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ATHEROSCLEROSIS & other HART-VESSLES DISEASES

V. VoloshynV. Voloshyn

(By Ya.Ya. Bodnar et al., Rubin & Farber, Serov et al.)

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Atherosclerosis is Atherosclerosis is a a disease of large and disease of large and medium-sized arteries that results in the medium-sized arteries that results in the

progressive accumulation within the progressive accumulation within the intima of smooth muscle cells and lipids.intima of smooth muscle cells and lipids.

The major complications of atherosclerosis, including ischemic heart disease, myocardial infarction, stroke, and gangrene of the extremities, account for more than half of the annual mortality in the United States.

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According to definition of WHPO, According to definition of WHPO, atherosclerosis is the “varied combinations atherosclerosis is the “varied combinations of changes of internal shell of arteries, of changes of internal shell of arteries, which show up as the nidus (hearths) which show up as the nidus (hearths) deposits of lipids, complex compounds of deposits of lipids, complex compounds of carbonhydratess, elements and matters of carbonhydratess, elements and matters of blood, formations of connecting tissue and blood, formations of connecting tissue and calcium deposits”.calcium deposits”.

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Risk Factors:Risk Factors:

Hypertension; Hypertension; High cholesterol level in blood;High cholesterol level in blood; Cigarette smoking;Cigarette smoking; Diabetes;Diabetes; Increasing age and male sex.Increasing age and male sex.

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Pathogeny of atherosclerosisPathogeny of atherosclerosisNosotropic essence of atherosclerosis consists Nosotropic essence of atherosclerosis consists

in the hearths deposits in intima of arteries so-in the hearths deposits in intima of arteries so-called atherogenic lipoproteins. Lipoproteides called atherogenic lipoproteins. Lipoproteides show itself spherical particles which consist of show itself spherical particles which consist of nucleus and external shell. Triglyceride and nucleus and external shell. Triglyceride and ethers of cholesterol formed the complement of ethers of cholesterol formed the complement of nucleus. The external shell consist of the nucleus. The external shell consist of the apoproteins, phospholipids and unethered apoproteins, phospholipids and unethered

cholesterolcholesterol..

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Cholesteryl ester

Atherogenic

low density lipoproteins (LDL)

High density lipoproteins (HDL)

anti-Atherogenic

chylo microns

16 %

Very low density lipoproteins (VLDL)

Cholesteryl ester 45 %

(LDL) is the form of lipid in the plasma that has been most closely associated with accelerated atherosclerosis

Apoprotein 55 %

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rubbish

rubbish receptor

apo B, E receptors

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Pathogeny of atherosclerosisPathogeny of atherosclerosis They considered lipoproteids of very They considered lipoproteids of very

low and low density are atherogenic, which low and low density are atherogenic, which contain the large supply of cholesterol (to contain the large supply of cholesterol (to 45%) and albumen a little. Lipoproteids of 45%) and albumen a little. Lipoproteids of high density, opposite, have a lot of high density, opposite, have a lot of albumen (55%) and comparatively little albumen (55%) and comparatively little cholesterol (16%). They execute a cholesterol (16%). They execute a antiaterogenic function, that prevent antiaterogenic function, that prevent development of atherosclerosis.development of atherosclerosis.

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Pathogeny of atherosclerosisPathogeny of atherosclerosis

In the modern time well-proven that not In the modern time well-proven that not natively lipoproteids of low density act natively lipoproteids of low density act leading part in genesis of atherosclerosis, but leading part in genesis of atherosclerosis, but them modified varieties:them modified varieties:

a) glucolisic lipoproteids (which added glucose);a) glucolisic lipoproteids (which added glucose);b) peroxide-modified lipoproteids, which b) peroxide-modified lipoproteids, which

appeared under act of free radicals and products of appeared under act of free radicals and products of peroxide oxidization of lipids;peroxide oxidization of lipids;

c) autoimmune complexes of lipoproteid-c) autoimmune complexes of lipoproteid-antibody;antibody;

d) lipoproteids, which suffered partial d) lipoproteids, which suffered partial degradation under act of proteolitic enzymes.degradation under act of proteolitic enzymes.

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The vascular endothelium The vascular endothelium interacts with macro-molecules interacts with macro-molecules and formed elements of the blood and plays a role in the and formed elements of the blood and plays a role in the transport of plasma proteins.transport of plasma proteins.

