1. Diseases of the cardiovascular system Maliqin Department of Pathology and Pathophysiology School of Medicine, Zhejiang University

2. atherosclerosis(AS) 1. etiology and pathogenesis Risk factors  Hyperlipemia:increased LDL, TG, VLDL, apoB,Lp(a) decreased HDL,apoA-I  Hypertension  Cigarette smoking  Elevated blood sugar levels  The other factors

3. pathogenesis --Theory of inflammatory response to injury  The injury of the endothelium  The accumulation of lipid  The infiltration of macrophages  The proliferation of SMC

4. 2.morphology Predilection for large arteries and medium-sized arteries Basic lesion  Fatty streak Accumulated lipid, foam cell  Fibrous plaque-- Fibrous cap

5. 黄色脂 质条纹

6. 2.morphology Predilection for large arteries and medium-sized arteries Basic lesion  Fatty streak Accumulated lipid, foam cell  Fibrous plaque-- Fibrous cap

8. 动脉管壁一侧明显增厚

9. Atheromatous plaque (atheroma ) Fibrous cap cholesterol crystal necnotic debris foam cell calcification neovascular formation

10. atheroma

14. complicated lesions  Hemorrhage in plaque  Rupture of the plaque  Thrombosis  Calcification  aneurysm: definition, lesion classification (true, pseudo-, Dissecting )

15. Ulcer formation

16. 3. Atherosclerosis of the important organs Aorta: abdominal aorta Coronary arteries Arteries of the brain The other organs

18. 3. Atherosclerosis of the important organs Aorta: abdominal aorta Coronary arteries Arteries of the brain The other organs

20. 基底动脉内血 栓形成 基底动脉 环硬化

21. 脑动脉 硬化致 脑萎缩

22. 3. Atherosclerosis of the important organs Aorta: abdominal aorta Coronary arteries Arteries of the brain The other organs

25. Coronary heart disease (C H D) Definition cardiac disease which result from insufficient coronary blood flows due to the narrowing of the coronary arteries

26. Causes Coronary atherosclerosis Distribution(location) features of the lesion Spasm of the coronary arteris Coronary arteritis

27. 正常心脏

29. 左冠状动脉 右冠状动脉

32. 正常冠状动脉

33. 冠状动 脉粥样 硬化， 管腔狭 窄

34. 冠状动脉管壁增厚及钙化 ，管腔明显狭窄

35. 斑块内钙化

36. 动脉管腔狭窄血栓形成

37. 冠状动脉 近端狭窄 冠状动脉 远端闭塞

38. 冠状动脉 硬化区

39. 冠状动脉阻塞冠状动脉阻塞

40. Causes Coronary atherosclerosis Distribution(location) features of the lesion Spasm of the coronary arteris Coronary arteritis

41. Classification 1. angina pectoris (AP) a symptom complex consisting of severe paroxymal chest pain resulting from transient ischemia

42. Precipitating factors Exertion, emotion, pain, cold weather, cigarette smoking, heavy meals

44. Classification Stable (exerting ) AP Instable (exerting) AP (Spontaneous) variant AP

45. 2. Myocardial infarction Subendocardial MI Multiple small lesion Transmural MI Distribution Morphology:shape, color, microscopic change Biochemical changes:

47. myocardial infarction granulation tissue

49. Complications Rupture of the heart Ventricular aneurysm Thrombosis Acute pericarditis Clinical complication

50. rupture of Infarct area

51. Pericardial tamponade

52. hematocele in heart sac

53. vntricular aneurysm

54. 3. Myocardial fibrosis 4. sudden coronary death

55. Hypertension Diagnostic criteria sustained diastolic pressure above 90 mmHg and/or sustained systolic pressure above 140mmHg

56. Classification Primary(essential) hypertension Secondary(symptomatic) Benign (chronic) hypertension Malignant(accelerated)

57. Morphology (1) Benign hypertension Stage of dysfunction Stage of artery lesion arteriolosclerosis — the basic lesion of hypertension Stage of organ dysfunction

58. Hypertensive heart disease Concentric hypertrophy Ecentric hypertrophy Arteriolar nephrosclerosis (primary granulo-contracted kidney) Microscopic change Gross alteration

61. concentric hypertrophy of left ventricle

63. decompensation distention of left ventricle

65. Hypertensive heart disease Concentric hypertrophy Ecentric hypertrophy Arteriolar nephrosclerosis (primary granulo-contracted kidney) Microscopic change Gross alteration

74. Hypertensive brain Edema of brain, hypertensive encephalopathy, hypertensive crisis Hemorrhage of brain Softening of brain Lesions of retina

76. Arteriole of eyeground

77. (2) Malignant hypertension Basic lesion: necrotic arteriolitis proliferating arteriosclerosis The major injured organs: kidney and brain

78. Etiology and pathogenesis Causes Genetic factors Environmental factors Dietary factors: Na+, K+,Ca2+ Social factors psychological stress other factors

79. Pathogenesis Variant factors — increased Volum, or Increased vasoconstriction retention of Sodium and water Vasoconstriction Thickening of the artery wall

80. Cardiomyopathy Classification: The common lesion: Primary cardiomyopathy Any dysfunction of the myocardium not attribulable to CHD,valvular disease, hypertension or pulmonary heart disease.

