病理生理-心血管系统疾病

DiseasesoftheCardiovascularSystem

心血管系统疾病(1)12021/3/26HeartDiseasewillkill1in3CVDisthe#1causeofdeathinmostcountries.22021/3/26结构血管心瓣膜心肌

心包大中动脉动脉粥样硬化小动脉高血压病内膜炎瓣膜病

心肌炎心脏肿瘤风湿病心包炎心脏血管血管壁动脉瘤32021/3/26MajorDisordersofCVSAtherosclerosisIschemicHeartDisease(IHD)HypertensionRheumaticHeartDisease(RHD)InfectiveEndocarditisValvularHeartDisease(VHD)42021/3/26Atherosclerosis动脉粥样硬化52021/3/26IntroductionDiseaseofthelargeandmedium-sizedarteries.Fatdeposits,hardeninganddestruction.MajorcauseofIHD,MIandStroke.Majorprimarycauseofdeathinmostcountries.62021/3/26ArteriosclerosisAtherosclerosisLargeBVIntimaHyalineMőnckebergMedialSclerosisMedialBVAteriolosclerosisSmallBVFullThicknessHyperplasticatheromaarteryarteriole细动脉硬化动脉硬化动脉粥样硬化动脉中层钙化72021/3/26Etiology病因学Exactcauseisunknown.RiskFactors…82021/3/26Age

-theolderyouget,thegreaterthechance.Sex

-maleshaveagreaterrisk,

evenafterwomenpassmenopause.Familyhistory

(Geneticfactors)

-iffamilymembershavehadCHD,thereisagreaterchance.UnchangeableRiskFactors92021/3/26HyperlipidemiaHypertensionCigaretteSmokingDiabetesMellitusObesityPhysicalInactivityAlcoholIntakeChangeableRiskFactors102021/3/26HyperlipidemiaHypercholesterolemia–risk

高胆固醇血症Hypertriglyceridemia-lesssignificant

高甘油三酯血症高脂血症112021/3/26TypesofCholesterolChylomicrons(CM)Verylowdensitylipoproteins(VLDL)LowdensityLipoprotein(LDL)HighdensityLipoprotein(HDL)122021/3/26LDLTheliverAmajorcomponentofthetissuesandcellsAtheroscleroticplaquethatclogsarteriesIncreasesriskofCHD

tissuesandcellsBadcholesterol!132021/3/26HDLTissuesandcells

Itdoesnothavethetendencytoclogarteries.

theliverGoodcholesterol!142021/3/26Hypertension

AmajorriskfactoratallagesBloodpressureexceeds160/95mmHg

morethanfivefold

greaterriskthanthosewithbloodpressuresof140/90mmHgorlower152021/3/26CigaretteSmokingSmokingaggravatestheinjuryofendothelialcells.Carbonmonoxide

Nicotine162021/3/26DiabetesMellitus糖尿病Uncontrolledbloodsugarencouragesthebuildupoffattydepositswithinthearterialwalls.A

diabeticpersonhas

2or3xhigherriskofatherosclerosis!172021/3/26ObesityCanleadtohighbloodpressure,raisedbloodcholesterollevels,anddiabetes182021/3/26PhysicalInactivityPhysicalactivity

BloodpressureHDLlevelRegular,moderateintensityactivitybriskwalking,swimming,cycling,dancing,skipping,tennis,etc.192021/3/26Insmallamountsitactsasavasodilator.1-2drinksisgood!Inlarge

amountsitactsasavasoconstrictor.3-4drinksisbad!AlcoholConsumption202021/3/26Risk

FactorsNonmodifiableAgeSexFamilyhistory(Genetic)PotentiallymodifiableHyperlipidemiaHypertensionSmokingDiabetesLifestyle,diet,andexercise212021/3/26PathogenesisReactiontovascularinjuryhypothesislipidinfiltration/insudationhypothesis…222021/3/26Atherosclerosis232021/3/26ArteryWall242021/3/26Atherosclerosis252021/3/26MonocytesLumenIntimaMacrophageFoamCellEndothelialCellsModifiedLDLAdhesion&DiapedesisSRsLDLRCytoplasmicLDChemotaxis262021/3/26CytoplasmicLDEndosomeLateEndosomeCETGFCSR-ACD36ABCA1ABCG1HDLCholesterolCrystalLALACATTranscriptionFactorsnCEHCholesterolCrystalApoA1ERLDProteinsFAModifiedLDLOxidationCholesterolEffluxATGLHSLNucleusADRPPerilipin272021/3/26Atheroma282021/3/26Morphology292021/3/26302021/3/26312021/3/26DevelopmentFattyStreak（脂纹）FibrousPlaque（纤维斑块）AtheromatousPlaque（Atheroma）粥样斑块（粥瘤）322021/3/26332021/3/26FattyStreaks脂纹342021/3/26352021/3/26362021/3/26Atheroma粥瘤FibrousCapNecroticcenterCholesterolCry.Macrophages372021/3/26382021/3/26392021/3/26402021/3/26Complications-developmentIschemiaRuptureErosion,ulcerationThrombosisembolismInfarctionBrain,myocardial,renal,gangreneAnginapectoris,atrophy,intermittentclaudicationHemorrhage412021/3/26RuptureAtherosclerosisAtrophyofthemediaAneurysmDissectinganeurysmsComplications-development422021/3/26CoronaryAtherosclerosis

