Atherosclerosis

ISCHEMIC CHEART DISEASE

Atherosclerosis

ATHEROSCLEROSIS IS THE CHRONIC DISEASE WITH THE LIPID AND PROTEIN ABNORMAL METABOLISMS, WITH THE DISTRUCTION OF LARGE ARTERIES AND AORTA, AND WITH A FORMATION OF ATHEROSCLEROTIC PLAQUES.

ATHEROSCLEROTIC PLAQUE

NORMAL ARTERY ATHEROSCLEROTIC

PLAQUE

Atherosclerosis
COMMON

RISK FACTORS ARE

1 2 3 4

INCREASING AGE MALE GENDER FAMILY HISTORY GENETIC ABNORMALITIRS

Atherosclerosis
POTENTIAL CONTROLLABLE RISK FACTORS ARE 1 HYPERLIPIDEMIA 2 HYPERTENTION 3 DIABETES MELLITUS 4 CIGARETTE SMOKING

Atherosclerosis
OTHER
1 OBESITY

RISK FACTORS ARE

2 PHYSICAL INACTIVITY
3 STRESS 4 POSTMENOPOUSAL ESTROGEN DEFICIENCY
6

Atherosclerosis
OTHER RISK FACTORS ARE 5 HIGH CARBOHYDRATE INTAKE

6 LIPOPROTEINS
7 HARDENED UNSATURATED FAT INTAKE 8 CHLAMYDIA PNEUMONIA
7

Pathogenesis of Atherosclerosis
According

considers atherosclerosis to be a chronic inflammatory Response of the arterial wall initiated by injury:

to injury hypothesis

Pathogenesis of Atherosclerosis
chronic endothelial injury 2 insudation of lipoproteins [LDL] 3 modification of lipoproteins by oxidation 4 adhesion of blood monocytes 5 adhesion of platelets

Pathogenesis of Atherosclerosis
6 migration of smooth muscle cells from the media into the intima 7 proliferation of smooth muscle cells in the intima 8 enhanced accumulation of intra and extra cellular lipids
10

ATHEROSCLEROTIC PLAQUE
The

change of the large arterial intima is called atherosclerotic plaque or atheroma atherosclerotic plaque is the intimal thickening with lipid accumulation

It consists of fibrous cap, necrotic core and fibrous basis.

11

atherosclerotic plaque
It has three principle components: 1 cells smooth muscle cells, macrophages other leukocytes 2 Extra cellular matrix- collagen, elastic fibers, proteoglycans 3 Intra cellular and extra cellular lipids

12

atherosclerotic plaque

There are two types of atherosclerotic plaque

vulnerable 2 stable

13

atherosclerotic plaque

1 vulnerable 2 STABLE

THERE ARE A LOT OF LIPIDS

14

Progress stages of atherosclerotic plaques according to infiltrative theory

1 2 3 4 5 6

Prelipidosis Lipidosis Sclerosis Atheromatosis Ulceration Calcinosis

15

2 stage is called lipidosis

aorta

Lipid strips

16

3 stage is called sclerosis

Artery with atherosclerotic plaque

Atherosclerotic plaque with sclerosis

17

4 stage is called atheromatosis 6 stage is called calcinosis

calcinosis

Atheromatosis or porridge-like substance

18

FORMS OF ATHEROSCLEROSIS
CEREBRAL

ARTERIES INJURY CARDIAC ARTERIES INJURY RENAL ARTERIES INJURY AORTA INJURY INTESTINAL ARTERIES INJURY EXTREMITY ARTERIES INJURY
19

CEREBRAL FORM OF ATHEROSCLEROSIS

ACUTE FORM MAY BE WITH THROMBOSIS OR EMBOLISM ON ULCERED PLAQUE

ISCHEMIC INFARCTION

20

CEREBRAL FORM OF ATHEROSCLEROSIS

Acute form may be as Hemorrhage within The brain due to rupture Of atherosclerotic aneurism

21

CEREBRAL FORM OF ATHEROSCLEROSIS

Chronic form may be as encephalopathy With cerebral atrophy (decreasing memory)

22

RENAL FORM OF ATHEROSCLEROSIS

Acute form may be as infarction

Chronic form is called Atherosclerotic Nephrosclerosis or Primary contracted kidney

23

Aortic form of atherosclerosis

Various forms of aorta lesion

24

Aortic form of atherosclerosis

Complications of atherosclerotic plaque connect with its ulceration. There are Aneurism Rupture of atherosclerotic plaque with retroperitoneal hematoma Thrombosis, the most feared complication Cholesterol or thrombus embolism

25

Intestinal form of atherosclerosis

Acute form may be as gangrenous necrosis of the intestine

Chronic form may be as ischemic enterocolitis

26

Extremity form of atherosclerosis

Acute form may be as gangrenous necrosis.

