病理学_心PPT课件.ppt

心血管系统疾病Diseasesofthecardiovascularsystem 1 动脉粥样硬化atherosclerosis AS 病因和发病学etiologyandpathogenesis危险因素Riskfactors血脂异常increasedLDL TG VLDLapoB Lp a decreasedHDL apoA I高血压Hypertension吸烟Cigarettesmoking高血糖Elevatedbloodsugarlevels其它因素Theotherfactors 2 二 危险因素 riskfactor 血脂异常 肥胖 吸烟 缺乏运动 高血压 糖尿病 3 脂蛋白的临床意义 Bad Good 4 发病机制pathogenesis 炎症反应理论炎症介质和生长因子的作用内皮细胞损伤Theinjuryoftheendothelium脂质沉积Theaccumulationoflipid单核细胞浸润Theinfiltrationofmacrophages平滑肌细胞增生TheproliferationofSMC数量增多 由中膜向内膜移动功能改变 吞噬 合成分泌细胞外基质 生长因子 5 6 SMC在动脉粥样硬化病灶形成中的作用 7 2 病理变化morphology 好发于大 中动脉最好发腹主APredilectionforlargearteriesandmedium sizedarteriesAS的基本病变是在动脉内膜形成粥样斑块 8 2 病理变化morphology 好发于大 中动脉Predilectionforlargearteriesandmedium sizedarteries基本病变Basiclesion脂纹Fattystreak脂质沉积Accumulatedlipid 泡沫细胞foamcell 9 黄色脂质条纹 10 纤维斑块Fibrousplaque肉眼 镜下 纤维帽形成Fibrouscap 脂质 泡沫细胞 11 正常主动脉 动脉粥样硬化的纤维斑块病变 12 动脉管壁一侧明显增厚 13 粥样斑块Atheromatousplaque 粥瘤atheroma 纤维帽Fibrouscap胆固醇结晶cholesterolcrystal坏死碎片necnoticdebris泡沫细胞foamcell钙化calcification肉芽增生neovascularformation 14 动脉分支开口处黄色隆起斑块 15 粥样斑块病变 16 17 动脉内膜下大量泡沫细胞堆积 18 斑块底部块纤维化斑块内胆固醇积聚 19 复合病变complicatedlesions 斑块内出血Hemorrhageinplaque斑块破裂Ruptureoftheplaque血栓形成Thrombosis钙化Calcification动脉瘤aneurysm定义definition病变lesion分类classification true pseudo Dissecting 20 粥样硬化斑块溃疡形成 21 腹主动脉 髂动脉血栓形成 22 腹主动脉血栓形成 肾硬化 髂动脉瘤 23 3 主要动脉的病变Atherosclerosisoftheimportantorgans主动脉Aorta abdominalaorta冠状动脉Coronaryarteries脑动脉Arteriesofthebrain其它Theothers 24 正常主动脉 动脉粥样硬化的纤维斑块病变 25 正常脑基底动脉环 26 基底动脉环硬化 27 基底动脉内血栓形成 基底动脉环硬化 28 脑动脉硬化致脑萎缩 29 新鲜足坏疽 30 足干性坏疽 31 冠心病Coronaryheartdisease CHD 定义Definition因冠状动脉狭窄所至冠状动脉供血不足引起的心脏病cardiacdiseasewhichresultfrominsufficientcoronarybloodflowsduetothenarrowingofthecoronaryarteries 32 病因Causes冠状动脉粥样硬化症Coronaryatherosclerosis好发部位Distribution location 病变特点featuresofthelesion冠状动脉痉挛Spasmofthecoronaryarteris冠状动脉炎Coronaryarteritis 33 四 对机体重要器官的影响 管腔狭窄程度 A 34 正常心脏 35 右冠状动脉 左冠状动脉 36 冠状动脉粥样硬化 左冠状动脉 右冠状动脉 37 38 冠状动脉狭窄 血栓形成 39 正常冠状动脉 40 冠状动脉粥样硬化 管腔狭窄 41 冠状动脉管壁增厚及钙化 管腔明显狭窄 42 斑块内钙化 43 动脉管腔狭窄血栓形成 44 冠状动脉近端狭窄 冠状动脉远端闭塞 45 冠状动脉硬化区 46 冠状动脉阻塞 47 CausesCoronaryatherosclerosisDistribution location featuresofthelesionSpasmofthecoronaryarterisCoronaryarteritis 48 冠心病分类Classification1 心绞痛anginapectoris AP asymptomcomplexconsistingofsevereparoxymalchestpainresultingfromtransientischemia 49 诱因PrecipitatingfactorsExertion emotion pain coldweather cigarettesmoking heavymeals 50 心绞痛病人 51 心绞痛类型Classification稳定型劳累性心绞痛Stable exerting