81. Dilated cardiomyopathy Hypertrophy(M>350g F>300g) Dilatation of the four cavities Heart failure

82. Microscopically, the heart in cardiomyopathy demonstrates hypertrophy of myocardial fibers (which also have prominent dark nuclei) along with interstitial fibrosis.

83. Here is a large, dilated left ventricle typical of a dilated, or congestive, cardiomyopathy. Many of these have no known etiology (so-called "idiopathic dilated cardiomyopathy") while others may be associated with chronic alcoholism. The heart is very enlarged and flabby.

84. Hypertrophic cardiomyopathy Hypertrophy of the myocardium Asymetric hypertrophy of the ventricular septum Obstruction of the outflow tract

85. There is marked left ventricular hypertrophy, with asymmetric bulging of a very large interventricular septum into the left ventricular chamber. This is hypertrophic cardiomyopathy.

86. Restrictive cardiomyopathy progressive fibrosis of the endocardium and subendocardial myocadium

87. This section of myocardium demonstrates amorphous deposits of pale pink material between myocardial fibers. This is characteristic for amyloid. Amyloidosis is a cause for "infiltrative" or "restrictive" cardiomyopathy. It is a nightmare for anesthesiologists when intractable arrhythmias occur during surgery on such patients.

88. KeShan disease Etiology Virus infection Coxsackie B Lack of Selennium Morphology Dilatation of the left and right ventricle

89. Rheumatism Etiology and pathogenesis Infection with group A beta hemolytic streptococci Immune injury

90. Basic lesion(three stages) Alterative and exudative phase Mucoid degeneration fibrinoid necrosis Proliferative phase (granulomatous phase )

91. Aschoff body (consist of) Fibrinoid necrosis Aschoff cell:awl-eye cell, caterpillar cell Aschoff giant cell Other inflammatory cells Fibrosis phase

94. Aschoff body (consist of) Fibrinoid necrosis Aschoff cell:awl-eye cell, caterpillar cell Aschoff giant cell Other inflammatory cells Fibrosis phase

95. Rheumatic heart disease Rheumatic endocarditis (verrucous endocarditis) Distribution: mitral valve 50% mitral and aortic valve 50% Lesion: vegetations sequla: valvular disease, MacCallum ’ s plaque

97. Rheumatic myocarditis Adults: local stromal myocarditis Children:diffuse stromal myocarditis Rheumatic pericarditis dry pericarditis wet pericarditis Clinical course

98. rheumatic myocarditis

100. rheumatic granulomas

101. Aschoff cell

102. Rheumatic myoicarditis Adults: local stromal myocarditis Children:diffuse stromal myocarditis Rheumatic pericarditis dry pericarditis wet pericarditis Clinical course

106. Rheumatic arthritis Large joints, reversible Rheumatic lesion of the skin Erythema annullare Subcutaneous nodules Rheumatic arteritis

107. Rheumatic encephalopathy Rheumatic arteritis of the brain Rheumatic encephalitis Chorea minor

108. Chronic valvular vitium of the heart stenosis, insufficiency Mitral stenosis The valvular changes The cardiac changes The clinical course

109. 风湿性心瓣膜病 左房扩张

110. 左房扩张 瓣膜硬化 左室萎缩

111. 二尖瓣 膜及腱 索增厚 变硬

112. 二尖瓣 狭窄 左心房 扩张

114. Mitral insufficiency The valvular changes The cardiac changes The clinical course Aortic stenosis and insufficiency

115. Subacute infective endocarditis(SBE) Etiology Streptococci. Morphology vegetations

116. Vegetations(compared with rheumatic valvitis) Large, yellow, located haphazardly, located at the margin of the valve containing causative organism friable

117. 亚急性 细菌性 心内膜 炎

118. 赘生物 瓣膜病 变

119. Complication Septicemia Embolism Immune injury

120. Myocarditis Etiology Morphology Viral myocarditis Bacterial myocarditis Isolated myocarditis Clinical course

121. The interstitial lymphocytic infiltrates shown here are characteristic for a viral myocarditis, which is probably the most common type of myocarditis.

122. Thank you!