基础医学各论Ⅰ：Diseases of the cardiovascular system

Diseasesofthe

cardiovascularsystem

atherosclerosis(AS)1.etiologyandpathogenesisRiskfactorsHyperlipemia:increasedLDL,TG,VLDL,apoB,Lp(a)decreasedHDL,apoA-IHypertensionCigarettesmokingElevatedbloodsugarlevelsTheotherfactors

pathogenesis--TheoryofinflammatoryresponsetoinjuryTheinjuryoftheendotheliumTheaccumulationoflipidTheinfiltrationofmacrophagesTheproliferationofSMC2.morphologyPredilectionforlargearteriesandmedium-sizedarteriesBasiclesionFattystreakAccumulatedlipid,foamcellFibrousplaque--Fibrouscap黄色脂质条纹2.morphologyPredilectionforlargearteriesandmedium-sizedarteriesBasiclesionFattystreakAccumulatedlipid,foamcellFibrousplaque--Fibrouscap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Atheromatousplaque(atheroma)

Fibrouscapcholesterolcrystalnecnoticdebrisfoamcellcalcificationneovascularformationatheroma

complicatedlesionsHemorrhageinplaqueRuptureoftheplaqueThrombosisCalcificationaneurysm:definition,lesionclassification(true,pseudo-,Dissecting)

Ulcerformation

3.Atherosclerosisoftheimportantorgans

Aorta:abdominalaortaCoronaryarteriesArteriesofthebrainTheotherorgans正常主动脉动脉粥样硬化的纤维斑块病变

3.AtherosclerosisoftheimportantorgansAorta:abdominalaorta

Coronaryarteries

ArteriesofthebrainTheotherorgans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

3.AtherosclerosisoftheimportantorgansAorta:abdominalaortaCoronaryarteriesArteriesofthebrain

Theotherorgans新鲜足坏疽

足干性坏疽Coronaryheartdisease

(CHD)

Definition

cardiacdiseasewhichresultfrominsufficientcoronarybloodflowsduetothenarrowingofthecoronaryarteriesCauses

CoronaryatherosclerosisDistribution(location)featuresofthelesionSpasmofthecoronaryarterisCoronaryarteritis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Causes

CoronaryatherosclerosisDistribution(location)featuresofthelesion

Spasmofthecoronaryarteris

Coronaryarteritis

Classification1.anginapectoris(AP)asymptomcomplexconsistingofsevereparoxymalchestpainresultingfromtransientischemiaPrecipitatingfactorsExertion,emotion,pain,coldweather,cigarettesmoking,heavymeals心绞痛病人

ClassificationStable(exerting)APInstable(exerting)AP(Spontaneous)variantAP2.MyocardialinfarctionSubendocardialMI

MultiplesmalllesionTransmuralMI

DistributionMorphology:shape,color,microscopicchangeBiochemicalchanges:myocardialinfarctiongranulationtissue

ComplicationsRuptureoftheheartVentricularaneurysmThrombosisAcutepericarditisClinicalcomplicationruptureofInfarctarea

Pericardialtamponadehematoceleinheartsacvntricularaneurysm3.Myocardialfibrosis4.suddencoronarydeathHypertensionDiagnosticcriteria

sustaineddiastolicpressureabove90mmHgand/orsustainedsystolicpressureabove140mmHgClassificationPrimary(essential)hypertensionSecondary(symptomatic)Benign(chronic)hypertensionMalignant(accelerated)Morphology(1)BenignhypertensionStageofdysfunctionStageofarterylesion

arteriolosclerosis—thebasiclesionofhypertensionStageoforgandysfunction

Hypertensiveheartdisease

ConcentrichypertrophyEcentrichypertrophyArteriolarnephrosclerosis(primarygranulo-contractedkidney)

MicroscopicchangeGrossalterationconcentrichypertrophyofleftventricledecompensationdistentionofleftventricleHypertensiveheartdisease

ConcentrichypertrophyEcentrichypertrophyArteriolarnephrosclerosis(primarygranulo-contractedkidney)

