Transcript Diseases of the cardiovascular system(马丽琴)

Diseases of the
cardiovascular system
Maliqin
Department of Pathology and Pathophysiology
School of Medicine, Zhejiang University
atherosclerosis(AS)
1. etiology and pathogenesis
Risk factors





Hyperlipemia:increased LDL, TG, VLDL,
apoB,Lp(a)
decreased HDL,apoA-I
Hypertension
Cigarette smoking
Elevated blood sugar levels
The other factors
pathogenesis
--Theory of inflammatory response to
injury
 The injury of the endothelium
 The accumulation of lipid
 The infiltration of macrophages
 The proliferation of SMC
2.morphology
Predilection for large arteries
and medium-sized arteries
Basic lesion
 Fatty streak
Accumulated lipid, foam cell
 Fibrous plaque-- Fibrous cap
黄色脂
质条纹
2.morphology
Predilection for large arteries
and medium-sized arteries
Basic lesion
 Fatty streak
Accumulated lipid, foam cell
 Fibrous plaque-- Fibrous cap
正
常
主
动
脉
动
脉
粥
样
硬
化
的
纤
维
斑
块
病
变
动脉管壁一侧明显增厚
•Atheromatous plaque (atheroma)
Fibrous cap
cholesterol crystal
necnotic debris
foam cell
calcification
neovascular formation
atheroma
complicated lesions
Hemorrhage
in plaque
Rupture of the plaque
Thrombosis
Calcification
aneurysm: definition, lesion
classification (true , pseudo-, Dissecting )
Ulcer
formation
3. Atherosclerosis
of the
important organs
• Aorta: abdominal aorta
• Coronary arteries
• Arteries of the brain
• The other organs
正
常
主
动
脉
动
脉
粥
样
硬
化
的
纤
维
斑
块
病
变
3. Atherosclerosis
of the
important organs
• Aorta: abdominal aorta
• Coronary arteries
• Arteries of the brain
• The other organs
基底动脉
环硬化
基底动脉内血
栓形成
脑动脉
硬化致
脑萎缩
3. Atherosclerosis
of the
important organs
• Aorta: abdominal aorta
• Coronary arteries
• Arteries of the brain
• The other organs
新
鲜
足
坏
疽
足
干
性
坏
疽
Coronary heart disease
(C H D)
Definition
cardiac disease which result
from insufficient coronary blood
flows due to the narrowing of the
coronary arteries
Causes
• Coronary atherosclerosis
Distribution(location)
features of the lesion
• Spasm of the coronary arteris
• Coronary arteritis
正常心脏
右
冠
状
动
脉
左
冠
状
动
脉
左冠状动脉
冠
状
动
脉
粥
样
硬
化
右冠状动脉
冠
状
动
脉
狭
窄
血
栓
形
成
正常冠状动脉
冠状动
脉粥样
硬化，
管腔狭
窄
冠状动脉管壁增厚及钙化 ，管腔明显狭窄
斑块内钙化
动脉管腔狭窄血栓形成
冠状动脉
近端狭窄
冠状动脉
远端闭塞
冠状动脉
硬化区
冠
状
动
脉
阻
塞
Causes
• Coronary atherosclerosis
Distribution(location)
features of the lesion
• Spasm of the coronary arteris
• Coronary arteritis
Classification
1. angina pectoris (AP)
a symptom complex consisting
of severe paroxymal chest pain
resulting from transient ischemia
Precipitating factors
Exertion, emotion, pain,
cold weather, cigarette
smoking, heavy meals
心
绞
痛
病
人
Classification
• Stable (exerting ) AP
• Instable (exerting) AP
• (Spontaneous) variant AP
2. Myocardial infarction
• Subendocardial MI
Multiple small lesion
• Transmural MI
Distribution
Morphology:shape, color,
microscopic change
Biochemical changes:
myocardial
infarction
granulation tissue
Complications
•Rupture of the heart
•Ventricular aneurysm
•Thrombosis
•Acute pericarditis
•Clinical complication
rupture of
Infarct area
Pericardial
tamponade
hematocele in
heart sac
vntricular
aneurysm
3. Myocardial fibrosis
4. sudden coronary death
Hypertension
Diagnostic criteria
sustained diastolic pressure
above 90 mmHg
and/or sustained systolic
pressure above 140mmHg
Classification
• Primary(essential) hypertension
• Secondary(symptomatic)
• Benign (chronic) hypertension
• Malignant(accelerated)
Morphology
(1) Benign hypertension
• Stage of dysfunction
• Stage of artery lesion
arteriolosclerosis—the basic
lesion of hypertension
• Stage of organ dysfunction
Hypertensive heart disease
Concentric hypertrophy
Ecentric hypertrophy
Arteriolar nephrosclerosis
(primary granulo-contracted
kidney)
Microscopic change
Gross alteration
concentric
hypertrophy
of left ventricle
decompensation
distention of left
ventricle
Hypertensive heart disease
Concentric hypertrophy
Ecentric hypertrophy
Arteriolar nephrosclerosis
(primary granulo-contracted
kidney)
Microscopic change
Gross alteration
Hypertensive brain
•Edema of brain, hypertensive
encephalopathy,
hypertensive crisis
•Hemorrhage of brain
•Softening of brain
Lesions of retina
Arteriole of eyeground
(2) Malignant hypertension
Basic lesion:
necrotic arteriolitis
proliferating arteriosclerosis
The major injured organs:
kidney and brain
Etiology and pathogenesis
Causes
• Genetic factors
• Environmental factors
Dietary factors: Na+, K+,Ca2+
Social factors
psychological stress
other factors
Pathogenesis
Variant factors—increased Volum,
or Increased vasoconstriction
• retention of Sodium and water
• Vasoconstriction
• Thickening of the artery wall
Cardiomyopathy
Classification:
The common lesion:
Primary cardiomyopathy
Any dysfunction of the myocardium
not attribulable to CHD,valvular disease
, hypertension or pulmonary heart
disease .
