Title: Atherosclerosis
1The only person who never makes a mistake is
the person who never does anything! - Theodore
Roosevelt
2Anatomy of Heart
3Circulation
4Coronary Arteries
5Pathology of CVS
- Dr. Venkatesh Murthy Shashidhar
- Senior Lecturer in Pathology
- Fiji School of Medicine.
6Major Disorders of CVS
- Atherosclerosis
- Hypertension
- Myocardial Infarction (MI)
- Stroke
- IHD - Ischemic Heart Disease
- VHD - Valvular Heart Disease
- RHD Rheumatic Heart Disease
- CHD - Congenital Heart Disease
7Atherosclerosis
- Chronic inflammatory disorder of intima of large
blood vessels characterised by formation of
fibrofatty plaques called atheroma. - Hardening of arteries - Arteriosclerosis
8Arteriosclerosis - Classification
9Introduction
- Large elastic arteries Starts in Intima
- Fat deposits, Hardening and destruction.
- Major cause of IHD, MI Stroke.
- Incidence is decreasing since 1995
- Better understanding Change in life style.
10Pathogenesis
- Unknown etiology Hyperlipidemia, life style,
hypertension, smoking, genetic etc. - Starts with Initial intimal injury,
inflammation, necrosis, Lipid accumulation,
Fibrosis - Atheroma. - Leads to Obstruction or destruction of vessel
- Organ damage due to ischemia.
- Complications - Thrombosis, embolism, aneurism,
dissection rupture.
11Common Sites
- Aorta, Carotid Iliac. (large vessels)
- Major Vessels - Heart, Brain Kidney.
- Coronary
- Renal
- Abdominal
- Limbs
12Morphology
- Fatty Dots
- Fatty Streaks
- Atheromatous Soft Plaque
- Fibrofatty Hard Plaque
- Complications
- Ulceration, Rupture,Hemorrhage, Thrombosis
- Atheroemboli or cholesterol emboli.
13Stages of Atheroma - Aorta
Stage VI III II
14Coronary Atherosclerosis
15Coronary Narrowing in Atherosclerosis
16Atheroma Aorta
17Atheroma Coronary Artery
18Atheroma Coronary Artery
19Thrombosis Coronary Artery
20Angiogram - Embolism Infarction
21Middle Cerebral A - Thrombosis
22Coronary Thrombosis With Infarction
23Subarachnoid Haemorrhage
24Cerebral Infarction (Stroke)
Haemorrhagic Necrosis
25(No Transcript)
26Risk Factors
- Non modifiable
- Age middle to late.
- Sex Males, complications
- Genetic - Hyperchol.
- Family history.
- Potentially Modifiable
- Hyperlipidemia HDL/LDL ratio.
- Hypertension.
- Smoking.
- Diabetes
- Life style, diet, excercise
27Hyperlipidemia
- Hypercholesterolemia Risk
- Hypertriglyceridemia - less significant
- LDL Increased risk
- HDL lowers the risk Reverse transport
- Mobilises the cholesterol from tissues to liver.
28Good Fats
- Mono unsaturated fats
- Poly unsaturated fats
- Omega-3 fatty acids (Fish)
29"Pleasure in the job puts perfection in the
work." -- Aristotle
30Pathology of Hypertension
- Dr. Venkatesh M. Shashidhar.
- Senior Lecturer in Pathology
- Fiji School of Medicine
31Introduction
- Sustained increase in blood pressure
- Systolic gt140 Diastolic gt 90 mm of Hg
- 25 of general population..!! (5)
- Chronic, end organ vascular damage
- disastrous late complications.
- Atherosclerosis, IHD, Renal damage, Stroke
32Hypertension - Introduction
- Affects Blood vessels ? organ damage.
- Silent Killer late symptoms dizziness,
headache, and visual difficulties. - It is the leading risk factor
- Number one reason for drug prescription.
- lt35 unaware, 21 have good control..!
- Complications bring to diagnosis but late
33Regulation of BP
- BP Cardiac Output x Peripheral Resistance
- Endocrine Factors
- Renin, Angiotensin, ANP, ADH, Aldosterone.
- Neural Factors
- Sympathetic Parasympathetic
- Blood Volume
- Sodium, Mineralocorticoids, ANP
- Cardiac Factors
- Heart rate Contractility.
34Control of Blood Pressure
Vasoconstrictors Angiotensin II Catecholamines
Blood Volume Na, Aldosterone
- Neural Factors
- Adrenergic Cons
- ß Adrenergic - Dil
Cardiac Factors Rate Contract..
35Kidney Disease Hypertension
Kidney Disease
Low - GFR
Renin
Angiotensin
Aldosterone
Vasoconstriction
Sodium Retention
Hypertension
36Severity of Hypertension
Normal lt140 lt90 Stage 1 (mild) 140-159
90-99 Stage 2 (mod.) 160-179 100-109 Stage 3
(severe) 180-209 110-119 Stage 4 (very severe)
gt210 gt120 Malignant Hypertension? Rapid Severe
37Classification
- Primary or Essential Hypertension(95)
- Unknown multifactorial.
- Secondary Hypertension (5-10)
- Renal GN, RAS, Renin tumors
- Endocrine Cushing, OCP, Thyrotoxicosis Myxdema,
Pheochromocytoma, Acromegaly.
38Organ Damage
- Blood Vessels
- Atherosclerosis, Arteriolosclerosis,
- Heart
- LVH, IHD, MI.
- Kidney
- Nephrosclerosis
- Eyes
- Retinopathy
- Brain
- Stroke
39Left ventricular Hypertrophy
Left Ventricular Hypertrophy
40Hyaline Arteriolosclerosis
41Hyperplastic Arteriolosclerosis
Narrow Lumen
Onion Skin Thickening Of arterioles.
42Cerebral Infarction - Stroke
43Benign Nephrosclerosis
Leathery Granularity due to minute scarring
44Renal Artery stenosis - Atrophy
Leathery Granularity Benign Nephrosclerosis
45Normal Retina - Fundoscopy
46Hypertensive Retinopathy
47Conclusions
- Persistent increased blood pressure
- 95 Essential, 5 secondary Kidney dis.
- Vessel damage ? Ischemia or Infarction
- Kidney, Brain, Heart Eyes.
- Complicates Atherosclerosis, Diabetes, IHD
48Thank you