Atherosclerosis

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The only person who never makes a mistake is
the person who never does anything! - Theodore
Roosevelt
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Anatomy of Heart
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Circulation
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Coronary Arteries
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Pathology of CVS

• Dr. Venkatesh Murthy Shashidhar
• Senior Lecturer in Pathology
• Fiji School of Medicine.

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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

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Atherosclerosis

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

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Arteriosclerosis - Classification
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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.

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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.

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Common Sites

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

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Morphology

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

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Stages of Atheroma - Aorta
Stage VI III II
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Coronary Atherosclerosis
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Coronary Narrowing in Atherosclerosis
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Atheroma Aorta
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Atheroma Coronary Artery
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Atheroma Coronary Artery
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Thrombosis Coronary Artery
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Angiogram - Embolism Infarction
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Middle Cerebral A - Thrombosis
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Coronary Thrombosis With Infarction
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Subarachnoid Haemorrhage
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Cerebral Infarction (Stroke)
Haemorrhagic Necrosis
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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

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Hyperlipidemia

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

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Good Fats

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

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"Pleasure in the job puts perfection in the
work." -- Aristotle
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Pathology of Hypertension

• Dr. Venkatesh M. Shashidhar.
• Senior Lecturer in Pathology
• Fiji School of Medicine

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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

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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

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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.

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Control of Blood Pressure
Vasoconstrictors Angiotensin II Catecholamines
Blood Volume Na, Aldosterone

• Neural Factors
• Adrenergic Cons
• ß Adrenergic - Dil

Cardiac Factors Rate Contract..
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Kidney Disease Hypertension
Kidney Disease
Low - GFR
Renin
Angiotensin
Aldosterone
Vasoconstriction
Sodium Retention
Hypertension
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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
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Classification

• Primary or Essential Hypertension(95)
• Unknown multifactorial.
• Secondary Hypertension (5-10)
• Renal GN, RAS, Renin tumors
• Endocrine Cushing, OCP, Thyrotoxicosis Myxdema,
  Pheochromocytoma, Acromegaly.

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Organ Damage

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

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Left ventricular Hypertrophy
Left Ventricular Hypertrophy
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Hyaline Arteriolosclerosis
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Hyperplastic Arteriolosclerosis
Narrow Lumen
Onion Skin Thickening Of arterioles.
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Cerebral Infarction - Stroke
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Benign Nephrosclerosis
Leathery Granularity due to minute scarring
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Renal Artery stenosis - Atrophy
Leathery Granularity Benign Nephrosclerosis
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Normal Retina - Fundoscopy
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Hypertensive Retinopathy
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Conclusions

• Persistent increased blood pressure
• 95 Essential, 5 secondary Kidney dis.
• Vessel damage ? Ischemia or Infarction
• Kidney, Brain, Heart Eyes.
• Complicates Atherosclerosis, Diabetes, IHD

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Thank you