27

Extremity form of atherosclerosis

Chronic form with muscle atrophy may be as Dejerine's syndrome [chronic Muscle fiber atrophy peripheral vascular disease] Trichrome stain
28

Cardiac form of atherosclerosis

Acute form occurs as myocardial infarction or acute ischemic heart disease

Chronic form consists of chronic forms of ischemic heart disease

29

ISCHEMIC HEART DISEASE

Ischemic

heart disease refers to a group of closely related syndromes caused by an imbalance between the myocardial oxygen demand and the blood supply.

30

ISCHEMIC HEART DISEASE

SYNONYMS ARE CORONARY HEART DISEASE AND CORONARY ARTERY DISEASE

A PICK INCIDENCE IS AFTER 50 YEARS IN MEN AND 60 YEARS IN WOMEN 90% OF ALL INCIDENCES ARE CAUSED BY CORONARY ARTERY NARROWING

31

ISCHEMIC HEART DISEASE

Classification is followed

Acute 1 2

types:

stenocardia (angina pectoris) sudden cardiac death 3 acute coronary insufficiency 4 myocardial infarction
32

ISCHEMIC HEART DISEASE

Classification

is followed

Chronic

types are as follow 1 gross post infarction cardiosclerosis 2 diffused atherosclerotic cardiosclerosis
33

ISCHEMIC HEART DISEASE

RISK FACTORS OF ISCHEMIC HEART DISEASE ARE AS FOLLOW 1 HYPERLIPIDEMIA 2 SMOKING 3 ARTERIAL HYPERTENTION 4 DECREASING OF PHYSICAL ACTIVITY 5 OBESITY 6 HIGH CALORIES DIET 7 STRESS

34

ISCHEMIC HEART DISEASE

ETIOLOGY OCCURS IN CORONARY ARTERY LUMEN:

1 ATHEROSCLEROTIC STENOSIS 2 CORONARY ARTERY THROMBOSIS 3 CORONARY ARTERY EMBOLISM 4 CORONARY ARTERY SPASM FOR A LONG TIME
35

The general role is played by local atherosclerotic plaque

75%

reduction blood suplay is followed by atherosclerotic plaque in the lumen of coronary arteries.
36

Thrombosis of coronary artery occurs in 90% with transmural infarction

Occlusive thrombus

Recurrent Transmural infarction

37

Sources of Thromboembolism occurs from

cardiac mural thrombus on endocardium covering transmural or subendocardial infarction

1

2 mural thrombus on atherosclerotic plaque of aortic sinus closed to coronary artery mouth
38

PROLOGGED CORONARY ARTERY SPASM

Reperfusion

of the myocardium leads to added perfuse as reversible then irreversible lesions of the myocardium. Increased myocardial oxygen demand with functional overexertion may also contribute to the development of myocardial ischemia.
39

Stages of myocardial infarction

1 ischemic stage 2 necrosis

3 scarring

40

MYOCARDIAL INFARCTION

This is an early acute myocardial infarction less then 1 day

41

MYOCARDIAL INFARCTION
This

is an acute myocardial infarction of several days duration

42

MYOCARDIAL INFARCTION

The granulation tissue seen here is most prominent from 2 to 3 weeks following onset of infarction.

Scar formation by 8 week

43

Classification of myocardial infarction

According to the time:

1 primary 2 reccurent (within 6 weeks after primary) 3 second (after 6 weeks from primary)
44

Classification of myocardial infarction

According to the location: 1 anterior and apical left ventricle 2 anterior intraventricle septum 3 posterior wall and posterior third of the intraventricle septum 4 lateral wall 5 papillary muscles 6 enlarge infarct with lesion two or more wall and even right ventricle lesion.
45

Classification of myocardial infarction

According to wall thickness of left ventricle

1 2 3 4

transmural infarction subendocardial infarction mural one subepicardial one

46

COMPLICATIONS OF THE INFARCTION

1Papillary

muscle dysfunction 2Papillary muscle rupture 3External rupture of the infarction 4Rupture of the ventricle septum 5Mural thrombosis 6Acute fibrinous pericarditis 7Ventricle aneurisms (acute, chronic)
47

The causes of death

1

Cardiac arrhythmias 2 Cardiogenic shock 3 Left ventricle failure 4 Rupture of wall, septum, papillary muscle 5 Thromboembolism within artery blood stream
48

COMPLICATIONS OF THE INFARCTION

Aneurisms of left ventricle

Acute aneurism with mural thrombus

Chronic aneurism
49

COMPLICATIONS OF THE INFARCTION

Rupture of cardiac wall in the infarction zone with Hemopericardium and heart tamponade

50

THE END

51