病理學(xué)--心腦血管疾病2.ppt

1、Disease of Cardiovascular System 舒細(xì)記 劉麗江,department of pathology,department of pathology,hypertensive encephalopathy,department of pathology,Atrophy of brain,department of pathology,This intermediate infarct of the frontal lobe shows liquefactive necrosis with formation of cystic spaces as resolutio

2、n begins.,department of pathology,hypertensive encephalopathy Haemorrhage Thrombosis Infarction liquefactive necrosis Atrophy,department of pathology,Malignant hypertension,department of pathology,is a clinical and pathological syndrome diastolic blood pressure 130-140mmHg,department of pathology,ne

3、crotizing arteriolitis,department of pathology,summarize,department of pathology,A sustained resting blood pressure of more than 140/90 mmHg is definition hypertension.,120/80mmHg,department of pathology,Primary hypertension (essential hypertension) 90-98% cases Secondary hypertension (symptomatic h

4、ypertension) Renal Endocrine Cardiovascular Neurology,department of pathology,hyaline arteriolosclerosis,department of pathology,hyperplastic arteriolosclerosis,department of pathology,necrotizing arteriolitis,department of pathology,hypertensive heart disease,department of pathology,primary granula

5、r atrophy of the kidney,department of pathology,hypertensive encephalopathy,department of pathology,Etiological factor Pathogenesis location Basic change Morphological features Gross Light microscopy Clinical features Outcome,department of pathology,Etiological factor: risk factor Pathogenesis: uncl

6、ear location: arteriolar Basic change: hyaline arteriosclerosis Morphological features Gross: Light microscopy: Clinical features: 140/90mmHg Outcome: cause death and disable,Hypertension,department of pathology,Atherosclerosis Coronary atherosclerosis, coronary heart disease Hypertension Rheumatism

7、 Infective endocarditis Cardiac valave Cardiomyopathy(myocardiopathy) Myocarditis,Production,department of pathology,department of pathology,Rheumatism,department of pathology,What is rheumatism? Rheumatism (rheumatic fever) is a disease of disordered immunity characterised by inflammatory changes i

8、n the heart and joints and in some cases associated with neurological symptoms.,department of pathology,is an acute, recurrent, inflammatory disease principally of children,“Special inflammation” Special morphological “Aschoff bodies”,department of pathology,Etiology and pathogenesis “ unclear ” ass

9、ociated with infection of group A streptococci suggests that it is the result of an immune response,department of pathology,This may be cross-react with unknown antibody in connective tissues, especially in heart and joints. Connective tissue disease Collagen disease,department of pathology,In heart

10、, Acute rheumatic pericarditis rheumatic myocarditis rheumatic endocarditis Chronic rheumatic valvular disease,department of pathology,In joints, Rheumatic polyarthritis (fibrinous inflammation),department of pathology,Morphology,department of pathology,Basic change,Alterative and exudative phase Pr

11、oliferation phase or granulomatous phase Fibrous phase or healed phase,department of pathology,Alterative and exudative phase,department of pathology,Proliferation phase,department of pathology,Proliferation phase,department of pathology,Alterative and exudative phase Proliferation phase or granulom

12、atous phase,department of pathology,Ashoff cell,department of pathology,department of pathology,department of pathology,In heart, Acute rheumatic pericarditis rheumatic myocarditis rheumatic endocarditis Chronic rheumatic valvular disease,department of pathology,rheumatic endocarditis,Fibroid necros

13、is inflammatory infiltrate,Thrombosis (white thrombus),organization,Fibrous scar,Chronic valvular disease,department of pathology,department of pathology,department of pathology,department of pathology,department of pathology,department of pathology,department of pathology,rheumatic myocarditis,depa

14、rtment of pathology,department of pathology,department of pathology,rheumatic pericarditis,Acute rheumatic fibrous pericarditis,department of pathology,rheumatic fibrous pericarditis,department of pathology,corvillosum,department of pathology,department of pathology,chronic constrictive pericarditis

15、.,department of pathology,chronic constrictive pericarditis.,department of pathology,department of pathology,department of pathology,department of pathology,Rheumatic pancarditis or Rheumatic carditis rheumatic pericarditis rheumatic myocarditis rheumatic endocarditis,+,+,department of pathology,In

16、joints, Rheumatic polyarthritis (fibrinous inflammation),department of pathology,department of pathology,summarize,department of pathology,What is rheumatism? Rheumatism (rheumatic fever) is a disease of disordered immunity characterised by inflammatory changes in the heart and joints and in some ca

17、ses associated with neurological symptoms.,department of pathology,is an acute, recurrent, inflammatory disease principally of children,“Special inflammation” Special morphological “Aschoff bodies”,department of pathology,department of pathology,In heart, Acute rheumatic pericarditis rheumatic myoca

