DISEASES OF CARDIOVASCULAR SYSTEM Department of Pathology, Huaxi Hospital Xu Huan 2009.10

1. DISEASES OF CARDIOVASCULAR SYSTEMDepartment of Pathology, Huaxi HospitalXu Huan2009.10

2. SYSTEMATIC PATHOLOGYCAUSES OF DISEASE PATHOGENESISBASIC PATHOLOGIC CHANGES PATHOCLINICAL RELATIONS

3. HOW TO STUDY BETTER REVIEW THENORMALSTRUCTURE ANDFUNCTIONOF THE ORGAN REVIEW THE CONTENT OF THEGENERAL PATHOLOGY NOTICE THECORRELATIONSHIPBETWEEN THE MORPHOLOGY AND THE FUNCTION

4. CARDIOVASCULAR SYSTEMTHE BLOOD VESSELSTHE HEART

5. VASCULAR DISEASES Atherosclerosis (ATH) Aneurysm Hypertension Vascular tumor

6. THE HEART DISEASES • Ischemic heart disease • Rheumatic heart disease • Infective heart disease • Virus myocarditis • Cardiomyopathy • Pericarditis

7. 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

8. NORMAL VESSELS artery veinlymphatics

9. NORMAL ARTERY Large(elastic) arteryMedium-sized(muscular)arterySmall artery and arteriole

10. Normal Aorta

16. Elastic and muscular artery--------ATH • Small artery and arteriole---------- Hypertension

17. vein and its valves

18. Capillary Arteriole venule

19. Vascular abnormalities • Narrowing or obstructing the lumen • Dilation or rupture of the wall

21. Atherosclerosis

22. Arteriosclerosis “hardening of the arteries” • Atherosclerosis-------most common • Arteriolosclerosis-----hypertension and diabetes mellitus • Medial calcific sclerosis-----rare

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

24. 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

25. BASIC PATHOLOGIC CHANGES fatty streaks fibrous plaque Atheromatous plaque (atheroma)

26. Fatty Streaks

27. Gross view 1. elongated Yellow streaks on the intima 2. Lesions tend to be much more prominent around the origins of major branches

28. Histological feature 1.Intimal thickening 2.Foamy cells accumulation

29. Fatty streak

31. Fatty Streaks The precursor lesion for atheromas? The relationship is uncertain !

32. Fibrous Plaque

33. Gross view 1.Plaques along the vessel length 2.gray fibrous cap can be seen

34. Fibrous plaque

35. 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

36. Atheromatous Plaque

37. 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

38. Atheromatous Plaque

39. 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.

40. Cholesterol clefts

41. Cholesterol fissure

42. inflammation calcification neovascularization

43. Masson’s trichrome stain

44. elastic fiber stain

45. Eccentric thickening

46. Cross section of coronary artery

47. Mild,moderate and severe atherosclerosis

48. Mild,moderate and severe ATH

49. COMPLICATIONS Rupture and ulceration Hemorrhage Thrombosis Aneurysm calcification

50. Rupture and ulceration