AP恶化性劳累性心绞痛Instable exerting AP自发型变异型心绞痛 Spontaneous variantAP 52 2 心肌梗死Myocardialinfarction心内膜下心肌梗死SubendocardialMI多发 小灶Multiplesmalllesion透壁性心肌梗死TransmuralMI部位Distribution病变Morphology 形状shape 颜色color 光镜microscopicchange生化改变Biochemicalchanges 53 新鲜心肌梗死 54 心肌梗死灶 肉芽组织 55 左心室大片坏死 56 合并症Complications心脏破裂Ruptureoftheheart3 13 4 7天多见室壁瘤Ventricularaneurysm10 38 愈合期多见附壁血栓Thrombosis 急性心包炎Acutepericarditis15 2 4天临床并发症Clinicalcomplication心律失常75 95 休克10 20 左心衰60 57 梗死区破裂口 58 心包填塞 59 心包内积血 60 左心室慢性室壁瘤 61 3 心肌纤维化Myocardialfibrosis4 冠状动脉性猝死suddencoronarydeath 62 高血压病Hypertension诊断标准Diagnosticcriteriasustaineddiastolicpressureabove90mmHgand orsustainedsystolicpressureabove140mmHg 63 分类ClassificationPrimary essential hypertensionSecondary symptomatic Benign chronic hypertensionMalignant accelerated 64 病变Morphology 1 良性高血压Benignhypertension机能紊乱期Stageofdysfunction动脉病变期Stageofarterylesion基本病变thebasiclesion细动脉硬化arteriolosclerosis内脏病变期Stageoforgandysfunction 65 高血压心脏病Hypertensiveheartdisease病变向心性肥大Concentrichypertrophy离心性肥大Ecentrichypertrophy临床病理联系 66 67 68 左心室向心性肥大 69 70 左心室失代偿性扩张 71 72 细动脉性肾硬化Arteriolarnephrosclerosis primarygranulo contractedkidney 镜下Microscopicchange肾血管 肾小球 肾小管 肾间质大体Grossalteration颗粒性固缩肾 73 高血压固缩肾 74 75 76 77 78 79 80 81 82 高血压脑HypertensivebrainhypertensiveencephalopathyHemorrhageofbrainSofteningofbrain视网膜病变Lesionsofretina 83 侧脑室出血 84 呈银丝状眼底细动脉 85 2 恶性高血压Malignanthypertension基本病变Basiclesion 坏死性细动脉炎necroticarteriolitis增生性小动脉硬化proliferatingarteriosclerosis主要受损器官Themajorinjuredorgans kidneyandbrain 86 病因和发病学Etiologyandpathogenesis病因CausesGeneticfactorsEnvironmentalfactorsDietaryfactors Na K Ca2 Socialfactorspsychologicalstressotherfactors 87 发病机制PathogenesisVariantfactors increasedVolum orIncreasedvasoconstrictionretentionofSodiumandwaterVasoconstrictionThickeningofthearterywall 88 心肌病Cardiomyopathy分类Classification 共同病变Thecommonlesion 原发性心肌病PrimarycardiomyopathyAnydysfunctionofthemyocardiumnotattribulabletoCHD valvulardisease hypertensionorpulmonaryheartdisease 89 扩张性心肌病DilatedcardiomyopathyHypertrophy M 350gF 300g DilatationofthefourcavitiesHeartfailure继发 附壁血栓 二三尖瓣相对关闭不全 90 Microscopically theheartincardiomyopathydemonstrateshypertrophyofmyocardialfibers whichalsohaveprominentdarknuclei alongwithinterstitialfibrosis 91 Hereisalarge dilatedleftventricletypicalofadilated orcongestive cardiomyopathy Manyofthesehavenoknownetiology so called idiopathicdilatedcardiomyopathy whileothersmaybeassociatedwithchronicalcoholism