2004-7-22-124743-Ch06CardivascularDis╲╲病理学课件.ppt

DISEASE OF THE CARDIOVASCULAR SYSTEM Prof: Tian Dong Ping 田东萍 Department of Pathology , Shantou University Medical College Atherosclerosis Definition: Atherosclerosis is a disease which affects large and medium-size arteries,Characterized by intimal fatty deposits followed by proliferation of smooth muscle cells, ultimately with collagenization. Causes : Not Clear Clinical Significance Cause 50% or more deaths. Involved arteries supply brain, heart, kidneys, lower extremities and small bowel. Myocardial infarct (heart attack). Cerebral infarction (stroke), and Aneurysm are major consequences. Gangrene of lower legs, ischemic heart d/s and ischemic encepholopathy and others 1. Calcification 2. Plague ulceration 3. Intimal hemorrhage 4. Thrombosis and embolism 5. Aneurysm Risk Factors Age: 4-6th decades; but, the disease begins much younger age, slowly progressive. Sex: Men are more prone to have the d/s. After menopause, female increase and by 60-70 yrs equal to male. Genetic: hyperlipidemia, hypertension, diabetes, smoking and familial risk factor. Hyperlipidemia Hyperclosterolemia-more responsible than hypertriglyceridemia for atherosclerosis. High LDL cause higher risk; HDL acts in reverse, helps prevent atherosclerosis and ischemic heart disease (HDL move choles-terol to liver for excretion in bile). Genetic defects(familial hyperchlosterole- mia)-inadequate hepatic uptake of LDL. Pathogenesis Two major hypotheses: 1. Response to injury- chronic endothelial injury; insudation of lipoprotein-LDL; adhesion of blood monocytes platelets; porliferation/migration of smooth muscle cells; lipids accumulation within cells. 2. Chronic inflammatory response. Aneurysms and Dissection Localized abnormal dilatation of a blood vessel, most commonly-aorta heart. Blood enters the wall of the artery, dissect- ing between its layers. Marfan Two major causes for aneurysm-atheroscl- erosis and cystic medial degeneration. Mycotic aneurysm-infect