回帖：Chapter 6 Diseases of Cardiovascular System
§1. Atherosclerosis (AS)
1. Etiology and pathogenesis
(1)Risk factors
①Hyperlipidemia
②Hypertension
③Smoking
④Diabetes and hyperinsulimemia
⑤Heredity: LDL-receptor gene mutation → LDL↑ → familial hypercholesterolemia
⑥Others: Age, Sex, Obesity
(2)Pathogenesis
①Response to injury hypothesis
②Lipid infiltration hypothesis
③The role of macrophage hypothesis
2. Morphology
(1)Basic pathologic changes
①Fatty streak
·Gross: yellow flat spots or streaks, slightly raised
·LM: composed of lipid-filled foam cells (Macrophage, SMC)
②Fibrous plaque
·Gross: irregular grey-white raised plaque
·LM: Fibrous cap: hyaline degeneration of collagen, SMC embed in ECM
foam cells, lipid, inflammatory cells
③Atheromatous plaque (atheroma)
·Gross: whitish yellow irregular elevated plaque
·LM: Surface: fibrous cap
Center: amorphous necrotic substance, lipid, cholesterol crystal, calcification
Surrounding: granulation tissue, lymphocytes, foam cells
Media: become thin
(2)Complicated lesion
①Hemorrhage in plaque
②Rupture of plaque
③Thrombosis → infarction
④Calcification
⑤Aneurysm formation
3. Lesions in principal arteries
(1)Aorta: aneurysm
(2)Coronary artery: coronary heart disease
(3)Carotid artery and Cerebral artery
·Ischemic atrophy of brain
·Infarction: thrombosis
·Hemorrhage: aneurysm (Willis circle)
(4)Renal artery
(5)Artery of extremities: claudication, gangrene
(6)Mesenteric artery
§2. Coronary atherosclerosis and coronary heart disease
1. Coronary atherosclerosis
(1)Distribution: Left anterior descending coronary artery > Right coronary artery > Left coronary artery > Left circumflex coronary artery
(2)Features: crescent plaque of myocardial side, eccentric stenosis
(3)Grades: Ⅰ < 25%
Ⅱ 26%-50%
Ⅲ 51%-75%
Ⅳ > 76%
2. Coronary heart disease (CHD)
(1)Angina pectoris
·Pathogenesis: Acute, temporarily, comparatively coronary arterial blood supply↓
Cardiac oxygen demand↑
·Clinical types
①Stable angina pectoris
②instable angina pectoris
③Variant angina pectoris (Prinzmetal angina pectoris)
(2)Myocardial infarction (MI)
①Subendocardial myocardial infarction
·Concept: the area of ischemic necrosis limited to the inner 1/3 and involves papillary muscle, trabeculae carnae
·Circumferential infarction
②Transmural myocardial infarction (regional myocardial infarction)
·Concept: the area of ischemic necrosis involves the full or nearly full (>2/3) thickness of the ventricular wall
·Lesion: Anemic infarct
·Lab: CPK↑, LDH↑, SGPT↑, SGOT↑
③Complication
·Heart failure
·Myocardial rupture
·Ventricular aneurysm
·Mural thrombosis
·Cardiogenic shock
·Acute pericarditis
·Arrhythmias
(3)Myocardial fibrosis
·Cause: moderate-severe stenosis of the coronary artery
·Van Gieson stain: fibrosis (red), myocardium (yellow)
(4)Sudden coronary death
§3. Hypertension
1. Etiology and pathogenesis
(1)Etiology
①Genetic factors
②Diet: intake of sodium↑
③Psychological factors: stress
④Others: obesity, smoking, age↑
(2)Pathogenesis
①Renal retention of excess sodium
②Functional vasoconstriction
③Structural hypertrophy
2. Pathologic changes
(1)Benign hypertension (Chronic hypertension)
①Stage of functional disturbance
·Arteriole: temporal spasm, without structural changes
·Clinical feature