18、rditis rheumatic endocarditis Chronic rheumatic valvular disease,department of pathology,department of pathology,department of pathology,department of pathology,department of pathology,In joints, Rheumatic polyarthritis (fibrinous inflammation),department of pathology,department of pathology,Etiolog

19、ical factor Pathogenesis location Basic change Morphological features Gross Light microscopy Clinical features Outcome,department of pathology,Etiological factor: group A streptococci Pathogenesis: unclear location: heart and joints Basic change: three phase(proliferative inflammation) Morphological

20、 features Gross: Light microscopy: Clinical features: child Outcome: cause chronic valvular disease,rheumatism,department of pathology,Atherosclerosis Coronary atherosclerosis, coronary heart disease Hypertension Rheumatism Infective endocarditis Cardiac valave Cardiomyopathy(myocardiopathy) Myocard

21、itis,Production,department of pathology,department of pathology,department of pathology,Infective endocarditis,department of pathology,department of pathology,department of pathology,department of pathology,department of pathology,病變特點(diǎn)： 1、病變的瓣膜常見 2、致病力弱的病原菌 3、贅生物“大”、“松”、“脆”,department of pathology,d

22、epartment of pathology,Atherosclerosis Coronary atherosclerosis, coronary heart disease Hypertension Rheumatism Infective endocarditis Cardiac valave Cardiomyopathy(myocardiopathy) Myocarditis,Production,department of pathology,department of pathology,Cardiomyopathy Dilated cardiomyopathy Hypertroph

23、ic cardiomyopathy Restrictive cardiomyopathy,department of pathology,department of pathology,This is a heart from a patient with dilated cardiomyopathy. Note the dilated left ventricle.,department of pathology,This is a heart from a patient with hypertrophic dilated cardiomyopathy. Note the thicknes

24、s of the left ventricular wall. A normal heart is shown on the left for comparison. IVS=intraventricular septum.,department of pathology,This is a heart from a patient with restrictive cardiomyopathy due to amyloidosis.,Atherosclerosis Coronary atherosclerosis, coronary heart disease Hypertension Rh

25、eumatism Infective endocarditis Cardiac valave Cardiomyopathy(myocardiopathy) Myocarditis,Production,department of pathology,department of pathology,department of pathology,due to a dense interstitial infiltrate of inflammatory cells,department of pathology,department of pathology,department of path

26、ology,department of pathology,department of pathology,department of pathology,Atherosclerosis Coronary atherosclerosis, coronary heart disease Hypertension Rheumatism Infective endocarditis Cardiac valave Cardiomyopathy(myocardiopathy) Myocarditis,Production,department of pathology,Atherosclerosis C

27、oronary atherosclerosis, coronary heart disease Hypertension Rheumatism Infective endocarditis Cardiac valave Cardiomyopathy(myocardiopathy) Myocarditis,Production,department of pathology,Atherosclerosis (AS, ATH),department of pathology,1,department of pathology,Risk factor 1. Hyperlipidemia 2. Hyp

28、ertension 3. Cigarette smoking 4. Diabetes 5. Familial predisposition 6. Other factors,department of pathology,department of pathology,Atheromatous plaque (atheroma),department of pathology,Complicated lesion,department of pathology,Complicated lesion,Hemorrhage Rupture Thrombosis Calcification Aneu

29、rysm,?,department of pathology,Aorta atherosclerosis,department of pathology,department of pathology,Coronary atherosclerosis and coronary heart disease (ischemic heart disease),2,department of pathology,coronary atherosclerosis 病變特點(diǎn)： 1、最常累及左前降支 2、心肌面病變重 3、分支處病變重,department of pathology,department o

30、f pathology,Pathogenesis Coronary atherosclerosis Acute plaque changes Coronary artery thrombosis Coronary artery vasospasm Other pathological processes,department of pathology,Myocardial infarction The term myocardial infarction indicates the development of an area of myocardial necrosis caused by

31、local ischemia.,department of pathology,Subtype: Subendocardial myocardial infarction Transmural myocardial infarction,department of pathology,Mural thrombosis Cardiac shock Heart failure Ventricular aneurysm Rupture Conduction system abnormalities ,department of pathology,Hypertension,3,department

32、of pathology,A sustained resting blood pressure of more than 140/90 mmHg is definition hypertension.,120/80mmHg,department of pathology,Primary hypertension (essential hypertension) 90-98% cases Secondary hypertension (symptomatic hypertension) Renal Endocrine Cardiovascular Neurology,department of pathology,hyaline arteriolosclerosis,department of pathology,hyperplastic arteriolosclerosis,department of path