Diseases of cardiovascular system department of pathology huaxi hospital xu huan 2009 10
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DISEASES OF CARDIOVASCULAR SYSTEM Department of Pathology, Huaxi Hospital Xu Huan 2009.10. SYSTEMATIC PATHOLOGY CAUSES OF DISEASE PATHOGENESIS BASIC PATHOLOGIC CHANGES PATHOCLINICAL RELATIONS. HOW TO STUDY BETTER REVIEW THE NORMAL STRUCTURE AND FUNCTION OF THE ORGAN

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Diseases of cardiovascular system department of pathology huaxi hospital xu huan 2009 10
DISEASES OF CARDIOVASCULAR SYSTEMDepartment of Pathology, Huaxi HospitalXu Huan2009.10


SYSTEMATIC PATHOLOGYCAUSES OF DISEASE PATHOGENESISBASIC PATHOLOGIC CHANGES PATHOCLINICAL RELATIONS


HOW TO STUDY BETTER

REVIEW THENORMALSTRUCTURE ANDFUNCTIONOF THE ORGAN

REVIEW THE CONTENT OF THEGENERAL PATHOLOGY

NOTICE THECORRELATIONSHIPBETWEEN THE MORPHOLOGY AND THE FUNCTION


Cardiovascular system the blood vessels the heart
CARDIOVASCULAR SYSTEMTHE BLOOD VESSELSTHE HEART


Vascular diseases

VASCULAR DISEASES

Atherosclerosis (ATH)

Aneurysm

Hypertension

Vascular tumor


  • THE HEART DISEASES

  • Ischemic heart disease

  • Rheumatic heart disease

  • Infective heart disease

  • Virus myocarditis

  • Cardiomyopathy

  • Pericarditis


Incidence and mortality
Incidence and Mortality

In the city

  • Brain vascular disease 93.7/106 17.7% 2

  • Heart disease 90.7/106 17.1% 3

    In the country

  • Brain vascular disease 105.5/106 2o.4% 2

  • Heart disease 71.8/106 13.9% 4

    Ministry of Health,China,2008


Normal vessels

NORMAL VESSELS

artery

veinlymphatics


Normal artery

NORMAL ARTERY

Large(elastic) arteryMedium-sized(muscular)arterySmall artery and arteriole


Normal

Aorta




Capillary

Arteriole

venule


Vascular abnormalities
Vascular abnormalities

  • Narrowing or obstructing the lumen

  • Dilation or rupture of the wall



Arteriosclerosis hardening of the arteries
Arteriosclerosis “hardening of the arteries”

  • Atherosclerosis-------most common

  • Arteriolosclerosis-----hypertension and diabetes mellitus

  • Medial calcific sclerosis-----rare


DEFINITION

Atherosclerosis is a degenerative disease of large and medium-sized arteries characterized by lipid deposition and fibrosis


Affects the large and medium-sized arteries

It is a chronic inflammatory response of the arterial wall initiated by injury to the endothelium

Lesions comprise fatty streaks, fibrous plaque, atheromatous plaque and complicated lesions

Major cause of organ ischaemia


BASIC PATHOLOGIC CHANGES

fatty streaks

fibrous plaque

Atheromatous plaque (atheroma)



Gross view

1. elongated Yellow streaks on the intima

2. Lesions tend to be much more prominent around the origins of major branches


Histological feature

1.Intimal thickening

2.Foamy cells

accumulation



Fatty streaks
Fatty Streaks

The precursor lesion for atheromas?

The relationship is uncertain !



Gross view

1.Plaques along the vessel length

2.gray fibrous cap can be seen



Histological feature

1.Fibrous cap

2.foamy cells, Smooth muscle cells and fibrous tissue

inflammatory cells can be seen

3.The structures of media are basically complete



Gross view

1.Raised focal lesions with a soft, yellow grumous core of lipid and covered by a firm,gray fibrous cap.

2.Complications often can be seen



Histological feature

1.A thick and hyalined fibrous cap.

2.Amorphous pink-staining core with blank fissure in it.

