35939987 Path Anatomy 18 Atherosclerosis

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AtherosclerosisISCHEMIC CHEART

DISEASE


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Atherosclerosis

ATHEROSCLEROSIS IS THE CHRONICDISEASE WITH THE LIPID AND PROTEIN

ABNORMAL METABOLISMS, WITH THE

DISTRUCTION OF LARGE ARTERIES ANDAORTA, AND WITH A FORMATION OFATHEROSCLEROTIC PLAQUES.


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ATHEROSCLEROTIC PLAQUE

NORMAL ARTERY

ATHEROSCLEROTICPLAQUE


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Atherosclerosis

COMMON RISK FACTORS ARE

1 INCREASING AGE

2 MALE GENDER3 FAMILY HISTORY

4 GENETIC ABNORMALITIRS


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Atherosclerosis

POTENTIAL CONTROLLABLE RISKFACTORS ARE

1 HYPERLIPIDEMIA

2 HYPERTENTION

3 DIABETES MELLITUS

4 CIGARETTE SMOKING


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Atherosclerosis

OTHER RISK FACTORS ARE

1 OBESITY

2 PHYSICAL INACTIVITY

3 STRESS

4 POSTMENOPOUSAL ESTROGEN DEFICIENCY


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Atherosclerosis

OTHER RISK FACTORS ARE5 HIGH CARBOHYDRATE INTAKE

6 LIPOPROTEINS

7 HARDENED UNSATURATED FAT INTAKE

8 CHLAMYDIA PNEUMONIA


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Pathogenesis ofAtherosclerosis

According to injury hypothesisconsiders

atherosclerosis to be a chronicinflammatory

Response of the arterial wallinitiated by injury:


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1 chronic endothelial injury

2 insudation of lipoproteins [LDL]

3 modification of lipoproteins byoxidation

4 adhesion of blood monocytes5 adhesion of platelets


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6 migration of smooth muscle cells

from the media into the intima

7 proliferation of smooth muscle cells

in the intima

8 enhanced accumulation of intra andextra cellular lipids


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ATHEROSCLEROTIC PLAQUE

The change of the large arterialintima is called atherosclerotic plaqueor atheroma

atherosclerotic plaque is the intimalthickening with lipid accumulation

It consists of fibrous cap, necrotic coreand fibrous basis.


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atherosclerotic plaque

It has three principle components:

1 cellssmooth muscle cells, macrophages

other leukocytes2 Extra cellular matrix- collagen, elastic fibers,

proteoglycans

3 Intra cellular and extra cellular lipids


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There are two types of atheroscleroticplaque

1 vulnerable

2 stable



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1 vulnerable 2 STABLE

THERE AREA LOT OF LIPIDS


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Progress stages of atheroscleroticplaques according to infiltrative

theory 1 Prelipidosis

2 Lipidosis

3 Sclerosis

4 Atheromatosis

5 Ulceration 6 Calcinosis


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2 stage is called lipidosis

aorta

Lipid strips


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3 stage is called sclerosis

Artery with atherosclerotic plaque

Atherosclerotic plaque with sclerosis


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4 stage is called atheromatosis6 stage is called calcinosis

Atheromatosis or porridge-likesubstance

calcinosis


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FORMS OF ATHEROSCLEROSIS

CEREBRAL ARTERIES INJURY

CARDIAC ARTERIES INJURY

RENAL ARTERIES INJURYAORTA INJURY

INTESTINAL ARTERIES INJURY

EXTREMITY ARTERIES INJURY


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ACUTE

FORM MAYBE WITH

THROMBOSIS OR

EMBOLISM ONULCERED PLAQUE

ISCHEMIC INFARCTION

CEREBRAL FORM OFATHEROSCLEROSIS


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Acute form may be as Hemorrhage withinThe brain due to ruptureOf atherosclerotic aneurism


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Chronic form may be as encephalopathy

With cerebral atrophy (decreasing memory)


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RENAL FORM OFATHEROSCLEROSIS

Acute form may be asinfarction

Chronic form is called

Atherosclerotic

Nephrosclerosis or

Primary contracted

kidney


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Aortic form of atherosclerosis

Various forms of aorta lesion


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Aortic form of atherosclerosis

Complications of atherosclerotic plaqueconnect with its ulceration. There are

Aneurism

Rupture of atherosclerotic plaque withretroperitoneal hematoma

Thrombosis, the most feared complication Cholesterol or thrombus embolism


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Intestinal form of atherosclerosis

Acute form may be asgangrenous necrosisof the intestine

Chronic form may beas ischemicenterocolitis


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Extremity form of atherosclerosis

Acute form may be as gangrenousnecrosis.