Dilated cardiomyopathy
Hypertrophy(M>350g F>300g)
Dilatation of the four cavities
Heart failure
Microscopically, the heart in cardiomyopathy demonstrates
hypertrophy of myocardial fibers (which also have prominent dark
nuclei) along with interstitial fibrosis.
Here is a large, dilated left ventricle typical of a dilated, or
congestive, cardiomyopathy. Many of these have no known
etiology (so-called "idiopathic dilated cardiomyopathy")
while others may be associated with chronic alcoholism. The
heart is very enlarged and flabby.
Hypertrophic cardiomyopathy
•Hypertrophy of the myocardium
•Asymetric hypertrophy of the
ventricular septum
•Obstruction of the outflow tract
There is marked left ventricular hypertrophy, with asymmetric
bulging of a very large interventricular septum into the left
ventricular chamber. This is hypertrophic cardiomyopathy.
Restrictive cardiomyopathy
progressive fibrosis of the
endocardium and subendocardial
myocadium
This section of myocardium demonstrates amorphous deposits of
pale pink material between myocardial fibers. This is characteristic
for amyloid. Amyloidosis is a cause for "infiltrative" or "restrictive"
cardiomyopathy. It is a nightmare for anesthesiologists when
intractable arrhythmias occur during surgery on such patients.
KeShan disease
Etiology
•Virus infection
Coxsackie B
•Lack of Selennium
Morphology
Dilatation of the left
and right ventricle
Rheumatism
Etiology and pathogenesis
•Infection with group A beta
hemolytic streptococci
•Immune injury
Basic lesion(three stages)
• Alterative and exudative
phase
Mucoid degeneration
fibrinoid necrosis
• Proliferative phase
(granulomatous phase)
Aschoff body (consist of)
Fibrinoid necrosis
Aschoff cell:awl-eye cell,
caterpillar cell
Aschoff giant cell
Other inflammatory cells
• Fibrosis phase
Aschoff body (consist of)
Fibrinoid necrosis
Aschoff cell:awl-eye cell,
caterpillar cell
Aschoff giant cell
Other inflammatory cells
• Fibrosis phase
Rheumatic heart disease
Rheumatic endocarditis
(verrucous endocarditis)
Distribution:
mitral valve 50%
mitral and aortic valve 50%
Lesion: vegetations
sequla: valvular disease,
MacCallum’s plaque
疣
状
风
湿
性
心
内
膜
炎
Rheumatic myocarditis
Adults: local stromal myocarditis
Children:diffuse stromal myocarditis
Rheumatic pericarditis
dry pericarditis
wet pericarditis
Clinical course
rheumatic myocarditis
rheumatic granulomas
Aschoff cell
Rheumatic myoicarditis
Adults: local stromal myocarditis
Children:diffuse stromal myocarditis
Rheumatic pericarditis
dry pericarditis
wet pericarditis
Clinical course
Rheumatic arthritis
Large joints, reversible
Rheumatic lesion of the skin
Erythema annullare
Subcutaneous nodules
Rheumatic arteritis
Rheumatic encephalopathy
Rheumatic arteritis of the brain
Rheumatic encephalitis
Chorea minor
Chronic valvular vitium
of the heart
stenosis, insufficiency
Mitral stenosis
The valvular changes
The cardiac changes
The clinical course
风湿性心瓣膜病 左房扩张
左房扩张
瓣膜硬化
左室萎缩
二尖瓣
膜及腱
索增厚
变硬
二尖瓣
狭窄
左心房
扩张
主
动
脉
瓣
关
闭
不
全
Mitral insufficiency
The valvular changes
The cardiac changes
The clinical course
Aortic stenosis and
insufficiency
Subacute infective
endocarditis(SBE)
Etiology
Streptococci.
Morphology
vegetations
Vegetations(compared with
rheumatic valvitis)
Large, yellow,
located haphazardly,
located at the margin of the valve
containing causative organism
friable
亚急性
细菌性
心内膜
炎
赘生物
瓣膜病
变
Complication
•Septicemia
•Embolism
•Immune injury
Myocarditis
Etiology
Morphology
Viral myocarditis
Bacterial myocarditis
Isolated myocarditis
Clinical course
The interstitial lymphocytic infiltrates shown here are
characteristic for a viral myocarditis, which is probably the
most common type of myocarditis.
Thank you!