Download Atherosclerosis

Cardiovascular diseases
pathology
Vascular diseases
Atherosclerosis
A disease that results in arterial wall
thickens as a result of build- up of fatty
materials such cholesterol, resulting in
acute and chronic luminal obstruction
with accumulation of inflammatory
cell, macrophages, abnormal blood
flow, and diminished oxygen supply.
Atherosclerosis
causes
- diabetes mellitus
- heavy alcohol abuse
- high blood pressure
- high blood cholesterol level
- high fat diet
- increasing age
- obesity
- family history
- smoking
Atherosclerosis
Signs and symptoms
* atherosclerosis begins in early age, but it is usually
asymptomatic in the early stages
* in about 65% of patients with atherosclerosis, the
first symptom in cardiovascular
and heart attack.
* most arterial flow disrupting events
occur at location with less than 50%
lumen narrowing
Atherosclerosis
other signs and symptoms
1. stroke ;could be reversible and undesirable, dependent
to the duration of the ischemic attack. and the degree of the
obstruction
2. peripheral vascular disease: present with severe pain,
pallor, and parasthesia of the extremities with involved
blood vessel
3. renal artery stenosis: can cause high blood pressure
4. Mesenteric angina: characterized by epigastric and
periumbilical postprandial pain, sometime with
melena and hematomesis.
5. Abdominal aortic aneurysm: is often fetal
Atherosclerosis
Pathophysiology
-
accumulation of cholesterol, calcium, inflammatory
cells with the intima of vessel wall called
atheroma
- After long time , the atheroma ulcerates( before
ulceration the disease usually asymptomatic)
- After atheroma ulceration, the contents go out,
activate clot formation within the narrowed lumen
- Complete blocking leads to ischemia of specific
organs.
Diagnosis
Stress test
angiography
Myocardial infarction
Myocardial infarction
Is an irreversible necrosis of heart
muscle secondary to prolonged ischemia
and imbalance of oxygen supply and
demand.
Myocardial infarction
* the leading cause of death worldwide
* there is a male predominance
* premenopausal women has some protection
due to estrogen effect
* the disease increases with age
* most patients who develop an acute myocardial
infarction are older than 50 years
Myocardial infarction
Symptoms
1. Chest pain, retrosternal, compressing, continuous,
radiating to the left arm, associated with nausea,
vomiting and profuse sweating .
2. Shortness of breathing
3. Atypical symptoms: abdominal pain, back pain,
jaw pain, altered mental status.
Myocardial infarction
Diagnosis
1. Typical chest pain
2. Electrocardiogram changes
3. Elevated cardiac enzymes
4. Cardiac catheterization
(diagnosis and treatment)
Myocardial infarction
classification
1. Transmural: extends through the
whole thickness of the heart muscle,
associated with atherosclerosis and
occlusion of large artery
2.subendocardial: involving a small
area in the subendocardial wall of the
left ventricle, and associated with
occlusion or narrowing of small artery.
Endocarditis
Endocarditis is an infection of the
endocardial surface. Can involve
one or more heart valves
divided into:
1. Native valves endocarditis: usually
aggressive disease (staph. Or strep.)
2. Prosthetic valve endocarditis:
early endocarditis (within 60days after valve surgery)
late endocarditis (after 60 days after valve surgery)
3. Endocarditis related to intravenous drug use:
usually involve the tricuspid valve (right side)
Endocarditis
symptoms
. Fever in more than 90%of patients
. Cordial signs, valvular insufficiency and heart failure
. Neurological signs (stroke) in 20% of patients, due to
trauma of the endocardium and bacterial embolic stroke
. Wight loss, headache, night sweat and joint pain
Endocarditis
Important findings
- New cardiac murmur
- Petechial skin rash
- splinter hemorrhage
- splenomegaly
Myocarditis
Myocarditis is an inflammation
of heart muscle (myocardium),
which can give the same clinical
picture as myocardial infarction
The cardiac muscle is damaged
by inflammatory infiltration with
out blockage of coronary artery
Myocarditis can cause cell death
(necrosis), or can be reversible
Myocarditis
Causes
• Infections, viruses are the most common,
bacterial, fungal, parasitic
•Toxins
drug toxicity such as chemotherapy
•Immunological reactions
rheumatic conditions, allergies
Myocarditis
Symptoms and diagnosis
* Can present with chest pain which mimic the
pain due to myocardial infarction
* The patients commonly developed heart failure
* Cardiac enzymes are usually elevated
*Electrocardiogram can help to
differentiate from myocardial
infarction
* In some cases myocardial
biopsy is needed for diagnosis
Pericarditis and cardiac tamponade
Pericarditis is the inflammation of
pericardium which can case fluid accumulation
in the pericardial space
Cardiac tamponade is an urgent condition
characterized by huge amount of fluid
accumulation within the pericardial space , and
case cardiac diastolic dysfunction, and severe
Haemodynamic abnormality such as
hypotension and shock
Pericarditis and cardiac tamponade
Causes
1. Traumatic (hemorrhagic)
2. Viral causes
3. Bacterial causes
4. Systemic causes
Pericarditis and cardiac tamponade
Signs and symptoms
Pericarditis
•Sharp sudden onset chest pain
•The pain usually increased by movement
or inspiration
•Low grade fever
•Pericardial friction rub
Pericarditis and cardiac tamponade
Signs and symptoms
Cardiac tamponade
-Severe hypotension
-Severe tachycardia
-Cyanosis
-Decreased level of consciousness
Pericarditis and cardiac tamponade
diagnosis
* echocardiogram: the best test to
detect fluid collection
* chest X-ray
Thank you
TOXOPLASMA LYMPHADENITIS
Differential diagnosis
Leshmanial lymphadenitis: discrete
granulomas with giant cells are seen.
Other causes of glaucomatous
lymphadenitis, cat scratch disease,
sarcoidosis, mycobacteria, syphilis:
significant areas of necrosis and true
granuloma formation are unusual in
toxoplasma.
quantitative analysis of the calculi
29.2% melamine
52.2% urice acid
18.% unidentifiable