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Extremity form of atherosclerosis

Chronic form withmuscle atrophymay be as

Dejerine'ssyndrome[chronic

peripheralvascular disease]

Muscle fiber atrophy

Trichrome stain


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Cardiac form of atherosclerosis

Acute form occurs as myocardial infarction

or acute ischemic heart disease

Chronic form consists of chronic forms ofischemic heart disease


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ISCHEMIC HEART DISEASE

Ischemic heart diseaserefers to a group of closely

related syndromes causedby an imbalance between

the myocardial oxygendemand and the blood

supply.


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SYNONYMS ARE CORONARY HEARTDISEASE AND

CORONARY ARTERY DISEASE

A PICK INCIDENCE IS AFTER 50 YEARS INMEN AND 60 YEARS IN WOMEN

90% OF ALL INCIDENCES ARE CAUSEDBY CORONARY ARTERY NARROWING


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Classification is followed

Acute types:

1 stenocardia (angina pectoris)2 sudden cardiac death3 acute coronary insufficiency4 myocardial infarction


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Classification is followed

Chronic types are as follow

1 gross post infarctioncardiosclerosis

2 diffused atheroscleroticcardiosclerosis


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RISK FACTORS OF ISCHEMIC HEARTDISEASE ARE AS FOLLOW

1 HYPERLIPIDEMIA

2 SMOKING 3 ARTERIAL HYPERTENTION

4 DECREASING OF PHYSICAL ACTIVITY

5 OBESITY 6 HIGH CALORIES DIET

7 STRESS


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ETIOLOGY OCCURS IN CORONARY ARTERYLUMEN:

1 ATHEROSCLEROTIC STENOSIS

2 CORONARY ARTERY THROMBOSIS

3 CORONARY ARTERY EMBOLISM

4 CORONARY ARTERY SPASM FOR ALONG TIME


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The general role is played by localatherosclerotic plaque

75% reductionblood suplay is

followed byatheroscleroticplaque in the

lumen ofcoronaryarteries.

Thrombosis of coronary artery


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Thrombosis of coronary arteryoccurs in 90% with transmural

infarction

Occlusive thrombus RecurrentTransmuralinfarction


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Sources of Thromboembolismoccurs from

1 cardiac muralthrombus onendocardium coveringtransmural or

subendocardialinfarction

2 mural thrombus on

atherosclerotic plaqueof aortic sinus closedto coronary arterymouth


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PROLOGGED CORONARY ARTERYSPASM

Reperfusion of the myocardium leads to

added perfuse as reversible then

irreversible lesions of the myocardium. Increased myocardial oxygen demand

with functional overexertion may also

contribute to the development ofmyocardial ischemia.


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Stages of myocardial infarction

1 ischemic stage

2 necrosis

3 scarring


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MYOCARDIAL INFARCTION

This is an earlyacute myocardialinfarction

less then 1 day


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This is an acutemyocardial

infarction ofseveral daysduration


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The granulationtissue seen here ismost prominent from

2 to 3 weeksfollowing onset ofinfarction.

Scar formation by 8week

l f f d l


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Classification of myocardialinfarction

According to the time:

1 primary

2 reccurent (within 6 weeks afterprimary)

3 second (after 6 weeks fromprimary)

Cl f f d l


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According to the location:

1 anterior and apical left ventricle

2 anterior intraventricle septum

3 posterior wall and posterior third of the

intraventricle septum

4 lateral wall

5 papillary muscles

6 enlarge infarct with lesion two or morewall and even right ventricle lesion.

Cl ifi i f di l


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According to wall thickness of left ventricle

1 transmural infarction

2 subendocardial infarction3 mural one

4 subepicardial one


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COMPLICATIONS OF THEINFARCTION

1Papillary muscle dysfunction

2Papillary muscle rupture

3External rupture of the infarction4Rupture of the ventricle septum

5Mural thrombosis

6Acute fibrinous pericarditis7Ventricle aneurisms (acute, chronic)

The causes of death


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The causes of death

1 Cardiac arrhythmias2 Cardiogenic shock3 Left ventricle failure4 Rupture of wall, septum, papillary

muscle5 Thromboembolism within artery

blood stream

COMPLICATIONS OF THE


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Aneurisms of left ventricle

Acute aneurismwith mural thrombus

Chronic aneurism

COMPLICATIONS OF THE


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Rupture of cardiacwall in

the infarction zonewithHemopericardium

andheart tamponade


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THE END

Documents

35939987 Path Anatomy 18 Atherosclerosis