心血管系统疾病1-动脉粥样硬化、冠心病.pptVIP

粥样斑块(atheromatousplaque)01“粥瘤”（atheroma）02大体灰黄斑块，既向内膜表面隆起03又向深部压迫中膜04切面纤维帽瓷白05深部多量黄色粥糜样物06基质有SMC深部—无定形坏死物，胆固醇结晶，钙化底周—肉芽组织，少许FC、淋巴C严重中膜SMC萎缩—变薄镜下表层—纤维帽，玻变粥样斑块logo动脉粥样硬化轻、中、重比较Basicpathology:atherosclerosisBasicpathology:atherosclerosisSummary:morphologyofAS01表层—纤维帽,大量胶原玻变,基质,SMC02深部—大量无定形坏死物,胆固醇结晶,钙化03底周—肉芽组织，少许FC、淋巴C04中膜—SMC萎缩变薄,弹力纤维破坏05外膜—不同程度外膜炎,炎细胞浸润(4)复合病变（complicatedlesion）斑块内出血(Hemorrhage):斑块突然增大,阻塞斑块破裂(Rupture):溃疡形成(Ulceration)血栓形成(Thrombosis):附壁血栓,栓塞,梗死钙化(Calcification):A壁硬脆A瘤形成(Aneurysm):局限性扩张或壁内大血腔血管管腔狭窄(Stenosis)：中等ABasicpathology:atherosclerosis复合病变(Complicatedlesion)①斑块内出血斑块破溃③血栓形成；④钙化；⑤动脉瘤形成动脉粥样硬化—出血(Hemorrhage)动脉粥样硬化—溃疡(Ulceration)动脉粥样硬化—血栓形成(Thrombosis)动脉粥样硬化—钙盐沉积(Calcification)动脉粥样硬化—动脉瘤(aneurysm)aneurysm夹层动脉瘤形成(AortaDissectingAneurisms)2.主要动脉病变主动脉粥样硬化(AortaAS)部位腹主A,后壁,分支开口，病变主动脉瘤形成→Rupture→大出血→致命(2)冠状动脉粥样硬化(CoronaryAS)左冠状A前降支右冠状A干左冠状A旋支Outcomes心肌急剧暂时缺血→心绞痛（Anginapectoris)严重持久缺血→心肌梗死(myocardialinfarction)慢性供血不足→心肌硬化(myocardialfibrosis)突然停搏,心室颤动→心源性猝死(1h,6h)(Suddencoronarydeath，SCD)(3)脑动脉粥样硬化CerebralVesselsAS基底动脉,大脑中动脉,Willis环脑萎缩→痴呆脑梗死BrainInfarct(Stroke)脑出血:动脉瘤形成→破裂→偏瘫→死亡MiddleCerebralAS-Thrombosis(4)肾动脉粥样硬化(RenalAS)5%55%30%10%肾动脉开口,主干,叶间动脉动脉粥样硬化性固缩肾肾血管性高血压(不规则瘢痕)(5)四肢动脉粥样硬化(LimbsvesselAS)足趾干性坏疽03间歇跛行02下肢A:髂A,股A01(6)肠系膜动脉粥样硬化

(MesentericarteriesAS)肠梗死:01剧烈腹痛,腹胀,发热,便血,肠梗阻,休克02冠心病

(Coronaryheartdisease)

(CHD)1.心绞痛（anginapectoris）心肌急剧暂时缺血2.心肌梗死（myocardialinfarction）心肌严重持久急性缺血3.心肌纤维化（myocardialfibrosis）长期慢性缺血,慢性心衰4.冠状A性猝死（Suddencoronarydeath，SCD）6h(1h),突然停搏、心室颤动,原发性心脏骤停型冠心病Types:coronaryheartdiseaseSites:左前降支,心壁侧,新月形,偏心性狭窄Degree≤25%26~50%51~75%76%Lesion:coronaryheartdiseaseLeftCoronaryArteryAnteriorDescending(LAD)LeftCircumfl