Liuyisheng
? The cardiovascular
system is composed
of heart,arterials,
capillaries and veins.
It is the structure
foundation for
keeping blood
circulation,material
exchanges between
blood and tissue and
transmitting
information of body
fluid.
Normal heart
? The structure changes of cardiovascular system
will be responsible for the functional changes
that disturb whole and/or local blood circulation.
The disorders of cardiovascular system affect
the human health and life and are a leading
cause of death in the world.
The valve of
normal heart
Mainly discuss the commonest diseases of
heart and arterials,including,
? ① degenerative vascular disorders
including atherosclerosis,hypertension;
? ② ischemic heart disease including
myocardial infarction;
? ③ myocarditis and cardiomyopathy；
? ④ diseases of the pericarditis；
? ⑤ rheumatic fever；
? ⑥ infective endocarditis；
? ⑦ disorder of cardiac valves
Rheumatic fever (RF)
? This is a multisystem disease and an
acute,often recurrent,inflammatory
disease principally of children that
generally follows a pharyngeal(but
not skin) infection with group A
beta-hemolytic streptococci,
? RF is a systemic disorder affecting,
? ① heart,pericarditis,myocarditis,
and endocarditis;
? ② joint,polyarthritis;
? ③ skin,subcutaneous nodules and
erythema;
? ④ arteries,arteritis.
? Aschoff bodies constitute foci of fibrinoid
necrosis surrounded by lymphocytes,
macrophages,an occasional plasma cell,
and plump,activated” histiocytes called
Anitschkow cells or Aschoff cells,Lesions
stimulate fibroblast proliferation and lead
to scarring,
Aschoff nodule at high magnification,The
most characteristic component is the
Aschoff giant cell,Several appear here as
large cells with two or more nuclei that
have prominent nucleoli,
Rheumatic heart disease
can be classified into three main types：
? 1.rheumatic myocarditis
? 2.rheumatic pearicarditis
? 3.rheumatic pancarditis
Acute rheumatic fever
These warty vegetations average only a few
millimeters and form along the line of valve
closure over areas of endocardial inflammation,
tuberculous pericarditis
Acute rheumatic carditis is marked by a
peculiar form of granulomatous inflammation
with so-called "Aschoff nodules" seen best
in myocardium.,
A fibrinous pericarditis,The surface
appears roughened from the normal
glistening appearance by the strands of
pink-tan fibrin.
The surface of the heart,There are thin
strands of fibrinous exudate that extend from
the epicardial surface to the pericarial sac,
This is typical for a fibrinous pericarditis.
Infective endocarditis
? Infective endocarditis(IE) is
characterized by colonization or
invasion of the heart valves or the
mural endocardium by a
microbiologic agent,leading to the
formation of bulky,friable
vegetations laden with organisms.,
? Traditional IE has been
classified on clinical grounds
into acute and subacute forms,
Both rheumatic heart disease
and infective endocarditis are
common topics in examinations
An acute infective endocarditis on the mitral valve
has spread into the septum all the way to the
tricuspid valve,producing a fistula.
An subacute infective endocarditis,The
aortic valve demonstrates a large,irregular,
reddish tan vegetation,
Microscopically,the valve in infective endocarditis
demonstrates friable vegetations of fibrin and platelets
(pink) mixed with inflammatory cells and bacterial
colonies (blue),The friability explains how portions of
the vegetation can break off and embolize.
the finger at the right are small splinter
hemorrhages in a patient with infective
endocarditis,
Heart valve disease
? Heart valve disease are
characterized principally by
valvular involvement and
disfunction,The functional
disturbances engendered by
valvular disease are stenosis
and insufficiency,
Stenosis is the failure of a valve to open
completely,thereby impeding forward flow,
Insufficiency or regurgitation,in contrast,results
from failure of a valve to close completely,
thereby allowing reversed flow,
valvular stenosis valvular insufficiency
The mitral valve as seen from above in the left atrium,The
mitral valve demonstrates the typical "fish mouth" shape
with chronic rheumatic scarring,
Here is a congenital bicuspid aortic valve,
Most bicuspid valves are prone to
calcification,
An aortic valve need not be bicuspid to calcify,
Sometimes in older adults,a normal tricuspid
aortic valve will undergo calcification,a so-
called "senile calcific aortic stenosis." Nodules
of calcification are seen on the cusps here.
