心血管系统疾病

心血管系统疾病Diseasesofthecardiovascularsystem 陕西中医学院病理教研室 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 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 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 黄色脂质条纹 纤维斑块Fibrousplaque肉眼 镜下 纤维帽形成Fibrouscap 脂质 泡沫细胞 正常主动脉 动脉粥样硬化的纤维斑块病变 动脉管壁一侧明显增厚 粥样斑块 粥瘤 纤维帽Fibrouscap胆固醇结晶cholesterolcrystal坏死碎片necroticdebris泡沫细胞foamcell钙化calcification肉芽增生granulationformation 动脉分支开口处黄色隆起斑块 粥样斑块病变 动脉内膜下大量泡沫细胞堆积 斑块底部块纤维化斑块内胆固醇积聚 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 粥样硬化斑块溃疡形成 腹主动脉 髂动脉血栓形成 腹主动脉血栓形成 肾硬化 髂动脉瘤 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 正常主动脉 动脉粥样硬化的纤维斑块病变 正常脑基底动脉环 基底动脉环硬化 基底动脉内血栓形成 基底动脉环硬化 脑动脉硬化致脑萎缩 新鲜足坏疽 足干性坏疽 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 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Spasmofthecoronaryarteries冠状动脉炎Coronaryarteritis 正常心脏 右冠状动脉 左冠状动脉 冠状动脉粥样硬化 左冠状动脉 右冠状动脉 冠状动脉狭窄 血栓形成 正常冠状动脉 冠状动脉粥样硬化 管腔狭窄 冠状动脉管壁增厚及钙化 管腔明显狭窄 斑块内钙化 动脉管腔狭窄血栓形成 冠状动脉近端狭窄 冠状动脉远端闭塞 冠状动脉硬化区 冠状动脉阻塞 CausesCoronaryatherosclerosisDistribution location featuresofthelesionSpasmofthecoronaryarteriesCoronaryarteritis 冠心病分类Classification1 心绞痛anginapectoris AP asymptomcomplexconsistingofsevereparoxymalchestpainresultingfromtransientischemia 诱因PrecipitatingfactorsExertion emotion pain coldweather cigarettesmoking heavymeals 心绞痛病人 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 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 形状颜色光镜microscopicchange生化改变Biochemicalchanges 新鲜心肌梗死 心肌梗死灶 肉芽组织 左心室大片坏死 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 梗死区破裂口 心包填塞 心包内积血 左心室慢性室壁瘤 3 心肌纤维化Myocardialfibrosis4 冠状动脉性猝死suddencoronarydeath 高血压病Hypertension诊断标准Diagnosticcriteriasustaineddiastolicpressureabove90mmHgand orsustainedsystolicpressureabove140mmHg 分类ClassificationPrimary essential hypertensionSecondary symptomatic Benign chronic hypertensionMalignant accelerated 动脉病变期Stageofarterylesion基本病变thebasiclesion细动脉硬化arteriolosclerosis内脏病变期Stageoforgandysfunction 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 左心室向心性肥大 左心室失代偿性扩张 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 高血压固缩肾 高血压脑HypertensivebrainhypertensiveencephalopathyHemorrhageofbrainSofteningofbrain视网膜病变Lesionsofretina 侧脑室出血 呈银丝状眼底细动脉 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 病因和发病学Etiologyandpathogenesis病因CausesGeneticfactorsEnvironmentalfactorsDietaryfactors Na K Ca2 Socialfactorspsychologicalstressotherfactors 发病机制PathogenesisVariantfactors increasedVolum orIncreasedvasoconstrictionretentionofSodiumandwaterVasoconstrictionThickeningofthearterywall 心肌病Cardiomyopathy分类Classification 共同病变Thecommonlesion 原发性心肌病PrimarycardiomyopathyAnydysfunctionofthemyocardiumnotattribulabletoCHD valvulardisease