—  SPECIALTY CONFERENCE  —

Cardiovascular Pathology
 Monday, March 19, 2012, 7:30 PM
Convention Centre 220-222




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Corona Mortis: Myocardial Ischemia - Morphology and Contemporary Views on Causation and Forensic Aspects
Moderator: JAGDISH BUTANY
Toronto General Hospital
Toronto, ON, Canada
Disclosure: In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Symposium) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. The speakers listed below have indicated they have nothing to disclose.
Panelists:

Coronary Artery Disease and Myocardial Ischemia
James R. Stone, Mass General Hosp, Boston, MA

Pathophysiology of Myocardial Ischemia
Carmela D. Tan, Cleveland Clinic, Cleveland, OH

Coronary Artery Pathology of Surgical Interventions
Mary N. Sheppard, Royal Brompton Hospital, London, England

Coronary Artery Disease: Interventional Pathology
Renu Virmani, CV Path, Gaithersburg, MD

Sudden Death and Myocardinal Ischemia: The Forensic Approach
Christopher Milroy, The Ottawa Hospital, Ottawa, ON



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Case 1

Submitted by: James Stone - Mass General Hosp, Boston, MA

Clinical Summary:

The patient was 57 year-old man with a past medical history of hypertension and hypercholesterolemia, which were felt to be well controlled by his primary care provider. He was a former smoker, quitting several years earlier. He died unexpectedly in his sleep, two days after complaining of intermittent pain in his upper back between the shoulder blades.


Case 1 - Slide 1
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Case 2

Submitted by: Carmela Tan - Cleveland Clinic, Cleveland, OH

Clinical Summary:

A 72 year old woman with history of dementia had been bedbound at home for the past six months. She was recently admitted for treatment of a urinary tract infection and discharged to a skilled nursing facility. Four days later, she was brought to the Emergency Department after having been found unresponsive. Postmortem examination revealed a thrombus within the main pulmonary trunk extending into the right pulmonary artery.


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Case 3

Submitted by: Mary Sheppard - Royal Brompton Hospital, London, England

Clinical Summary:

75 year old male with routine bypass surgery as well as Mitral valve repair for floppy mitral valve. Prolonged bypass time 5 hours. Did not regain cardiac output and died on the operating table. At autopsy vein grafts to LAD,posterior descending coronary artery and obtuse marginal branch. No macroscopic evidence of acute or chronic myocardial infarction.


Case 3 - Slide 1
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Case 4

Submitted by: Renu Virmani - CV Path, Gaithersburg, MD

Clinical Summary:

Case #4a: 67 year old woman with a history of acute MI and left circumflex (LCA) balloon angioplasty in 1999, BMS placement in LCA in 2000, DES (Cypher sirolimus-eluting stents) placement in LAD and LD1 in 2006, BMS placement in LD1 in 2007, and DES (Taxus Liberte Paclitaxel-eluting stents and Endeavor Resolute Zotarolimus-eluting stents) in RCA in 2007; presented with AMI and cardiogenic shock in April 2010.

Case #4b: 61 year old black male, with history of ischemic cardiomyopathy, ventricular and supraventricular arrhythmias, hypertension, hyperlipidemia, diabetes, acute and chronic renal failure, coronary artery stents in LAD and RCA 10 years ago (BMS), in LCX 9 years ago (BMS), and in RI 4 years ago (DES). The subject received AICD placement 8 years ago and replacement 2 years ago, and recent ablation; found deceased on floor at home.


Case 4a - Figure 1
LAD Cypher 1.25x Movat
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LAD Cypher 4x Movat
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LAD Cypher 10x Movat
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LAD Cypher 10x HE

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LAD Cypher 40x Luna
Case 4b - Figure 1
RCA BMS 2x Movat
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RCA BMS 10x Movat
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RI DES 2x Movat

Case 4a - Figure 4
RI DES 20x Movat
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RI DES 40x HE




Case 5

Submitted by: Christopher Milroy - The Ottawa Hospital, Ottawa, ON

Clinical Summary:

Clinical History: 53 year old male. Had a confrontation with the police. He was taken to a police station where he was declared fit for interview by a medical officer and released after a few hours detention. He subsequently complained of back pain, collapsed and could not be resuscitated. Can you date the lesions(s) seen on microscopy ?

Pertinent Laboratory Data:

Toxicology was negative Vitreous biochemistry was unremarkable


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Handouts for all Specialty Conferences will be accessible via the "Educational Materials" section on the homepage the morning after each respective conference. Printed copies of the handout will not be available at the meeting.