病理生理 心血管系统疾病.pptx

1、Diseases of the Cardiovascular System心血管系统疾病 (1),Heart Disease will kill 1 in 3,CVD is the #1 cause of death in most countries.,结构,血 管,心瓣膜,心 肌,心 包,大中动脉 动脉粥样硬化,小动脉 高血压病,内膜炎瓣膜病,心 肌 炎,心脏肿瘤,风湿病,心 包 炎,心脏,血管,血管壁 动脉瘤,Major Disorders of CVS,Atherosclerosis Ischemic Heart Disease (IHD) Hypertension Rheumatic

2、 Heart Disease (RHD) Infective Endocarditis Valvular Heart Disease (VHD),Atherosclerosis,动脉粥样硬化,Introduction,Disease of the large and medium-sized arteries.Fat deposits, hardening and destruction.Major cause of IHD, MI and Stroke.Major primary cause of death in most countries.,Arteriosclerosis,Ather

3、osclerosisLarge BVIntima,Hyaline,Mnckeberg Medial SclerosisMedial BV,AteriolosclerosisSmall BVFull Thickness,Hyperplastic,atheroma,artery,arteriole,细动脉硬化,动脉硬化,动脉粥样硬化,动脉中层钙化,Etiology 病因学,Exact cause is unknown.Risk Factors,Age - the older you get, the greater the chance.Sex - males have a greater ris

4、k, even after women pass menopause.Family history (Genetic factors) - if family members have had CHD, there is a greater chance.,Unchangeable Risk Factors,HyperlipidemiaHypertensionCigarette SmokingDiabetes MellitusObesityPhysical Inactivity Alcohol Intake,Changeable Risk Factors,Hyperlipidemia,Hype

5、rcholesterolemia risk 高胆固醇血症Hypertriglyceridemia - less significant 高甘油三酯血症,高脂血症,Types of Cholesterol,Chylomicrons (CM)Very low density lipoproteins (VLDL)Low density Lipoprotein (LDL)High density Lipoprotein (HDL),LDL,The liver A major component of the tissues and cellsAtherosclerotic plaque that c

6、logs arteriesIncreases risk of CHD,tissues and cells,Bad cholesterol !,HDL,Tissues and cells It does not have the tendency to clog arteries.,the liver,Good cholesterol !,Hypertension,A major risk factor at all agesBlood pressure exceeds 160/95mmHg more than five fold greater risk than those with blo

7、od pressures of 140/90 mmHg or lower,Cigarette Smoking,Smoking aggravates the injury of endothelial cells. Carbon monoxideNicotine,Diabetes Mellitus 糖尿病,Uncontrolled blood sugar encourages the build up of fatty deposits within the arterial walls.A diabetic person has 2 or 3 x higher risk of atherosc

8、lerosis!,Obesity,Can lead to high blood pressure, raised blood cholesterol levels, and diabetes,Physical Inactivity,Physical activity Blood pressure HDL levelRegular, moderate intensity activity brisk walking, swimming, cycling, dancing, skipping, tennis, etc.,In small amounts it acts as a vasodilat

9、or. 1-2 drinks is good!In large amounts it acts as a vasoconstrictor. 3-4 drinks is bad!,Alcohol Consumption,Risk Factors,Non modifiableAge Sex Family history (Genetic),Potentially modifiableHyperlipidemiaHypertensionSmokingDiabetesLife style, diet, and exercise,Pathogenesis,Reaction to vascular inj

10、ury hypothesislipid infiltration/insudation hypothesis ,Atherosclerosis,Artery Wall,Atherosclerosis,Monocytes,Lumen,Intima,Macrophage,Foam Cell,Endothelial Cells,Modified LDL,Adhesion & Diapedesis,SRs,LDLR,CytoplasmicLD,Chemotaxis,Cytoplasmic LD,Endosome,LateEndosome,CE,TG,FC,SR-A,CD36,ABCA1,ABCG1,H

11、DL,Cholesterol Crystal,LAL,ACAT,Transcription Factors,nCEH,Cholesterol Crystal,ApoA1,ER,LD Proteins,FA,Modified LDL,Oxidation,CholesterolEfflux,ATGLHSL,Nucleus,ADRP,Perilipin,Atheroma,Morphology,Development,Fatty Streak（脂纹）Fibrous Plaque（纤维斑块）Atheromatous Plaque （Atheroma） 粥样斑块（粥瘤）,Fatty Streaks 脂 纹

12、,Atheroma 粥瘤,Fibrous CapNecrotic centerCholesterol Cry.Macrophages,Complications - development,Ischemia,Rupture,Erosion, ulceration,Thrombosis,embolism,Infarction,Brain, myocardial, renal, gangrene,Angina pectoris, atrophy, intermittent claudication,Hemorrhage,Rupture,Atherosclerosis,Atrophy of the

