Cardiovascular diseases. pathology

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1 Cardiovascular diseases pathology

2 Atherosclerosis Vascular diseases 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.

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4 Atherosclerosis causes - diabetes mellitus - heavy alcohol abuse - high blood pressure - high blood cholesterol level - high fat diet - increasing age - obesity - family history - smoking

5 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

6 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

7 4. Mesenteric angina: characterized by epigastric and periumbilical postprandial pain, sometime with melena and hematomesis. 5. Abdominal aortic aneurysm: is often fetal

8 Pathophysiology Atherosclerosis - 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.

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10 Stress test angiography Diagnosis

11 Myocardial infarction

12 Myocardial infarction Is an irreversible necrosis of heart muscle secondary to prolonged ischemia and imbalance of oxygen supply and demand.

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14 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

15 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.

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17 Myocardial infarction Diagnosis 1. Typical chest pain 2. Electrocardiogram changes 3. Elevated cardiac enzymes 4. Cardiac catheterization (diagnosis and treatment)

18 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.

19 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)

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21 symptoms Endocarditis. 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

22 Endocarditis Important findings - New cardiac murmur - Petechial skin rash - splinter hemorrhage - splenomegaly

23 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

24 Myocarditis Causes Infections, viruses are the most common, bacterial, fungal, parasitic Toxins drug toxicity such as chemotherapy Immunological reactions rheumatic conditions, allergies

25 Symptoms and diagnosis Myocarditis * 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

26 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

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28 Pericarditis and cardiac tamponade Causes 1. Traumatic (hemorrhagic) 2. Viral causes 3. Bacterial causes 4. Systemic causes

29 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

30 Pericarditis and cardiac tamponade Signs and symptoms Cardiac tamponade -Severe hypotension -Severe tachycardia -Cyanosis -Decreased level of consciousness

31 Pericarditis and cardiac tamponade diagnosis * echocardiogram: the best test to detect fluid collection * chest X-ray

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33 Thank you

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35 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.

36 quantitative analysis of the calculi 29.2% melamine 52.2% urice acid 18.% unidentifiable

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