MicroscopicchangeGrossalterationHypertensivebrainEdemaofbrain,hypertensiveencephalopathy,hypertensivecrisisHemorrhageofbrainSofteningofbrainLesionsofretinaArterioleofeyeground(2)MalignanthypertensionBasiclesion:

necroticarteriolitisproliferatingarteriosclerosisThemajorinjuredorgans:kidneyandbrainEtiologyandpathogenesisCausesGeneticfactorsEnvironmentalfactors

Dietaryfactors:Na+,K+,Ca2+SocialfactorspsychologicalstressotherfactorsPathogenesisVariantfactors—increasedVolum,orIncreasedvasoconstrictionretentionofSodiumandwaterVasoconstrictionThickeningofthearterywallCardiomyopathyClassification:Thecommonlesion:Primarycardiomyopathy

AnydysfunctionofthemyocardiumnotattribulabletoCHD,valvulardisease,hypertensionorpulmonaryheartdisease.Dilatedcardiomyopathy

Hypertrophy(M>350gF>300g)DilatationofthefourcavitiesHeartfailureMicroscopically,theheartincardiomyopathydemonstrateshypertrophyofmyocardialfibers(whichalsohaveprominentdarknuclei)alongwithinterstitialfibrosis.Hereisalarge,dilatedleftventricletypicalofadilated,orcongestive,cardiomyopathy.Manyofthesehavenoknownetiology(so-called"idiopathicdilatedcardiomyopathy")whileothersmaybeassociatedwithchronicalcoholism.Theheartisveryenlargedandflabby.HypertrophiccardiomyopathyHypertrophyofthemyocardiumAsymetrichypertrophyoftheventricularseptumObstructionoftheoutflowtractRestrictivecardiomyopathyprogressivefibrosisoftheendocardiumandsubendocardialmyocadiumThereismarkedleftventricularhypertrophy,withasymmetricbulgingofaverylargeinterventricularseptumintotheleftventricularchamber.Thisishypertrophiccardiomyopathy.Thissectionofmyocardiumdemonstratesamorphousdepositsofpalepinkmaterialbetweenmyocardialfibers.Thisischaracteristicforamyloid.Amyloidosisisacausefor"infiltrative"or"restrictive"cardiomyopathy.Itisanightmareforanesthesiologistswhenintractablearrhythmiasoccurduringsurgeryonsuchpatients.KeShandiseaseEtiologyVirusinfectionCoxsackieBLackofSelenniumMorphologyDilatationoftheleftandrightventricleRheumatismEtiologyandpathogenesisInfectionwithgroupAbetahemolyticstreptococciImmuneinjuryBasiclesion(threestages)Alterativeandexudativephase

MucoiddegenerationfibrinoidnecrosisProliferativephase(granulomatousphase)Aschoffbody(consistof)

FibrinoidnecrosisAschoffcell:awl-eyecell,caterpillarcellAschoffgiantcellOtherinflammatorycellsFibrosisphaseAschoffbody(consistof)

FibrinoidnecrosisAschoffcell:awl-eyecell,caterpillarcellAschoffgiantcellOtherinflammatorycellsFibrosisphaseRheumaticheartdiseaseRheumaticendocarditis(verrucousendocarditis)Distribution:mitralvalve50%mitralandaorticvalve50%Lesion:vegetationssequla:valvulardisease,MacCallum’splaque疣状风湿性心内膜炎Rheumaticmyocarditis

Adults:localstromalmyocarditis

Children:diffusestromalmyocarditisRheumaticpericarditis

drypericarditiswetpericarditisClinicalcourse

rheumaticmyocarditisrheumaticgranulomasAschoffcellRheumaticmyoicarditis

Adults:localstromalmyocarditis

Children:diffusestromalmyocarditisRheumaticpericarditis

drypericarditiswetpericarditisClinicalcourseRheumaticarthritisLargejoints,reversibleRheumaticlesionoftheskinErythemaannullareSubcutaneousnodulesRheumaticarteritisRheumaticencephalopathyRheumaticarteritisofthebrainRheumaticencephalitisChoreaminorChronicvalvularvitiumof