Post on 06-Apr-2018
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AtherosclerosisISCHEMIC CHEART
DISEASE
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Atherosclerosis
ATHEROSCLEROSIS IS THE CHRONICDISEASE WITH THE LIPID AND PROTEIN
ABNORMAL METABOLISMS, WITH THE
DISTRUCTION OF LARGE ARTERIES ANDAORTA, AND WITH A FORMATION OFATHEROSCLEROTIC PLAQUES.
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ATHEROSCLEROTIC PLAQUE
NORMAL ARTERY
ATHEROSCLEROTICPLAQUE
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Atherosclerosis
COMMON RISK FACTORS ARE
1 INCREASING AGE
2 MALE GENDER3 FAMILY HISTORY
4 GENETIC ABNORMALITIRS
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Atherosclerosis
POTENTIAL CONTROLLABLE RISKFACTORS ARE
1 HYPERLIPIDEMIA
2 HYPERTENTION
3 DIABETES MELLITUS
4 CIGARETTE SMOKING
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Atherosclerosis
OTHER RISK FACTORS ARE
1 OBESITY
2 PHYSICAL INACTIVITY
3 STRESS
4 POSTMENOPOUSAL ESTROGEN DEFICIENCY
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Atherosclerosis
OTHER RISK FACTORS ARE5 HIGH CARBOHYDRATE INTAKE
6 LIPOPROTEINS
7 HARDENED UNSATURATED FAT INTAKE
8 CHLAMYDIA PNEUMONIA
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Pathogenesis ofAtherosclerosis
According to injury hypothesisconsiders
atherosclerosis to be a chronicinflammatory
Response of the arterial wallinitiated by injury:
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Pathogenesis ofAtherosclerosis
1 chronic endothelial injury
2 insudation of lipoproteins [LDL]
3 modification of lipoproteins byoxidation
4 adhesion of blood monocytes5 adhesion of platelets
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Pathogenesis ofAtherosclerosis
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 andextra cellular lipids
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ATHEROSCLEROTIC PLAQUE
The change of the large arterialintima is called atherosclerotic plaqueor atheroma
atherosclerotic plaque is the intimalthickening with lipid accumulation
It consists of fibrous cap, necrotic coreand fibrous basis.
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atherosclerotic plaque
It has three principle components:
1 cellssmooth muscle cells, macrophages
other leukocytes2 Extra cellular matrix- collagen, elastic fibers,
proteoglycans
3 Intra cellular and extra cellular lipids
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There are two types of atheroscleroticplaque
1 vulnerable
2 stable
atherosclerotic plaque
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atherosclerotic plaque
1 vulnerable 2 STABLE
THERE AREA LOT OF LIPIDS
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Progress stages of atheroscleroticplaques according to infiltrative
theory 1 Prelipidosis
2 Lipidosis
3 Sclerosis
4 Atheromatosis
5 Ulceration 6 Calcinosis
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2 stage is called lipidosis
aorta
Lipid strips
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3 stage is called sclerosis
Artery with atherosclerotic plaque
Atherosclerotic plaque with sclerosis
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4 stage is called atheromatosis6 stage is called calcinosis
Atheromatosis or porridge-likesubstance
calcinosis
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FORMS OF ATHEROSCLEROSIS
CEREBRAL ARTERIES INJURY
CARDIAC ARTERIES INJURY
RENAL ARTERIES INJURYAORTA INJURY
INTESTINAL ARTERIES INJURY
EXTREMITY ARTERIES INJURY
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ACUTE
FORM MAYBE WITH
THROMBOSIS OR
EMBOLISM ONULCERED PLAQUE
ISCHEMIC INFARCTION
CEREBRAL FORM OFATHEROSCLEROSIS
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CEREBRAL FORM OFATHEROSCLEROSIS
Acute form may be as Hemorrhage withinThe brain due to ruptureOf atherosclerotic aneurism
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CEREBRAL FORM OFATHEROSCLEROSIS
Chronic form may be as encephalopathy
With cerebral atrophy (decreasing memory)
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RENAL FORM OFATHEROSCLEROSIS
Acute form may be asinfarction
Chronic form is called
Atherosclerotic
Nephrosclerosis or
Primary contracted
kidney
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Aortic form of atherosclerosis
Various forms of aorta lesion
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Aortic form of atherosclerosis
Complications of atherosclerotic plaqueconnect with its ulceration. There are
Aneurism
Rupture of atherosclerotic plaque withretroperitoneal hematoma
Thrombosis, the most feared complication Cholesterol or thrombus embolism
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Intestinal form of atherosclerosis
Acute form may be asgangrenous necrosisof the intestine
Chronic form may beas ischemicenterocolitis
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Extremity form of atherosclerosis
Acute form may be as gangrenousnecrosis.
