congestive heart failure(1)课件

IntroductiontoCardiovascularPathology FredClayton SystemicPathologyofCongestiveHeartFailurePathologyofMyocarditisPathologyofCardiomyopathyDilatedCardiomyopathyHypertrophicCardiomyopathyRestrictiveCardiomyopathy CongestiveHeartFailure CardiacoutputinsufficientformetabolicrequirementsofthebodySystolicdysfunction decreasedmyocardialcontractilityDiastolicdysfunction insufficientexpansionforventricularvolumeProblemsareaccentuatedbyincreaseddemand highoutputheartfailure CHF Body sCompensation TachycardiaFrank Starling increasedEndDiastolicVolumeMyocardialhypertrophyRenin angiotensin aldosteronesystemCatecholamines positiveinotropiceffectAdrenergicredistributionofbloodflowIncreaseoxygenextractionfromhemoglobin Left sidedHeartFailure IschemicheartdiseaseHypertensionAorticandmitralvalvediseaseMyocardialdisease Lungs Pulmonaryedema Dyspnea breathlessnessOrthopnea dyspnealyingdownParoxysmalnocturnaldyspnea extremedyspnea Lung PulmonaryEdema palepinkedemafluidfillingalveoli Lung alveolarhemorrhage heme filledmacrophages heartfailurecells withironstaintoright Kidneys reducedperfusion Ischemictubularnecrosis ATNPrerenalazotemia Kidney ATN BraininCHF cerebralhypoxia IrritabilityLossofattentionspanRestlessnessStuporComa Right sidedheartfailure PurecorpulmonaleConsequenceofleft sidedfailureMyocardial myocarditis cardiomyopathy constrictivepericarditis Rightfailure systemiceffects Liver chronicpassivecongestionSpleen congestivesplenomegalyKidneys congestionandhypoxiaSub Q peripheraledemaandanasarcaPleuralspace effusionsBrain venouscongestionandhypoxiaPortal ascites Liver chronicpassivecongestion bloodpoolsnearthecentralveins Liver chronicpassivecongestion Liver chronicpassivecongestion bloodpoolsnearthecentralveins Liver chronicpassivecongestion redcellpoolingnearcentralveinsandpericentralnecrosisofthehepatocytes CHF finalpathwaytodeath IschemicheartdiseaseHypertensiveheartdiseaseValvularheartdiseaseCardiomyopathyMyocarditisSpecificheartmusclediseases MyocarditisEtiology Viral CoxsackieA ECHO InfluenzaChlamydiaandRickettsia psittaci typhiBacteria diphtheria TB StrepFungal Protozoa Trypanosomes ToxoHypersensitivity SLE RHD drugsPhysicalAgents RadiationIdiopathic Giantcellmyocarditis MyocarditisMorphology Gross dilated flabbyheart palepatcheswithhemorrhageMicroscopic interstitialinflammatoryinfiltratewithmyocytenecrosis fibrosisMononuclearcells idiopathicorviralNeutrophils bacterialEosinophils hypersensitivityorprotozoaGranulomatous TBorsarcoid Dilated globoidheartinmyocarditis Myocarditis meetsDallascriteriaofaTlymphocyteinfiltrateandmyocytenecrosisordropout Thisisusuallyeitherviralorofunknowncause Diphtheriamyocarditis duetoatoxinratherthanbacterialinvasion Thereissomeinflammation myocytechanges seethebignucleolus Myocytenecrosis notshown alsohappens Bacterialcolonyinmyocarditis Toxoplasmosis Chagasdisease GiantCellMyocarditis MyocytenecrosisMultinucleatedgiantcellsLymphocytes plasmacells macrophages eosinophils andneutrophilsOftenfulminant rapidprogressiontodeathDifferentialdiagnosis cardiacsarcoidosis GiantCellMyocarditis GiantCellMyocarditis Cardiomyopathies DilatedCardiomyopathy Gross increasedweight dilatation endocardialfibrosis normalvalvesandcoronaryarteriesMicroscopic myocytehypertrophy myofibrillarlossandinterstitialfibrosisEtiology viral genetic toxinsClinicalsignificance heartfailure death Dilatedcardiomyopathy Cardiomyopathy lossofmyofibrils Cardiomyopathy trichromestainshowingextensivefibrosis blue betweenthemyocytes Themyocytesalsovaryinsize andsomehavepartiallossofmyofibrils NormalHeart EM Lossoffibrilsincardiomyopathy Themyocyteatlowerleftisaboutnormal theothershaveanextensivelossofmyofibrils Cardiomyopathy lossoffibrilsandasmallcontractionbandinthetopcenter HypertrophicCardiomyopathy Hypertrophyofventricularseptum 95 Disarrayofmyofibers 100 Volumereductionofventricles 90 EndocardialthickeningofLV 75 Mitralvalveleafletthickening 75 Dilatedatria 100 Abnormalintramuralcoronaries 50 Hypertrophiccardiomyopathy Hypertrophiccardiomyopathy Hypertrophiccardiomyopathy Hypertrophiccardiomyopathy myofiberdysarray notallfibersarepullingthesamedirection Thusthecontractionisineffective However thecardiacconductionsystemcanhavethesesameproblems whichmightcausethearrhythmiasandsuddendeaththesepatientstendtodieof HypertrophicCardiomyopathy Etiology hereditary mostlyautosomaldominant canappearsporadicallyClinicalsignificance syncope arrhythmiasandsuddendeathwithariskof2 6 peryearCannotequatewithhypertrophyalone Thereisvariationinheartsizewithoutdisease Largeheartscorrelatewithendurance Secretariat LanceArmstrong RestrictiveCardiomyopathy AmyloidosisEndomyocardialfibrosis subendocardialfibrosisLoeffler sendocarditis eosinophilicinfiltrateEndocardialfibroelastosis Amyloidosis noticethepinkmaterialbetweenthemyocytes Amyloidosis CongoRedisvery verypositive Amyloidosis thisheartisthickened pale andhasarubberyconsistencythatinterfereswithcardiacexpansionduringdiastole Endomyocardialfibrosis fibrosisundertheendocardiumandinthetheinnerthirdofthemyocardium Endomyocardialfibrosisofaventricularwall Whenextensive thiswouldcauserestrictiveheartfailuretoo Endocardialfibroelastosis elasticstain black isverypositive Thisdisease whichoccurredinyoungchildrenandwasonce1 5 000births nowisalmostneverseen Etiologyisnotknown viralsuchasmumps Endocardialfibroelastosis SpecificHeartMuscleDiseases Toxic alcohol catecholamines cocaine AdriamycinMetabolic hemochromatosis hyperthyroidismNeuromuscular musculardystrophyStoragedisease glycogen Fabry sdiseaseInfiltrative sarcoidosis Heart Becker smusculardystrophy lookslikeidiopathicdilatedcardiomyopathy Notethefibrosisandlossofmyofibrilsinsomecells Byelectronmicroscopy thiswasAdriamycintoxicity Seetheclearvacuoles theyaredilatedsarcoplasticreticulum andseverelossofmyofibrils Cocaineheart necrosiswithcontractionbands Thiscouldhappenwithanyseverechronicstimulationsuchastoomuchpre