13、media,Aneurysm,Dissecting aneurysms,Complications - development,Coronary Atherosclerosis冠状动脉粥样硬化,狭窄程度,I 级25%II级26%-50%III级51%-75%IV级75%,Coronary AS,Coronary Heart Disease （CHD）冠状动脉性心脏病（冠状动脉粥样硬化性心脏病）,Coronary Heart Disease , CHD,Any vascular disorder that narrows or occludes the coronary arteries.Ath

14、erosclerosis is the most common cause.Risk factors,临床表现,心绞痛心肌梗死心肌纤维化冠状动脉性猝死,冠状动脉供血不足 心肌耗氧量剧增,Myocardial ischemia心肌缺血,Local, temporary deprivation of the coronary blood supplyAngina pectoris 心绞痛Transient cardiac ischemia without cell death resulting in substernal chest pain.,Angina Pectoris心绞痛,Stabil

15、e angina 稳定性心绞痛Most common type, coronary artery atherosclerosis, increased cardiac demand Unstabile angina 不稳定性心绞痛nonocclusive thrombus, occurs at rest Prinzmetal angina 变异性心绞痛coronary artery vasospasmoften occurring at rest,Myocardial infarction, MI心肌梗死,MI is the death of cardiac muscle resulting

16、from ischemia . The most important form of IHD The leading cause of death,A heart attack occurs when one of the arteries that supplies the heart muscle becomes blocked.Blockage may be caused by spasm of the artery or by atheriosclerosis with clot formation. The blockage results in damaged tissue and

17、 a permanent loss of contraction of this portion of the heart muscle.,Myocardial Infarction, MI,胸骨后剧烈疼痛，难以缓解发热、白细胞增高、血沉加快心肌酶谱增高心电图变化,Angina vs MI,Anginanarrowed coronary arterytightness or ache in the chest, breathlessness, sick feeling, dizzinesscomes on with exertion or emotiongoes away with rest

18、- usually 2-10 mins,MI (heart attack)due to sudden blockage of the coronary arterychest pain “like a band”, indigestion, breathlessness, sickness, looking palecomes on at any timedoesnt go away - if still there in 15 minutes,类型,Subendocardial Myocardial Infarction心内膜下心肌梗死Transmural Myocardial Infarc

19、tion透壁性心肌梗死,Transmural infarction,The ischemic necrosis involves the full or nearly full thickness of the ventricular wall in the distribution of a single coronary artery.,Subendocardial infarction,Constitutes an area of ischemic necrosis limited to the inner one third or at most one half of the ven

20、tricular wall.,Morphology,The microscopic and gross changes represent a spectrum.,Gross,0-18 h No gross change 18-24 h Vague pallor and softening 1- 7 d Yellow pallor 7-28 d Central pallor with a red border Months White, firm scar,Microscopic Sequence of Changes,1-4h Wavy myocyte fibers4-24 h Coagul

21、ative necrosis1-4 d Neutrophilic infiltrate4-7 d Macrophages7-28 d Granulation tissueMonths Fibrotic scar,生化改变,30min，糖原减少或消失肌红蛋白、肌凝蛋白、肌钙蛋白肌酸磷酸激酶（CK）、AST、LDH1,合并症,乳头肌功能失调或断裂心脏破裂室壁瘤附壁血栓急性心包炎,Complications,Heart failureCardiac ruptureVentricular aneurysm Mural thrombus and thromboembolismCardiogenic sh

22、ockFibrinous pericarditisCardiac arrhythmias,心肌纤维化Myocardial Fibrosis,Chronic Ischemic Heart Disease慢性缺血性心脏病Ischemic Cardiomyopathy缺血性心肌病,Myocardial Fibrosis心肌纤维化,Sudden cardiac death心源性猝死,Death within 1 hour of the onset of symptomsfatal cardiac arrhythmia, ventricular fibrillationCoronary artery d

23、isease (80%)Hypertrophic cardiomyopathyMitral valveprolapseAortic valvestenosisCongenital heart abnormalitiesMyocarditis,120,急性冠状动脉综合征Acute Coronary Syndrome，ACS,不稳定性心绞痛急性心肌梗死冠状动脉性猝死,缺血心肌再灌注,溶栓经皮冠状动脉成型术（PTCA）血栓旋切术冠状动脉搭桥,Summary,AtherosclerosisKey terms Risk factors Development of atherosclerosis Ischemic Heart Disease (IHD)Angina pectorisMI,Thanks,