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Atherosclerosis

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Major cause of IHD, MI & Stroke. Incidence is decreasing since 1995 ... Atherosclerosis, IHD, Renal damage, Stroke. Hypertension - Introduction ... – PowerPoint PPT presentation

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Title: Atherosclerosis


1
The only person who never makes a mistake is
the person who never does anything! - Theodore
Roosevelt
2
Anatomy of Heart
3
Circulation
4
Coronary Arteries
5
Pathology of CVS
  • Dr. Venkatesh Murthy Shashidhar
  • Senior Lecturer in Pathology
  • Fiji School of Medicine.

6
Major 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

7
Atherosclerosis
  • Chronic inflammatory disorder of intima of large
    blood vessels characterised by formation of
    fibrofatty plaques called atheroma.
  • Hardening of arteries - Arteriosclerosis

8
Arteriosclerosis - Classification
9
Introduction
  • 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.

10
Pathogenesis
  • 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.

11
Common Sites
  • Aorta, Carotid Iliac. (large vessels)
  • Major Vessels - Heart, Brain Kidney.
  • Coronary
  • Renal
  • Abdominal
  • Limbs

12
Morphology
  • Fatty Dots
  • Fatty Streaks
  • Atheromatous Soft Plaque
  • Fibrofatty Hard Plaque
  • Complications
  • Ulceration, Rupture,Hemorrhage, Thrombosis
  • Atheroemboli or cholesterol emboli.

13
Stages of Atheroma - Aorta
Stage VI III II
14
Coronary Atherosclerosis
15
Coronary Narrowing in Atherosclerosis
16
Atheroma Aorta
17
Atheroma Coronary Artery
18
Atheroma Coronary Artery
19
Thrombosis Coronary Artery
20
Angiogram - Embolism Infarction
21
Middle Cerebral A - Thrombosis
22
Coronary Thrombosis With Infarction
23
Subarachnoid Haemorrhage
24
Cerebral Infarction (Stroke)
Haemorrhagic Necrosis
25
(No Transcript)
26
Risk 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

27
Hyperlipidemia
  • Hypercholesterolemia Risk
  • Hypertriglyceridemia - less significant
  • LDL Increased risk
  • HDL lowers the risk Reverse transport
  • Mobilises the cholesterol from tissues to liver.

28
Good Fats
  • Mono unsaturated fats
  • Poly unsaturated fats
  • Omega-3 fatty acids (Fish)

29
"Pleasure in the job puts perfection in the
work." -- Aristotle
30
Pathology of Hypertension
  • Dr. Venkatesh M. Shashidhar.
  • Senior Lecturer in Pathology
  • Fiji School of Medicine

31
Introduction
  • 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

32
Hypertension - 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

33
Regulation 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.

34
Control of Blood Pressure
Vasoconstrictors Angiotensin II Catecholamines
Blood Volume Na, Aldosterone
  • Neural Factors
  • Adrenergic Cons
  • ß Adrenergic - Dil

Cardiac Factors Rate Contract..
35
Kidney Disease Hypertension
Kidney Disease
Low - GFR
Renin
Angiotensin
Aldosterone
Vasoconstriction
Sodium Retention
Hypertension
36
Severity 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
37
Classification
  • Primary or Essential Hypertension(95)
  • Unknown multifactorial.
  • Secondary Hypertension (5-10)
  • Renal GN, RAS, Renin tumors
  • Endocrine Cushing, OCP, Thyrotoxicosis Myxdema,
    Pheochromocytoma, Acromegaly.

38
Organ Damage
  • Blood Vessels
  • Atherosclerosis, Arteriolosclerosis,
  • Heart
  • LVH, IHD, MI.
  • Kidney
  • Nephrosclerosis
  • Eyes
  • Retinopathy
  • Brain
  • Stroke

39
Left ventricular Hypertrophy
Left Ventricular Hypertrophy
40
Hyaline Arteriolosclerosis
41
Hyperplastic Arteriolosclerosis
Narrow Lumen
Onion Skin Thickening Of arterioles.
42
Cerebral Infarction - Stroke
43
Benign Nephrosclerosis
Leathery Granularity due to minute scarring
44
Renal Artery stenosis - Atrophy
Leathery Granularity Benign Nephrosclerosis
45
Normal Retina - Fundoscopy
46
Hypertensive Retinopathy
47
Conclusions
  • Persistent increased blood pressure
  • 95 Essential, 5 secondary Kidney dis.
  • Vessel damage ? Ischemia or Infarction
  • Kidney, Brain, Heart Eyes.
  • Complicates Atherosclerosis, Diabetes, IHD

48
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