms, while working in his garden. He had been maintained on cyclosporin since his transplant.
Which of the following complications would most likely be found at autopsy in the transplanted heart?
A. Allograft rejection
B. Atherosclerosis of coronary arteries
C. Graft vascular disease
D. Hyaline arteriolosclerosis
E. Hyperplastic arteriolosclerosis
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| drduck
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B.......
sudden death...
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| Luckyall
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mmm agree
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| ssrpk
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there can be several causes of suddent death, an MI or maybe an arrythmia, however in transplanted heart there is unque pathology seen in the coronaries which ain't athersclerosis as atherosclerotic disease takes decades to develop.
In transplanted heart over time there will be coronary arteriosclerosis manifested by diffuse concentric intimal thickening causing severe stenosis, and as against atherosclerotic disease internal elastic lamina and media remains intact.
Refer to robbin's textbook, they have an excellent pathology slide.
answer is C
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| epica
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C
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| new_n_lost
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| new_n_lost
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The correct answer is C.
Patients receiving heart transplants are prone to develop a number of complications, the most serious of which is graft vascular disease, AKA graft arteriosclerosis. This complication develops years after transplantation and is due to intimal thickening of coronary arteries without associated atheroma formation or significant inflammation. Thickening of the arterial intima is due to proliferation of fibroblasts and myocytes and leads to progressive stenosis of the lumen. Since transplanted hearts are denervated, chest pain does not accompany the ischemic injury. Graft vascular disease is of unknown etiology and cannot be prevented with current immunosuppressant therapy.
Allograft rejection (choice A) is certainly a major postoperative problem. However, thanks to early diagnosis based on periodic endomyocardial biopsy and the availability of immunosuppressant therapy, this complication can be prevented or successfully treated.
Atherosclerosis of coronary arteries (choice B) is by far the most frequent cause of ischemic heart disease. Although recurrence of atherosclerosis may be observed in the transplanted heart of patients predisposed to this condition, it rarely results in sudden death 5 years after transplantation.
Hyaline arteriolosclerosis (choice D) and hyperplastic arteriolosclerosis (choice E) are pathologic changes that result from chronic damage to arteriolar walls due to hypertension. Hyaline arteriolosclerosis is associated with benign hypertension and consists of thickening of the media caused by deposition of altered proteins. This change is actually not at all benign, since it leads to chronic ischemic injury to important organs, such as brain and kidneys, resulting in tissue damage (eg, nephrosclerosis in the kidney and white matter damage in the brain). Hyperplastic arteriolosclerosis follows untreated malignant hypertension. It leads to thickening of arteriolar wall media from hyperplasia of myocytes arranged in concentric layers (onion-skinning). Hyperplastic arteriolosclerosis leads to more severe and more rapid ischemic damage to kidneys, heart, and brain. Neither type of arteriolosclerosis is observed in transplanted hearts.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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