Theheartisveryenlargedandflabby 92 肥厚性心肌病HypertrophiccardiomyopathyHypertrophyofthemyocardiumAsymetrichypertrophyoftheventricularseptumObstructionoftheoutflowtract 93 Thereismarkedleftventricularhypertrophy withasymmetricbulgingofaverylargeinterventricularseptumintotheleftventricularchamber Thisishypertrophiccardiomyopathy 94 限制性心肌病Restrictivecardiomyopathyprogressivefibrosisoftheendocardiumandsubendocardialmyocadium 95 Thissectionofmyocardiumdemonstratesamorphousdepositsofpalepinkmaterialbetweenmyocardialfibers Thisischaracteristicforamyloid Amyloidosisisacausefor infiltrative or restrictive cardiomyopathy Itisanightmareforanesthesiologistswhenintractablearrhythmiasoccurduringsurgeryonsuchpatients 96 风湿病Rheumatism病因与发病机制EtiologyandpathogenesisInfectionwithgroupAbetahemolyticstreptococciImmuneinjury主要抗原 M蛋白 c多糖 97 基本病变Basiclesion threestages 变质渗出期AlterativeandexudativephaseMucoiddegenerationfibrinoidnecrosis增生期Proliferativephase肉芽肿期 granulomatousphase 98 风湿小体AschoffbodyFibrinoidnecrosisAschoffcell awl eyecell caterpillarcellAschoffgiantcellOtherinflammatorycells 99 风湿性肉芽肿纤维素样坏死 风湿细胞 100 风湿性肉芽肿中风湿细胞 101 纤维化期Fibrosisphase 102 风湿性心脏病RheumaticheartdiseaseRheumaticendocarditis verrucousendocarditis Distribution mitralvalve50 mitralandaorticvalve50 Lesion vegetationssequla valvulardisease MacCallum splaque 103 疣状风湿性心内膜炎 104 风湿性心肌炎RheumaticmyocarditisAdults localstromalmyocarditisChildren diffusestromalmyocarditis风湿性心包炎RheumaticpericarditisdrypericarditiswetpericarditisClinicalcourse 105 风湿性心肌炎风湿性肉芽肿形成 106 107 风湿性肉芽肿纤维素样坏死 风湿细胞 108 风湿性肉芽肿中风湿细胞 109 110 111 风湿性心外膜炎 绒毛心 112 风湿性关节炎RheumaticarthritisLargejoints reversible皮肤病变RheumaticlesionoftheskinErythemaannullareSubcutaneousnodules风湿性动脉炎Rheumaticarteritis 113 风湿性脑病RheumaticencephalopathyRheumaticarteritisofthebrainRheumaticencephalitisChoreaminor 114 心瓣膜病Chronicvalvularvitiumoftheheartstenosis insufficiency二尖瓣狭窄MitralstenosisThevalvularchangesThecardiacchangesTheclinicalcourse 115 风湿性心瓣膜病左房扩张 116 左房扩张 瓣膜硬化 左室萎缩 117 二尖瓣膜及腱索增厚变硬 118 二尖瓣狭窄 左心房扩张 119 主动脉瓣关闭不全 120 二尖瓣关闭不全MitralinsufficiencyThevalvularchangesThecardiacchangesTheclinicalcourse 121 亚急性感染性心内膜炎Subacuteinfectiveendocarditis SBE 病因Etiology草绿色链球菌等病变Morphologyvegetations 122 Vegetations comparedwithrheumaticvalvitis Large yellow locatedhaphazardly locatedatthemarginofthevalvecontainingcausativeorganismfriable 123 亚急性细菌性心内膜炎 124 赘生物 瓣膜病变 125 并发症Complication败血症Septicemia栓塞Embolism免疫损伤Immuneinju