diseases of cardiovascular system department of pathology huaxi hospital xu huan 2009 10 n.
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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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slide2
SYSTEMATIC PATHOLOGYCAUSES OF DISEASE PATHOGENESISBASIC PATHOLOGIC CHANGES PATHOCLINICAL RELATIONS
slide3

HOW TO STUDY BETTER

REVIEW THENORMALSTRUCTURE ANDFUNCTIONOF THE ORGAN

REVIEW THE CONTENT OF THEGENERAL PATHOLOGY

NOTICE THECORRELATIONSHIPBETWEEN THE MORPHOLOGY AND THE FUNCTION

vascular diseases

VASCULAR DISEASES

Atherosclerosis (ATH)

Aneurysm

Hypertension

Vascular tumor

slide6

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

slide10

Normal

Aorta

slide16
Elastic and muscular artery--------ATH
  • Small artery and arteriole---------- Hypertension
slide18

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
slide23

DEFINITION

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

slide24

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

slide25

BASIC PATHOLOGIC CHANGES

fatty streaks

fibrous plaque

Atheromatous plaque (atheroma)

slide27

Gross view

1. elongated Yellow streaks on the intima

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

slide28

Histological feature

1.Intimal thickening

2.Foamy cells

accumulation

fatty streaks
Fatty Streaks

The precursor lesion for atheromas?

The relationship is uncertain !

slide33

Gross view

1.Plaques along the vessel length

2.gray fibrous cap can be seen

slide35

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

slide37

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

slide39

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.

slide42

inflammation

calcification

neovascularization

slide43

Masson’s

trichrome

stain

slide44

elastic

fiber

stain

slide49

COMPLICATIONS

Rupture and ulceration

Hemorrhage

Thrombosis

Aneurysm

calcification

slide50

Rupture

and

ulceration

slide57

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)

slide62

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
slide69

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

slide79

angiogram

Of

Coronary

arteries

slide85

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!!

slide88

Etiological classification

  • Primary(essential or idiopathic) hypertension 90%~95%
  • Secondary hypertension
  • Pathological classification
  • Benign hypertension 95%
  • Malignant hypertension
slide90

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
slide92
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
slide97

GFR

Reabsorption

Macula densa

RENIN

BLOOD VOLUME

Juxtaglomerular

apparatus

Afferent arteriole

slide99

Causes of Renal hypertension

Induced renin secretion lead to vasoconstriction and increased peripheral resistance

Increased sodium reabsorption and therefore increased blood volume

slide100

Causes of secondary hypertension

  • Endocrine courses
  • Hormones produced by hyperplasial endocrine cells or tumor cells caused episodic vasoconstriction and thus induce hypertension
slide101

Cushing syndrom

(adrenocortical hyperfunction)

slide102

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
slide103

Phaeochromocytoma

(catecholamines )

Cortical adenoma

slide104

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……

slide106

Cause of Primary hypertension is not so clear

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

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
  • Accelerate atherogenesis
  • Weaken the wall of large and medium artery
  • Hyaline arteriolosclerosis
slide110

Hyaline

  • arteriolo-sclerosis
  • Leakage of plasma components
  • ECM produced by SMC
slide112

small artery

in hypertension

slide113

Hypertensive encephalopathy

Hypertensive crisis

Cerebral lacunar infarct

Cerebralhemorrhage

slide119

Hypertensive heart disease

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

slide120

Hypertensive Heart Disease

Weight of the heart exceeds 450g

slide121

Concentric hypertrophy

Free wall thickness exceeds 2.0cm

slide123

eccentric

hypertrophy

slide124

Malignant 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).

slide125

Basic pathologic changes

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

slide126

hyperplastic arteriolo-sclerosis

Onion-skin like

Laminated thicken

slide129
增生性小动脉硬化

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

slide130

Summary of hypertention

  • 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
  • Benign (haemangioma)
  • Borderline malignant (Kaposi sarcoma)
  • Malignant (angiosarcoma)
the heart

The heart

Ischemic heart disease

Rheumatic heart disease

Infective heart disease

Virus myocarditis

cardiomyopathy

slide143

DEFINITION

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

Narrowing of the lumen (75%,critical stenosis)

  • Acute plaque changes
  • Thrombosis
  • Coronary artery vasospasm

Pathogenesis

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

1.angina pectoris

2.acute myocardial infarction

3.sudden cardiac death

4.chronic IHD

slide152

Angina Pectoris

Definition

Intermittent chest pain caused by transient,reversible myocardial ischemia

angina pectoris

Type

Stable (typical)

Variant (prinzmetal)

Unstable (crescendo)

Angina Pectoris

  • More than one type of angina may be present in a given person
slide154

Stable(typical) Angina Pectoris

  • 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%)
slide155

VariantAngina Pectoris

  • Occur at rest ,awaken from sleep
  • Response to the uptake of vasodilator
  • Coronary artery spasm
unstable angina pectoris
UnstableAngina 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
slide157

Myocardial Infarction

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.

slide159

(15-20%)

(40-50%)

(30-40%)

slide161

Transmural

Infarcts

Subendocardial

Infarcts