3.Granulation tissue, some foamy cell and lymphocytes can be seen by the border

4.The internal elastic lamina is destroyed and the media of the artery becomes thinner.




inflammation

calcification

neovascularization


Masson’s

trichrome

stain


elastic

fiber

stain






COMPLICATIONS

Rupture and ulceration

Hemorrhage

Thrombosis

Aneurysm

calcification


Rupture

and

ulceration








Ulceration

and

calcification




Aneurysm
Aneurysm

  • An aneurysm is a localized abnormal dilation of a blood vessel or the heart

  • ATH, syphilis, congenital defects, trauma …

  • ATH is the most common cause of aneurysm


Classification of aneurysm
Classification of Aneurysm

  • True Aneurysm

  • Pseudoaneurysm

  • Dissecting Aneurysm

    (Dissecting hematoma)


Aortic aneurysm

Usually below renal arteries and above the bifurcation of the aorta






Hyperlipidemia
Hyperlipidemia

  • Major risk factor

  • CM, VLDL, IDL , LDL, HDL

  • “Good cholesterol”

  • Genetic defects in lipoprotein metabolism


Notice

  • 1﹢1≠2

  • Maybe no apparent risk factors


Pathogenesis of ath

Pathogenesis of ATH

The response to injury hypothesis

chronic inflammatory response of the arterial wall initiated by injury to the endothelium



angiogram

Of

Coronary

arteries




ATHOf the circle of Willis




Summary of ATH

Affects the large and medium-sized arteries

Basic change consists fatty streaks, fibrous plaque, atheromatous plaque and complicated lesions

It is a chronic inflammatory response of the arterial wall initiated by injury to the endothelium

Major cause of organ ischaemia


Hypertension

HYPERTENSION

Functional definition

Hypertension is considered as sustained systolic pressure greater than 140 mmHg and/or diastolic pressure greater than 90 mmHg

25% of the general population

are hypertensive!!


  • Etiological classification

  • Primary(essential or idiopathic) hypertension 90%~95%

  • Secondary hypertension

  • Pathological classification

  • Benign hypertension 95%

  • Malignant hypertension


Cause and pathogenesis of hypertension

CAUSE AND PATHOGENESIS

Of

HYPERTENSION


Regulation of blood pressure

  • The blood pressure is determined by the interaction of multiple genetic,environmental and demographic factors

  • Hypertension occurs when the relationship between cardiac output and total peripheral resistance is altered



Causes of secondary

hypertension

renal diseases

endocrine factors

cardiovascular factors

neurological factors


Renal hypertension
Renal hypertension

  • Acute glomerulonephritis

  • Chronic renal diseases

  • Polycystic disease

  • Renal artery stenosis

  • Renal vasculitis

  • Renin-producing tumors





GFR

Reabsorption

Macula densa

RENIN

BLOOD VOLUME

Juxtaglomerular

apparatus

Afferent arteriole



Causes of Renal hypertension

Induced renin secretion lead to vasoconstriction and increased peripheral resistance

Increased sodium reabsorption and therefore increased blood volume


  • Causes of secondary hypertension

  • Endocrine courses

  • Hormones produced by hyperplasial endocrine cells or tumor cells caused episodic vasoconstriction and thus induce hypertension


Cushing syndrom

(adrenocortical hyperfunction)


  • Clinic features

  • Central obesity and

  • moon face

  • Plethora and acne

  • Menstrual irregularity

  • Hirsutism and hair

  • thinning

  • Hypertension

  • Diabetes

  • Osteoporosis

  • Muscle wasting and

  • weakness

  • Atrophy of skin and

  • dermis: paper thin skin

  • with bruising tendency,

  • purple stride


Phaeochromocytoma

(catecholamines )

Cortical adenoma


Causes of primary hypertension:

1. Genetic influences (multigenetic disorders)

Caused by different combinations of genetic variations that are individually of little consequence

2. Environmental influences

Heavy consumption of salt、stress、smoking、fat 、 physical inactivity……



  • Cause of Primary hypertension is not so clear hypertension

  • Primary hypertension is a complex multi-factorial disorder .environmental factors affect the variables that control blood pressure in the genetically predisposed individual


Clinicopathological features of hypertension

Clinicopathological Features Of hypertension

Hypertension


New classification
New Classification hypertension

Systolic(mm Hg) diastolic (mm Hg)

  • Ideal <120 <80

  • Normal <130 <85

  • High normal 130-139 85-89

  • Stage 1 140-159 90-99

  • Stage 2 160-179 100-109

  • Stage 3 ≥180 ≥110

  • pure systolic ≥140 <90

    (WHO-ISH 1999)


