Pathology the heart of modern healthcare Broken heart

Pathology: the heart of modern healthcare

• • Broken heart Young at heart With all my heart Heart to heart My heart sank Hand on my heart Queen of hearts Heart and soul

Heart fact: coronary heart disease is the biggest cause of death in the UK

Heart fact: 1 in 5 deaths in the UK are from coronary heart disease

• The heart is a muscle • It pumps blood around the body • The heart has 4 chambers, 2 on the right and 2 on the left

• Dual circulation • Left high pressure • Right low pressure • Oxygen added to blood in lungs • Oxygen delivered to body by blood

Heart fact: nearly 70, 000 men and 50, 000 women have a heart attack in the UK each year

How can doctors look at the heart? • Scanners • X-rays • ECG • Echocardiography

Heart fact: heart disease costs the economy £ 9 billion each year

How do pathologists investigate the heart? • Blood tests • Biopsies • Genetic tests • Blood cultures • Autopsies

R R L

Atheroma Normal artery wall Blood within the artery Fatty deposits in wall of artery Fatty deposits reduce blood flow through artery

Atheroma Normal artery wall Fatty deposits reduce blood flow through artery

Artery blocked by blood clot

Risk factors for CHD • • • Smoking Obesity Lack of exercise Diet High cholesterol High blood pressure

Heart fact: smoking doubles your risk of having a heart attack

Heart fact: stopping smoking reduces your risk of having a heart attack by a third

Heart fact: almost half of all heart attacks are caused by high fat levels in the blood

Heart fact: if you have a high cholesterol level, you are three times more likely to have a heart attack than someone with a normal level

Heart fact: around 30% of heart disease is due to not eating enough fruit and vegetables

Heart fact: around 20% of heart disease is caused by not doing enough exercise

Heart fact: only 40% of men and 28% of women meet the guidelines for physical activity

Heart fact: being overweight doubles your chance of having a heart attack

Heart fact: diabetes increases your chance of having a heart attack and increases the effect of other risk factors

Heart fact: the heart is formed during the first 12 weeks of pregnancy

Heart fact: over 4, 500 babies are born with congenital heart disease in the UK each year

Heart fact: over 80% of babies with congenital heart disease now survive to adulthood

Pathology fact: over 70% of diagnoses in the NHS involve pathology

Pathology fact: over 700 million pathology tests are performed in the NHS each year

The study of disease in human tissue Histopathologists: • Are doctors • Look at cells and tissues removed in clinic or during an operation • Diagnose diseases including cancer • Work as part of teams • Some perform autopsies

• When someone has a heart transplant, histopathologists look at the heart to find out what was wrong with it • They also look at biopsies from transplanted hearts to see if they are being rejected • If someone dies of heart disease a histopathologist might examine the heart to find out what happened

Dilated cardiomyopathy

The study of chemicals in the blood and body fluids Clinical biochemists • Are scientists Chemical pathologists • Are doctors Both work in outpatient clinics, on hospitals wards and in the lab. Some tests are now done by patients at home.

Clinical biochemists: • Measure cholesterol levels in the blood • Measure the levels of heart enzymes in the blood • Diagnose and treat diabetes • Measure chemicals in the blood that indicate how well the heart is working

The study of infectious diseases • Microbiologists can be doctors or scientists • They perform tests to find out which antibiotics will be effective against an infection • And make sure that infections don’t spread from one patient to another • They work with patients and in the lab.

Microbiologists: • Detect organisms in the blood that might cause infection of the heart muscle or valves • Prevent, diagnose and treat the infections that are risk factors for coronary heart disease • Prevent infections in people with congenital heart disease or transplants

The study of the blood and bone marrow Haematologists: • Are doctors • Diagnose and treat anaemia, leukaemia and lymphoma • Work in outpatients clinics, on hospital wards and in the lab.

• The branch of pathology concerned with transfusion of blood and its components • Makes sure that blood transfusions are safe • Makes sure that donor and recipient blood groups match

• Haematologists diagnose and treat anaemia, which can have an effect on the heart • They also measure blood clotting to try and prevent blood clots which might cause a heart attack • You might need a transfusion after heart surgery to replace blood lost

• 2. 1 million blood donations were collected in 2008 from 1. 6 million donors • There are 4 blood groups; Group O is the most common in the UK

• The study of DNA and how diseases are inherited • Geneticists are usually scientists, some also have a medical degree • Technological advances in the last 20 years have had a huge impact on genetics

• Diagnose inherited forms of heart disease • Screen family members following unexpected cardiac death • Look at inherited risk factors for heart disease e. g. high cholesterol • Working on tests and treatments for inherited heart disease

Hypertrophic cardiomyopathy

The study of disorders of the immune system • e. g. allergies, immunodeficiency disorders • Most immunologists run clinics, provide advice on the wards and work in the lab.

• The study of inherited aspects of immunity • Support stem cell and organ transplants • Usually scientists

• Immune disorders can affect the heart e. g. autoimmune anaemia, Grave’s disease, lupus • Heart transplants could not be performed without careful tissue typing to match the donor and recipient

• Heart transplants have only become possible with advances in immunology • The first heart transplant was performed in 1967 • It takes up to 10 hours to perform a heart transplant • People have survived over 20 years following heart transplants

• The study of diseases of fetuses and babies • Paediatric pathologists are doctors • They perform post mortems to find out why babies have died • They also diagnose diseases in babies and children

• Paediatric pathologists provide information about heart defects • This helps families plan future pregnancies

The investigation of suspicious deaths • Perform post mortems to find out how people died • The most high profile of all pathology specialties but accounts for less than 1% of pathologists in the UK

• As well as performing autopsies, forensic pathologists give evidence in court and give advice to families, police and lawyers • Often investigate sudden death due to heart disease e. g. distinguishing between death due to drugs, inherited conditions, trauma or disease

The study of the effects of drugs and chemicals • Measure levels of drugs in the blood and other body fluids • May work for industry, in hospitals, with forensic cases or on the environment

• Ecstasy can trigger heart attacks, increases heart rate and blood pressure, can cause heart failure • Heroin lowers blood pressure, can make the heart rate slow and irregular, injection increases risk of heart valve infection, additives can cause blood clots

• Pathology as it applies to other animals • All the different branches of pathology are found in veterinary medicine as well

• Animals have heart disease too • Dogs can have inherited or acquired heart disease, just as humans do • In dogs the problems are often with the heart valves or muscle

• Cardiomyopathies are common in cats, particularly hypertrophic cardiomyopathy • Cats and dogs do not develop coronary heart disease

Pathology is involved in the • • Prevention Diagnosis Treatment Monitoring of heart disease