The arterial smooth muscle cell The arterial smooth muscle cell is important in (1) the is important in (1) the control of artery wall tone, (2) maintenance and repair, (3) control of artery wall tone, (2) maintenance and repair, (3) the metabolism of various blood-borne substances, the metabolism of various blood-borne substances, including lipids, and (4) the secretion of ! various cytokines.including lipids, and (4) the secretion of ! various cytokines.

The mononuclear phagocyte The mononuclear phagocyte has many functions, has many functions, including the uptake of low-density lipoproteins (LDL) and including the uptake of low-density lipoproteins (LDL) and the secretion of various hydrolases and cytokines.the secretion of various hydrolases and cytokines.

Lymphocytes and neutrophils Lymphocytes and neutrophils are involved in the response are involved in the response to tissue injury and may participate in auto- I immune to tissue injury and may participate in auto- I immune reactions, such as may occur with viral infections in vessels reactions, such as may occur with viral infections in vessels of transplanted organs.of transplanted organs.

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PPhasehases of s of ATHEROSCLEROSIS:ATHEROSCLEROSIS:

till lipid;till lipid; lipid blots (ribbons);lipid blots (ribbons); lipoidosis or atheromatic plate;lipoidosis or atheromatic plate; liposclerosis or liposclerotic plates;liposclerosis or liposclerotic plates; stage of complication (clots, calcifications, stage of complication (clots, calcifications,

ulcers ...)ulcers ...)

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Hystogenesis of atherosclerosis Hystogenesis of atherosclerosis (scheme)(scheme)

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Hystogenesis of atherosclerosisHystogenesis of atherosclerosis

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Endothelial cell

Smooth muscle cell

Lipid-laden macrophage

Extracellular lipid

Necrotic cell

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The fibrous cap The fibrous cap is a layer of fibrous connective is a layer of fibrous connective tissue that is much thicker and less cellular than tissue that is much thicker and less cellular than

the normal intima and contains fat-filled the normal intima and contains fat-filled macrophages (foam cells) and smooth muscle macrophages (foam cells) and smooth muscle

cells.cells.

The atheroma The atheroma is a necrotic mass of lipid that forms is a necrotic mass of lipid that forms the middle part of the characteristic lesion of the middle part of the characteristic lesion of atherosclerosis. The term atherosclerosis. The term atheroma atheroma originally originally

referred only to the fatty mass, but it is now used referred only to the fatty mass, but it is now used for the entire atherosclerotic lesion.for the entire atherosclerotic lesion.

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Pathoanatomical research of aortaPathoanatomical research of aorta scissorsscissors

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Clinic morphological forms and displays of atherosclerosisClinic morphological forms and displays of atherosclerosis

Clinic morphological forms

Clinic morphological displays

Acute Chronic

Atherosclerosis of aorta

Removing a layer by the layer of mid-dle shell from intima or adventi-tias

(розшаровуюча aneurysm). Rup-tures and bleeding. Thrombosis.

Thrombembolism with develop-ment of heart attacks and gangre-ne. Acute ischemic heart trouble (stenocardia,

heart attack of myocardium).

Atrophy of breastbone and vertebral bodies from

pressure at presence of aneurysm (sack,

cylindrical, fusiform)

Atherosclerosis of the coronary arteries

Acute ischemic heart trouble (stenocardia, heart attack of myocardium).

Chronic ischemic heart trouble (cardiosclerosis, chronic

aneurysm of heart)

Atherosclerosis of the cerebrum arteries

Haematoma, hemorragic infiltration, infarcts of cerebrum

A transitory ischemia – atrophy of brain,

oligophrenia, cystsAtherosclerosis of the

kidney's arteriesInfarcts of kidneys

Atherosclerotic nephrosclerosis

Atherosclerosis of the intestine arteries

Abdominal quinsy, gangrene, peritonitisAtrophy of mucous plate of

intestineAtherosclerosis of the

lower limb arteriesGangrene

Atrophy of muscles, alternating lameness

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Atherosclerosis of aortaAtherosclerosis of aorta

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Atherosclerosis of cerebrum Atherosclerosis of cerebrum arteriesarteries

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Gangrene of footGangrene of foot

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Atherosclerotic nephrosclerosisAtherosclerotic nephrosclerosis

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The endThe end