Primary or essential
hypertension
Hypertension is a disease largely
of the vasculature and as a
systolic pressure greater than
140 mmHg or a diastolic
pressure greater than 90 mmHg,
or both.
? There are pathological changes of
vasoconstriction,thickening of the
media,hyaline degeneration and
intimal fibrosis in benign
hypertension and fibrinoid necrosis
of the media with marked intimal
fibrosis and extreme narrowing of
the arteriole in malignant
hypertension.
? Hypertension can be classified
into two main types：
? (1) primary (essential)
hypertension,in which
subtypes are benign and
malignant(accelerated)
hypertension；
? (2) secondary hypertension.
The peripheral coronary arteries may undergo
sclerosis,as seen here in an artery branch with
a very small lumen,with chronic hypertension.
The left ventricle is markedly thickened in this
patient with severe hypertension that was
untreated for many years,The myocardial fibers
have undergone hypertrophy.
This is typical for hypertensive heart disease,Left
ventricle is very thickened (slightly over 2 cm in
thickness).
primary granular atrophy of the kidney
cerebral hemorrhage
Atherosclerosis
? Arteriosclerosis is an
imprecise term meaning
thickening and loss of
elasticity of the arteries
caused by any condition,
and its commonest types
are atherosclerosis (AS),
m?nckeberg’s medial
calcification and
arteriolosclerosis
(arteriolar sclerosis),
? AS is a
disease of
large and
medium-
sized
arteries
that results
in the
progressive
accumulati
on within
the intima
of smooth
muscle
cells and
lipids.
? The lesion of AS includes fatty streak,fibrous
plaque and atheromatous plaque,and the
complicated lesions are plaque rupture and
hemorrhage in plaque,thrombosis,dystrophic
calcification,ulceration,aneurysm formation,
neovasculerization and thinning of the
underlying tunica and media.
? The major
complications
of AS include
ischemic
heart disease,
myocardial
infarction,
stroke and
gangrene of
the
extremities.
The white arrow denotes the most prominent fatty
streak in the photo,but there are other fatty
streaks scattered over the aortic surface,Fatty
streaks are the earliest lesions seen with
atherosclerosis in arteries.
This high magnification of the atheroma shows
numerous foam cells and an occasional cholesterol cleft,
A few dark blue inflammatory cells are scattered within
the atheroma.
fibrous plaque
atheromatous plaque
This is a high magnification of the aortic
atheroma with foam cells and cholesterol
clefts.
thrombosis
Severe atherosclerosis of the aorta in which the
atheromatous plaques have undergone ulceration
along with formation of overlying mural thrombus.
The aorta shows a large overlying atheroma on
the left,Cholesterol clefts are numerous in this
atheroma,The surface on the far left shows
ulceration and hemorrhage,
An atherosclerotic
aneurysm of the aorta
in which a large "bulge"
appears just above the
aortic bifurcation,
The coronary artery shown here has
narrowing of the lumen due to build up of
atherosclerotic plaque,Severe narrowing
can lead to angina,ischemia,and infarction.
Normal coronary artery
Severe degree of narrowing in coronary artery,It
is "complex" in that there is a large area of
calcification on the lower right.
calcification
This is coronary atherosclerosis with the
complication of hemorrhage into atheromatous
plaque
A thrombosis of a coronary artery is shown here in cross
section,This acute thrombosis diminishes blood flow and
leads to infarction.
There is a pink to red recent thrombosis in this narrowed
coronary artery,The open,needle-like spaces in the
atheromatous plaque are cholesterol clefts.
This cross section through the heart demonstrates the
left ventricle on the left,Extending from the anterior
portion and into the septum is a large recent
myocardial infarction,
Left ventricular wall which has been sectioned
lengthwise to reveal a large recent myocardial
infarction,The center of the infarct contains
necrotic muscle that appears yellow-tan,
The earliest change histologically seen with
acute myocardial infarction in the first day is
contraction band necrosis,
Myocardial infarction,there is extensive
hemorrhage along with myocardial fiber necrosis
with contraction bands and loss of nuclei.
Myocardial infarction of 1 to 2 weeks in age,Note that
there are remaining normal myocardial fibers at the top,
Below these fibers are many macrophages along with
numerous capillaries and little collagenization.
The point of rupture of the myocardium is shown with the arrow,
A cross section through the heart reveals a
ventricular aneurysm with a very thin wall at the
arrow,Note how the aneurysm bulges out,
? The cardiovascular
system is composed
of heart,arterials,
capillaries and veins.