冠状动脉粥样硬化432021/3/26狭窄程度I级

≦25%II级 26%-50%III级 51%-75%IV级 >75%442021/3/26CoronaryAS452021/3/26CoronaryHeartDisease

（CHD）冠状动脉性心脏病（冠状动脉粥样硬化性心脏病）462021/3/26CoronaryHeartDisease

,CHDAnyvasculardisorderthatnarrowsoroccludesthecoronaryarteries.Atherosclerosisisthemostcommoncause.Riskfactors472021/3/26482021/3/26临床表现心绞痛心肌梗死心肌纤维化冠状动脉性猝死……IschemicHeartDisease缺血性心脏病

冠状动脉供血不足心肌耗氧量剧增492021/3/26Myocardialischemia

心肌缺血Local,temporarydeprivationofthecoronarybloodsupplyAnginapectoris心绞痛Transientcardiacischemiawithoutcelldeathresultinginsubsternalchestpain.502021/3/26AnginaPectoris

心绞痛Stabileangina稳定性心绞痛Mostcommontype,coronaryarteryatherosclerosis,increasedcardiacdemand

Unstabileangina不稳定性心绞痛nonocclusivethrombus,occursatrest

Prinzmetalangina变异性心绞痛coronaryarteryvasospasmoftenoccurringatrest512021/3/26522021/3/26Myocardialinfarction,MI

心肌梗死MIisthedeathofcardiacmuscleresultingfromischemia.ThemostimportantformofIHDTheleadingcauseofdeath532021/3/26542021/3/26Aheartattackoccurswhenoneofthearteriesthatsuppliestheheartmusclebecomesblocked.Blockagemaybecausedbyspasmofthearteryorbyatheriosclerosiswithclotformation.Theblockageresultsindamagedtissueandapermanentlossofcontractionofthisportionoftheheartmuscle.552021/3/26MyocardialInfarction,MI胸骨后剧烈疼痛,难以缓解发热、白细胞增高、血沉加快心肌酶谱增高心电图变化562021/3/26AnginavsMIAnginanarrowedcoronaryarterytightnessoracheinthechest,breathlessness,sickfeeling,dizzinesscomesonwithexertionoremotiongoesawaywithrest-usually2-10minsMI(heartattack)duetosuddenblockageofthecoronaryarterychestpain“likeaband”,indigestion,breathlessness,sickness,lookingpalecomesonatanytimedoesn’tgoaway-ifstilltherein15minutes572021/3/26类型SubendocardialMyocardialInfarction心内膜下心肌梗死TransmuralMyocardialInfarction透壁性心肌梗死582021/3/26TransmuralinfarctionTheischemicnecrosisinvolvesthefullornearlyfullthicknessoftheventricularwallinthedistributionofasinglecoronaryartery.592021/3/26SubendocardialinfarctionConstitutesanareaofischemicnecrosislimitedtotheinneronethirdoratmostonehalfoftheventricularwall.602021/3/26MorphologyThemicroscopicandgrosschangesrepresentaspectrum.

612021/3/26Gross0-18hNogrosschange18-24hVaguepallorandsoftening1-7dYellowpallor7-28dCentralpallorwitharedborderMonthsWhite,firmscar622021/3/26632021/3/26MicroscopicSequenceofChanges1-4hWavymyocytefibers4-24hCoagulativenecrosis1-4dNeutrophilicinfiltrate4-7dMacrophages7-28dGranulationtissueMonthsFibroticscar642021/3/26生化改变30min,糖原减少或消失肌红蛋白、肌凝蛋白、肌钙蛋白肌酸磷酸激酶（CK）、AST、LDH1652021/3/26合并症乳头肌功能失调或断裂心脏破裂室壁瘤附壁血栓急性心包炎662021/3/26ComplicationsHeartfailureCardiacruptureVentricularaneurysmMuralthrombusandthromboembolismCardiogenics