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Extremity form of atherosclerosis
Chronic form withmuscle atrophymay be as
Dejerine'ssyndrome[chronic
peripheralvascular disease]
Muscle fiber atrophy
Trichrome stain
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Cardiac form of atherosclerosis
Acute form occurs as myocardial infarction
or acute ischemic heart disease
Chronic form consists of chronic forms ofischemic heart disease
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ISCHEMIC HEART DISEASE
Ischemic heart diseaserefers to a group of closely
related syndromes causedby an imbalance between
the myocardial oxygendemand and the blood
supply.
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ISCHEMIC HEART DISEASE
SYNONYMS ARE CORONARY HEARTDISEASE AND
CORONARY ARTERY DISEASE
A PICK INCIDENCE IS AFTER 50 YEARS INMEN AND 60 YEARS IN WOMEN
90% OF ALL INCIDENCES ARE CAUSEDBY CORONARY ARTERY NARROWING
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ISCHEMIC HEART DISEASE
Classification is followed
Acute types:
1 stenocardia (angina pectoris)2 sudden cardiac death3 acute coronary insufficiency4 myocardial infarction
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ISCHEMIC HEART DISEASE
Classification is followed
Chronic types are as follow
1 gross post infarctioncardiosclerosis
2 diffused atheroscleroticcardiosclerosis
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ISCHEMIC HEART DISEASE
RISK FACTORS OF ISCHEMIC HEARTDISEASE ARE AS FOLLOW
1 HYPERLIPIDEMIA
2 SMOKING 3 ARTERIAL HYPERTENTION
4 DECREASING OF PHYSICAL ACTIVITY
5 OBESITY 6 HIGH CALORIES DIET
7 STRESS
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ISCHEMIC HEART DISEASE
ETIOLOGY OCCURS IN CORONARY ARTERYLUMEN:
1 ATHEROSCLEROTIC STENOSIS
2 CORONARY ARTERY THROMBOSIS
3 CORONARY ARTERY EMBOLISM
4 CORONARY ARTERY SPASM FOR ALONG TIME
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The general role is played by localatherosclerotic plaque
75% reductionblood suplay is
followed byatheroscleroticplaque in the
lumen ofcoronaryarteries.
Thrombosis of coronary artery
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Thrombosis of coronary arteryoccurs in 90% with transmural
infarction
Occlusive thrombus RecurrentTransmuralinfarction
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Sources of Thromboembolismoccurs from
1 cardiac muralthrombus onendocardium coveringtransmural or
subendocardialinfarction
2 mural thrombus on
atherosclerotic plaqueof aortic sinus closedto coronary arterymouth
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PROLOGGED CORONARY ARTERYSPASM
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 ofmyocardial ischemia.
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Stages of myocardial infarction
1 ischemic stage
2 necrosis
3 scarring
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MYOCARDIAL INFARCTION
This is an earlyacute myocardialinfarction
less then 1 day
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MYOCARDIAL INFARCTION
This is an acutemyocardial
infarction ofseveral daysduration
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MYOCARDIAL INFARCTION
The granulationtissue seen here ismost prominent from
2 to 3 weeksfollowing onset ofinfarction.
Scar formation by 8week
l f f d l
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Classification of myocardialinfarction
According to the time:
1 primary
2 reccurent (within 6 weeks afterprimary)
3 second (after 6 weeks fromprimary)
Cl f f d l
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Classification of myocardialinfarction
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 morewall and even right ventricle lesion.
Cl ifi i f di l
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Classification of myocardialinfarction
According to wall thickness of left ventricle
1 transmural infarction
2 subendocardial infarction3 mural one
4 subepicardial one
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COMPLICATIONS OF THEINFARCTION
1Papillary muscle dysfunction
2Papillary muscle rupture
3External rupture of the infarction4Rupture of the ventricle septum
5Mural thrombosis
6Acute fibrinous pericarditis7Ventricle aneurisms (acute, chronic)
The causes of death
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The causes of death
1 Cardiac arrhythmias2 Cardiogenic shock3 Left ventricle failure4 Rupture of wall, septum, papillary
muscle5 Thromboembolism within artery
blood stream
COMPLICATIONS OF THE
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COMPLICATIONS OF THEINFARCTION
Aneurisms of left ventricle
Acute aneurismwith mural thrombus
Chronic aneurism
COMPLICATIONS OF THE
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COMPLICATIONS OF THEINFARCTION
Rupture of cardiacwall in
the infarction zonewithHemopericardium
andheart tamponade
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THE END