病理学 5 Cardiovascular Diseases心血管疾病
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• SMCs --- migratory & proliferative activity • ECM --- ↑
Thickening of the wall luminal narrow Elasticity ↓
Two principal mechanisms of vascular diseases
Atherosclerosis (动脉粥样硬化, AS)
Intimal lesions called atheromas (粥样瘤), or atheromatous or atherosclerotic plaques (动脉粥样硬化斑块)
→ luminal narrow → Wall weakening
serious complications
Epidemiology
The constitutional (immutable) risk factors (无法改变的因素) ● Age dominant influence IHD rise with each decade / middle age or later ● Gender ● Genetics
Basic constituents: - Endothelial cells (ECs) - Smooth muscle cells (SMCs) - Extracellular matrix (ECM)
Vascular wall cells’ response to injury
• ECs --- dysfunction: contraction, proliferation
polygenic hypertension, diabetes, hereditary genetic derangement in lipoprotein metabolism
The major modifiable risk factors (可变的因素)
● Hyperlipidemia H-LDL-C, H-Lp(a), H-TG, L-HDL-C LDL: “bad cholesterol” delivering cholesterol to peripheral tissue high dietary cholesterol, saturated fats: egg yolk, animal fats
• Narrowing or completely obstructing the lumina • Weakening of the walls, leading to dilation or rupture
Arteriosclerosis (动脉硬化)
Hardening
Definition --- hard, thicken, lost elasticity of artery wall
Classification Atherosclerosis （动脉粥样硬化） Large & medium-sized arteries Mönckeberg medial calcific sclerosis （动脉中层钙化） Arteriolosclerosis （细动脉硬化） Essential hypertension, diabetes mellitus
- In US, myocardial infarction alone is responsible for 20-25% of all death
Systemic Pathology
·Etiology, Pathogenesis ·Pathologic morphology ·Clinico-pathological correlation ·Consequence
HDL： “good cholesterol” transporting cholesterol to the liver
exercise, moderate consumption of ethanol↑; obesity, smoking↓ Omega-3 fatty acids abundant in fish oil, beneficial to decrease LDL-C, TG ● Cigarette smoking ● Hypertension ● Diabetes mellitus
Chapter VI Diseases of Cardiovascular System
(心血管系统疾病)
Hale Waihona Puke Baiduardio vascular system
Heart
Blood vessels
“Pump”
More morbidity & mortality
- Approximately half of all death caused by disorders of circulatory system
Artery
• Large ( Elastic ): Aorta & large branches, pulmonary arteries
• Medial ( Muscular ): Coronary, renal arteries • Small (ф < 2mm): Arteriole (ф 20 ~ 100μm)
General pathology ↔ Systemic pathology
Example: Myocardial infarction
Morphology Coagulative necrosis Granulation tissue Scar
Consequences
Contractile dysfunction Heart failure shock, death Arrhythmias myocardial rupture Ventricular aneurysm ……
Cardio vascular diseases
Heart Blood vessels
Ischemic heart disease ← Atherosclerosis Hypertension
Rheumatic Heart Disease Valvular heart disease (Infective Endocarditis) Myocarditis Cardiomyopathy
Thickening of the wall luminal narrow Elasticity ↓
Two principal mechanisms of vascular diseases
Atherosclerosis (动脉粥样硬化, AS)
Intimal lesions called atheromas (粥样瘤), or atheromatous or atherosclerotic plaques (动脉粥样硬化斑块)
→ luminal narrow → Wall weakening
serious complications
Epidemiology
The constitutional (immutable) risk factors (无法改变的因素) ● Age dominant influence IHD rise with each decade / middle age or later ● Gender ● Genetics
Basic constituents: - Endothelial cells (ECs) - Smooth muscle cells (SMCs) - Extracellular matrix (ECM)
Vascular wall cells’ response to injury
• ECs --- dysfunction: contraction, proliferation
polygenic hypertension, diabetes, hereditary genetic derangement in lipoprotein metabolism
The major modifiable risk factors (可变的因素)
● Hyperlipidemia H-LDL-C, H-Lp(a), H-TG, L-HDL-C LDL: “bad cholesterol” delivering cholesterol to peripheral tissue high dietary cholesterol, saturated fats: egg yolk, animal fats
• Narrowing or completely obstructing the lumina • Weakening of the walls, leading to dilation or rupture
Arteriosclerosis (动脉硬化)
Hardening
Definition --- hard, thicken, lost elasticity of artery wall
Classification Atherosclerosis （动脉粥样硬化） Large & medium-sized arteries Mönckeberg medial calcific sclerosis （动脉中层钙化） Arteriolosclerosis （细动脉硬化） Essential hypertension, diabetes mellitus
- In US, myocardial infarction alone is responsible for 20-25% of all death
Systemic Pathology
·Etiology, Pathogenesis ·Pathologic morphology ·Clinico-pathological correlation ·Consequence
HDL： “good cholesterol” transporting cholesterol to the liver
exercise, moderate consumption of ethanol↑; obesity, smoking↓ Omega-3 fatty acids abundant in fish oil, beneficial to decrease LDL-C, TG ● Cigarette smoking ● Hypertension ● Diabetes mellitus
Chapter VI Diseases of Cardiovascular System
(心血管系统疾病)
Hale Waihona Puke Baiduardio vascular system
Heart
Blood vessels
“Pump”
More morbidity & mortality
- Approximately half of all death caused by disorders of circulatory system
Artery
• Large ( Elastic ): Aorta & large branches, pulmonary arteries
• Medial ( Muscular ): Coronary, renal arteries • Small (ф < 2mm): Arteriole (ф 20 ~ 100μm)
General pathology ↔ Systemic pathology
Example: Myocardial infarction
Morphology Coagulative necrosis Granulation tissue Scar
Consequences
Contractile dysfunction Heart failure shock, death Arrhythmias myocardial rupture Ventricular aneurysm ……
Cardio vascular diseases
Heart Blood vessels
Ischemic heart disease ← Atherosclerosis Hypertension
Rheumatic Heart Disease Valvular heart disease (Infective Endocarditis) Myocarditis Cardiomyopathy