It is the structure
foundation for
keeping blood
circulation,material
exchanges between
blood and tissue and
transmitting
information of body
fluid.
Normal heart
? The structure changes of cardiovascular system
will be responsible for the functional changes
that disturb whole and/or local blood circulation.
The disorders of cardiovascular system affect
the human health and life and are a leading
cause of death in the world.
The valve of
normal heart
Mainly discuss the commonest diseases of
heart and arterials,including,
? ① degenerative vascular disorders
including atherosclerosis,hypertension;
? ② ischemic heart disease including
myocardial infarction;
? ③ myocarditis and cardiomyopathy；
? ④ diseases of the pericarditis；
? ⑤ rheumatic fever；
? ⑥ infective endocarditis；
? ⑦ disorder of cardiac valves
Rheumatic fever (RF)
? This is a multisystem disease and an
acute,often recurrent,inflammatory
disease principally of children that
generally follows a pharyngeal(but
not skin) infection with group A
beta-hemolytic streptococci,
? RF is a systemic disorder affecting,
? ① heart,pericarditis,myocarditis,
and endocarditis;
? ② joint,polyarthritis;
? ③ skin,subcutaneous nodules and
erythema;
? ④ arteries,arteritis.
? Aschoff bodies constitute foci of fibrinoid
necrosis surrounded by lymphocytes,
macrophages,an occasional plasma cell,
and plump,activated” histiocytes called
Anitschkow cells or Aschoff cells,Lesions
stimulate fibroblast proliferation and lead
to scarring,
Aschoff nodule at high magnification,The
most characteristic component is the
Aschoff giant cell,Several appear here as
large cells with two or more nuclei that
have prominent nucleoli,
Rheumatic heart disease
can be classified into three main types：
? 1.rheumatic myocarditis
? 2.rheumatic pearicarditis
? 3.rheumatic pancarditis
Acute rheumatic fever
These warty vegetations average only a few
millimeters and form along the line of valve
closure over areas of endocardial inflammation,
tuberculous pericarditis
Acute rheumatic carditis is marked by a
peculiar form of granulomatous inflammation
with so-called "Aschoff nodules" seen best
in myocardium.,
A fibrinous pericarditis,The surface
appears roughened from the normal
glistening appearance by the strands of
pink-tan fibrin.
The surface of the heart,There are thin
strands of fibrinous exudate that extend from
the epicardial surface to the pericarial sac,
This is typical for a fibrinous pericarditis.
Infective endocarditis
? Infective endocarditis(IE) is
characterized by colonization or
invasion of the heart valves or the
mural endocardium by a
microbiologic agent,leading to the
formation of bulky,friable
vegetations laden with organisms.,
? Traditional IE has been
classified on clinical grounds
into acute and subacute forms,
Both rheumatic heart disease
and infective endocarditis are
common topics in examinations
An acute infective endocarditis on the mitral valve
has spread into the septum all the way to the
tricuspid valve,producing a fistula.
An subacute infective endocarditis,The
aortic valve demonstrates a large,irregular,
reddish tan vegetation,
Microscopically,the valve in infective endocarditis
demonstrates friable vegetations of fibrin and platelets
(pink) mixed with inflammatory cells and bacterial
colonies (blue),The friability explains how portions of
the vegetation can break off and embolize.
the finger at the right are small splinter
hemorrhages in a patient with infective
endocarditis,
Heart valve disease
? Heart valve disease are
characterized principally by
valvular involvement and
disfunction,The functional
disturbances engendered by
valvular disease are stenosis
and insufficiency,
Stenosis is the failure of a valve to open
completely,thereby impeding forward flow,
Insufficiency or regurgitation,in contrast,results
from failure of a valve to close completely,
thereby allowing reversed flow,
valvular stenosis valvular insufficiency
The mitral valve as seen from above in the left atrium,The
mitral valve demonstrates the typical "fish mouth" shape
with chronic rheumatic scarring,
Here is a congenital bicuspid aortic valve,
Most bicuspid valves are prone to
calcification,
An aortic valve need not be bicuspid to calcify,
Sometimes in older adults,a normal tricuspid
aortic valve will undergo calcification,a so-
called "senile calcific aortic stenosis." Nodules
of calcification are seen on the cusps here.