hypertensionorpulmonaryheartdisease 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 Microscopically theheartincardiomyopathydemonstrateshypertrophyofmyocardialfibers whichalsohaveprominentdarknuclei alongwithinterstitialfibrosis Hereisalarge dilatedleftventricletypicalofadilated orcongestive cardiomyopathy Manyofthesehavenoknownetiology so called idiopathicdilatedcardiomyopathy whileothersmaybeassociatedwithchronicalcoholism Theheartisveryenlargedandflabby 肥厚性心肌病HypertrophiccardiomyopathyHypertrophyofthemyocardiumAsymetrichypertrophyoftheventricularseptumObstructionoftheoutflowtract Thereismarkedleftventricularhypertrophy withasymmetricbulgingofaverylargeinterventricularseptumintotheleftventricularchamber Thisishypertrophiccardiomyopathy 限制性心肌病Restrictivecardiomyopathyprogressivefibrosisoftheendocardiumandsubendocardialmyocadium Thissectionofmyocardiumdemonstratesamorphousdepositsofpalepinkmaterialbetweenmyocardialfibers Thisischaracteristicforamyloid Amyloidosisisacausefor infiltrative or restrictive cardiomyopathy Itisanightmareforanesthesiologistswhenintractablearrhythmiasoccurduringsurgeryonsuchpatients 风湿病Rheumatism病因与发病机制EtiologyandpathogenesisInfectionwithgroupAbetahemolyticstreptococciImmuneinjury主要抗原 M蛋白 c多糖 基本病变Basiclesion threestages 变质渗出期AlterativeandexudativephaseMucoiddegenerationfibrinoidnecrosis增生期Proliferativephase肉芽肿期 纤维化期 风湿小体AschoffbodyFibrinoidnecrosisAschoffcell awl eyecell caterpillarcellAschoffgiantcellOtherinflammatorycells 风湿性肉芽肿 纤维素样坏死 风湿细胞 风湿性肉芽肿中风湿细胞 纤维化期Fibrosisphase 风湿性心脏病RheumaticheartdiseaseRheumaticendocarditis verrucousendocarditis Distribution mitralvalve50 mitralandaorticvalve50 Lesion vegetationssequla valvulardisease MacCallum splaque 疣状风湿性心内膜炎 风湿性心肌炎RheumaticmyocarditisAdults localstromalmyocarditisChildren diffusestromalmyocarditis风湿性心包炎RheumaticpericarditisdrypericarditiswetpericarditisClinicalcourse 风湿性心肌炎风湿性肉芽肿形成 风湿性肉芽肿纤维素样坏死 风湿细胞 风湿性肉芽肿中风湿细胞 风湿性心外膜炎 绒毛心 风湿性关节炎RheumaticarthritisLargejoints reversible皮肤病变RheumaticlesionoftheskinErythemaannullareSubcutaneousnodules风湿性动脉炎Rheumaticarteritis 风湿性脑病RheumaticencephalopathyRheumaticarteritisofthebrainRheumaticencephalitisChoreaminor 心瓣膜病Chronicvalvularvitiumoftheheartstenosis insufficiency二尖瓣狭窄MitralstenosisThevalvularchangesThecardiacchangesTheclinicalcourse 风湿性心瓣膜病左房扩张 左房扩张 瓣膜硬化 左室萎缩 二尖瓣膜及腱索增厚变硬 二尖瓣狭窄 左心房扩张 主动脉瓣关闭不全 二尖瓣关闭不全MitralinsufficiencyThevalvularchangesThecardiacchangesTheclinicalcourse 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 Vegetations comparedwithrheumaticvalvulitis Large yellow locatedhaphazardly locatedatthemarginofthevalvecontainingcausativeorganismfriable 亚急性细菌性心内膜炎 赘生物 瓣膜病变 并发症Complication败血症Septicemia栓塞Embolism免疫损伤Immuneinjury 心肌炎Myocarditis病因Et