Vascular pathology
Vascular pathology hypertension

  • Accelerate atherogenesis

  • Weaken the wall of large and medium artery

  • Hyaline arteriolosclerosis


  • Hyaline hypertension

  • arteriolo-sclerosis

  • Leakage of plasma components

  • ECM produced by SMC



small artery hypertension

in hypertension


Hypertensive encephalopathy hypertension

Hypertensive crisis

Cerebral lacunar infarct

Cerebralhemorrhage



Cerebral hypertensionhemorrhage


Cerebral infract and hemorrhage
Cerebral hypertensionInfract and hemorrhage

CT scan




Hypertensive heart disease hypertension

The presence of left ventricular hypertrophy in an individual with a history of hypertension and other cause of ventricular hypertrophy have been excluded


Hypertensive Heart Disease hypertension

Weight of the heart exceeds 450g


Concentric hypertrophy hypertension

Free wall thickness exceeds 2.0cm



eccentric hypertension

hypertrophy


Malignant Hypertension hypertension

1.Dramatic elevation of blood pressure over a short period of time with a progressive renal disease.

2.Often discovered in young and middle age.

3.Diastolic blood pressure usually over 120mmHg.

4.Clinical course is short(months to 1-2years).


Basic pathologic changes hypertension

Artery: hyperplastic

arteriolosclerosis

necrotizing arteriolitis

Heart: hypertrophy of the left

ventricle and dilation

Kidney: haematuria and renal failure

Brain: severe headache,

cerebral hemorrhage

Eyes: retinal hemorrhage ,papilledema


hyperplastic arteriolo-sclerosis hypertension

Onion-skin like

Laminated thicken




增生性小动脉硬化 hypertension

hyaline arteriolosclerosis

Benign Hypertension

hyperplastic arteriolosclerosis

Malignant Hypertension

necrotizing arteriolitis

Malignant Hypertension

细动脉玻璃样变

坏死性细动脉炎

malignant

benign


Summary of hypertention hypertension

  • sustained systolic pressuregreater than 140 mmHg and/or diastolic pressure greater than 90 mmHg

  • Mainly affects the small arteries and arteriole

  • Basic changes consists hyaline Arteriolosclerosis, Hyperplastic arteriolosclerosis

  • Uncontrolled hypertension has serious effects on heart,kidney and brain


Vascular tumours
Vascular Tumours hypertension

  • Benign (haemangioma)

  • Borderline malignant (Kaposi sarcoma)

  • Malignant (angiosarcoma)


Cavernous hemangioma hypertension


Kaposi sarcoma
Kaposi sarcoma hypertension


angiosarcoma hypertension


The heart

The heart hypertension

Ischemic heart disease

Rheumatic heart disease

Infective heart disease

Virus myocarditis

cardiomyopathy


Normal heart hypertension




Ventricle valve hypertension


Normal cardiac muscle hypertension



DEFINITION hypertension

IHDrefers to a group of closely related syndromes by an imbalance between the myocardial oxygen demand and the blood supply.

The most common cause is narrowing of the lumen of the coronary arteries by atherosclerosis

(Coronary heart disease )


Pathogenesis

Pathogenesis






Thrombosis stenosis)


thrombosis stenosis)


Syndromes 1 angina pectoris 2 acute myocardial infarction 3 sudden cardiac death 4 chronic ihd

Syndromes stenosis)

1.angina pectoris

2.acute myocardial infarction

3.sudden cardiac death

4.chronic IHD


Angina Pectoris stenosis)

Definition

Intermittent chest pain caused by transient,reversible myocardial ischemia


Angina pectoris

Type stenosis)

Stable (typical)

Variant (prinzmetal)

Unstable (crescendo)

Angina Pectoris

  • More than one type of angina may be present in a given person


  • Stable(typical) Angina Pectoris stenosis)

  • Episodic chest pain associated

  • with exertion or other form

  • of stress

  • Crushing substernal sensation,

  • radiate down the left arm

  • Relieved by rest or by

  • intake of nitroglycerin

  • A fixed atherosclerotic

  • narrowing(≧75%)


Variant stenosis)Angina Pectoris

  • Occur at rest ,awaken from sleep

  • Response to the uptake of vasodilator

  • Coronary artery spasm


Unstable angina pectoris
Unstable stenosis)Angina Pectoris

  • Increased frequency of angina pectoris

  • More intense and often last longer than stable angina pectoris

  • Induced by acute plaque change with partial thrombosis,distal embolization and/or vasospasm

  • More serious,potentially irreversible myocardial ischemia


Myocardial Infarction stenosis)

Definition

An area of myocardial necrosis caused by local ischemia.

Location

Determined by the site of the vascular occlusion and by the anatomy of the coronary circulation.



(15-20%) stenosis)

(40-50%)

(30-40%)


Locations of MI stenosis)


Transmural stenosis)

Infarcts

Subendocardial

Infarcts


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