Primary or essential
hypertension
Hypertension is a disease largely
of the vasculature and as a
systolic pressure greater than
140 mmHg or a diastolic
pressure greater than 90 mmHg,
or both.
? There are pathological changes of
vasoconstriction,thickening of the
media,hyaline degeneration and
intimal fibrosis in benign
hypertension and fibrinoid necrosis
of the media with marked intimal
fibrosis and extreme narrowing of
the arteriole in malignant
hypertension.
? Hypertension can be classified
into two main types：
? (1) primary (essential)
hypertension,in which
subtypes are benign and
malignant(accelerated)
hypertension；
? (2) secondary hypertension.
The peripheral coronary arteries may undergo
sclerosis,as seen here in an artery branch with
a very small lumen,with chronic hypertension.
The left ventricle is markedly thickened in this
patient with severe hypertension that was
untreated for many years,The myocardial fibers
have undergone hypertrophy.
This is typical for hypertensive heart disease,Left
ventricle is very thickened (slightly over 2 cm in
thickness).
primary granular atrophy of the kidney
cerebral hemorrhage
Atherosclerosis
? Arteriosclerosis is an
imprecise term meaning
thickening and loss of
elasticity of the arteries
caused by any condition,
and its commonest types
are atherosclerosis (AS),
m?nckeberg’s medial
calcification and
arteriolosclerosis
(arteriolar sclerosis),
? AS is a
disease of
large and
medium-
sized
arteries
that results
in the
progressive
accumulati
on within
the intima
of smooth
muscle
cells and
lipids.
? The lesion of AS includes fatty streak,fibrous
plaque and atheromatous plaque,and the
complicated lesions are plaque rupture and
hemorrhage in plaque,thrombosis,dystrophic
calcification,ulceration,aneurysm formation,
neovasculerization and thinning of the
underlying tunica and media.
? The major
complications
of AS include
ischemic
heart disease,
myocardial
infarction,
stroke and
gangrene of
the
extremities.
The white arrow denotes the most prominent fatty
streak in the photo,but there are other fatty
streaks scattered over the aortic surface,Fatty
streaks are the earliest lesions seen with
atherosclerosis in arteries.
This high magnification of the atheroma shows
numerous foam cells and an occasional cholesterol cleft,
A few dark blue inflammatory cells are scattered within
the atheroma.
fibrous plaque
atheromatous plaque
This is a high magnification of the aortic
atheroma with foam cells and cholesterol
clefts.
thrombosis
Severe atherosclerosis of the aorta in which the
atheromatous plaques have undergone ulceration
along with formation of overlying mural thrombus.
The aorta shows a large overlying atheroma on
the left,Cholesterol clefts are numerous in this
atheroma,The surface on the far left shows
ulceration and hemorrhage,
An atherosclerotic
aneurysm of the aorta
in which a large "bulge"
appears just above the
aortic bifurcation,
The coronary artery shown here has
narrowing of the lumen due to build up of
atherosclerotic plaque,Severe narrowing
can lead to angina,ischemia,and infarction.
Normal coronary artery
Severe degree of narrowing in coronary artery,It
is "complex" in that there is a large area of
calcification on the lower right.
calcification
This is coronary atherosclerosis with the
complication of hemorrhage into atheromatous
plaque
A thrombosis of a coronary artery is shown here in cross
section,This acute thrombosis diminishes blood flow and
leads to infarction.
There is a pink to red recent thrombosis in this narrowed
coronary artery,The open,needle-like spaces in the
atheromatous plaque are cholesterol clefts.
This cross section through the heart demonstrates the
left ventricle on the left,Extending from the anterior
portion and into the septum is a large recent
myocardial infarction,
Left ventricular wall which has been sectioned
lengthwise to reveal a large recent myocardial
infarction,The center of the infarct contains
necrotic muscle that appears yellow-tan,
The earliest change histologically seen with
acute myocardial infarction in the first day is
contraction band necrosis,
Myocardial infarction,there is extensive
hemorrhage along with myocardial fiber necrosis
with contraction bands and loss of nuclei.
Myocardial infarction of 1 to 2 weeks in age,Note that
there are remaining normal myocardial fibers at the top,
Below these fibers are many macrophages along with
numerous capillaries and little collagenization.
The point of rupture of the myocardium is shown with the arrow,
A cross section through the heart reveals a
ventricular aneurysm with a very thin wall at the
arrow,Note how the aneurysm bulges out,
