Chapter08心血管系统疾病.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Precipitation of fibrin Organization, fibrosis thickening, shortening, commissural fusion of leaflets and tendinous cord Rheumatic myocarditis Perivascular Aschoff body Rheumatic pericarditis Serous exudate pericardial effusion Fibrinous exudate cor villosum constrictive pericarditis Rheumatic arthritis Serous inflammation Complete resolution Large joints: migratory Local signs: arthralgia Self-limited, no chronic deformity Rheumatic arteritis Often involves small arteries, Fibrinoid necrosis Mononuclear infiltration Aschoff bodies Fibrosis Lumen narrowing CNS changes Rheumatic arteritis, Subcortical encephalitis Minor chorea / Sydenham chorea (a neurologic disorder with involuntary purposeless, rapid movements) 感染性心内膜炎 Infective endocarditis 病原微生物直接侵袭心内膜特别是心瓣膜而引起的心内膜炎 急性感染性心内膜炎 亚急性感染性心内膜炎 急性感染性心内膜炎 病原：致病力强的化脓菌： 金黄色葡萄球菌、溶血性链球菌、肺炎球菌 心瓣膜：发生在原来无病变的正常心内膜 主要累及二尖瓣、主动脉瓣 临床上：起病急，发展快，病程短，死亡率高 亚急性感染性心内膜炎 病原：致病力较小病原微生物： 草绿色链球菌，肠球菌，真菌等。 心瓣膜：发生在原来有病变的心内膜 主要累及二尖瓣、主动脉瓣 菜花状或息肉状疣状赘生物： 纤维素、血小板、NC、坏死物 细菌团 血管：动脉栓塞和血管炎； 肾： 微栓塞致灶性肾小球肾炎。 临床上：病程长，数月或1年 CARDIOMYOPATHY Heart disease resulting from a primary abnormality in the myocardium, of unknown cause . Three clinical, functional, and pathologic patterns 1. Dilated (congestive) cardiomyopathy progressive cardiac hypertrophy, dilation, and contractile (systolic) dysfunction. Heart: heavy, large, and flabby, with dilation of all chambers and the wall thinning, mural thrombi, functional mitral or tricuspid regurgitation. Histologic changes: nonspecific, hypertrophied muscle cells with enlarged nuclei, attenuated or streched, interstitial and endocardial fibrosis. 2. Hypertrophic cardiom