Diseases of the cardiovascular system

Transcription

1 Diseases of the cardiovascular system 心血管系统疾病 Zhengrong Mao PhD,Associate Prof. Pathology and pathophysiology Department Zhejiang University School of Medicine

2 Diseases of the cardiovascular system ATHEROSCLEROSIS CORONARY HEART DISEASE HYPERTENSION RHEUMATISM INFECTIVE ENDOCARDITIS VALVULAR HEART DISEASE

3 Diseases of the cardiovascular system ATHEROSCLEROSIS CORONARY HEART DISEASE HYPERTENSION RHEUMATISM INFECTIVE ENDOCARDITIS VALVULAR HEART DISEASE

4 Arteriosclerosis 动脉硬化 thickening,hardening, and loss of elasticity of arterial walls Atherosclerosis 动脉粥样硬化 Arteriolosclerosis 细动脉硬化 Arterial medial calcification 动脉中层钙化

5 Definition Etiology Pathology Basic morphologic changes Atherosclerosis of the important organs

6 Atherosclerosis(AS) 1.Definition: A disease of large and medium-sized muscular arteries Endothelial dysfunction Vascular inflammation Buildup of lipids, cholesterol, calcium, and cellular debris within the intima of the vessel wall Plaque formation Vascular remodeling Acute and chronic luminal obstruction Abnormalities of blood flow Diminished oxygen supply to target organs

7 Risk factors 2. Etiology 1)Hyperlipidemia( 高脂血症 ) 2)Hypertension( 高血压 ) 3)Cigarette smoking( 吸烟 ) 4)Diabetes mellitus( 糖尿病 ) 5)Genetics ( 遗传因素 ) 6)Age and sex( 年龄 性别 ) 7)Metabolic syndrome,ms( 代谢综合征 )

8 3.Pathogenesis 1)Dyslipidemia increased LDL, ox-ldl, VLDL, decreased HDL,the accumulation of lipid 2)Endothelial dysfunction 3)Proliferation of SMC 4)Chronic Inflammation 5)Infiltration of macrophages

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10 3. Morphology Basic lesion 1)Fatty streak( 脂纹 ) -foam cell 2)Fibrous plaque( 纤维斑块 )-fibrous cap 3)Atheromatous plaque( 粥样斑块 ) - atheroma 4)Complicated plaque ( 复合病变 )

11 1)Fatty streak Macroscopic changes Thin, flat, yellow streaks 1~2mm 1~5cm

12 1)Fatty streak Microscopic changes Foam cells lipid-laden macrophages SMCs (Sudan staining)

13 2)Fibrous plaque Macroscopic changes raised focal lesions a soft, yellow core of lipid covered by a firm, white fibrous cap

14 2)Fibrous plaque Microscopic changes Surface: A fibrous cap Core: extracellular lipid and foam cells

15 3)Atheromatous plaque Macroscopic changes lesions significantly raised(atheroma) necrotic core + firm, white fibrous cap thickening and hardening of the wall

16 3)Atheromatous plaque Microscopic changes Surface: A fibrous cap Deep: A necrotic core(+cholesterol clefts) Bottom and border: granulation tissue,foam cells,lymphocytes Media: Atrophied Adventitia: Capillaries, CT, L, P

17 Cholesterol clefts

18 4)Complicated lesions Hemorrhage in plaque Rupture of the plaque Thrombosis Calcification Aneurysm( 动脉瘤 )

19 Hemorrhage in plaque Calcification

20 Thrombosis

21 Aneurysm of abdominal aorta

22 Summary of Atherosclerosis

23 4. Atherosclerosis of the important organs Aorta: Aneurysm of abdominal aorta Coronary arteries: CHD Arteries of the brain Arteries of kidneys Arteries of the lower extremities and the mesentery

24 Atrophy of brain

25 Foot Gangrene

26 Coronary artherosclerosis Location and frequencies Left anterior descending coronary A(LAD) (40%- 50%) Right coronary A (RCA)(30%-40%) Left circumflex coronary A. (LCA)(15%-20%) LAD>RCA>LCA and LCX

27 Ⅰ 25% Ⅱ 26%~50% Ⅲ 51%~75% Ⅳ 76%

28 ATHEROSCLEROSIS CORONARY HEART DISEASE HYPERTENSION RHEUMATISM INFECTIVE ENDOCARDITIS VALVULAR HEART DISEASE

29 Coronary heart disease (CHD) ischemic heart disease,(ihd) 1. Definition: Cardiac disease which result from insufficient coronary blood flows due to the narrowing of the coronary arteries

30 2.Causes Impaired coronary perfusion Myocardial ischemia Coronary atherosclerosis Distribution (location) features of the lesion Spasm of the coronary arteris Coronary arteritis

31 3. Clinical features 1) Angina Pectoris 2) Myocardial Infarction 3) Myocardial Fibrosis 4) Sudden Coronary Death

32 1). angina pectoris (AP) Transient (15 s to 15 min) myocardial ischemia Precipitations: excited emotion, pain, cold weather, cigarette smoking, heavy work Paroxysmal( 阵发性 ) and usually recurrent attacks of substernal( 胸骨下 ) or precordial( 心前区 ) chest discomfort radiate to left shoulder

33 Three patterns (1) Stable or typical angina (2) Prinzmetal or variant angina (3) Unstable or crescendo angina

34 2). Myocardial infarction severe and persistent( 持续性 ) substernal chest pain Myocardial necrosis Subendocardial MI limited to the inner one third or at most one half of the ventricular wall Circumferential infarction ( 环状梗死 ) Transmural MI Involving the full or nearly full thickness of the ventricular wall

35 Subendocardial MI limited to the inner one third or at most one half of the ventricular wall Circumferential infarction

36 Morphology Macroscopic changes Shape, color: after 6 hours; irregular, yellow, grey white Microscopic changes: necrosis, granulation tissue, fibrosis Biochemical changes: SGOT( 谷草转氨酶 ) SGPT( 谷丙转氨酶 ) CPK( 肌酸磷酸激酶 ) LDH( 乳酸脱氢酶 )

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38 fresh myocardial infarction

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40 Complications (1) Left ventricular failure (2) Rupture of the heart (3) Ventricular aneurysm (4) Mural thrombosis (5) Cardiac shock (6) Acute pericarditis (7) Arrhythmias( 心律失常 )

41 Rupture of the heart

42 Mural thrombosis

43 3). Myocardial fibrosis Chronic ischemic heart disease 4). Sudden coronary death