病理生理心血管系统疾病

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1、DiseasesoftheCardiovascularSystem心血管系统疾病(2)MajorDisordersofCVSAtherosclerosisIschemicHeartDisease(IHD)HypertensionRheumaticHeartDisease(RHD)InfectiveEndocarditisValvularHeartDisease(VHD)Hypertension（HTN）高血压病Hypertension，高血压病IntroductionAsustaineddiastolicpressure>90mmHgand/orasy

2、stolicpressure>140mmHg25%ofgeneralpopulation,silentkillerChronic,endorgan&vasculardamageDisastrouslatecomplicationsAtherosclerosis,IHD,Renaldamage,StrokeRegulationofBPEndocrineFactorsRenin,Angiotensin,ANP,ADH,AldosteroneNeuralFactorsSympathetic&ParasympatheticBloodVolumeSodium,M

3、ineralocorticoidsCardiacFactorsHeartrate&ContractilitySeverityofHypertensionNormal<140<90Stage1(mild)140-15990-99Stage2(mod.)160-179100-109Stage3(severe)180-209110-119Stage4(verysevere)>210>120MalignantHypertensionRapid&SevereClassificationPrimaryorEssentialHTN(95%)UnknownSecon

4、daryHTN(5-10%)Renal–GN,RenintumorsEndocrine–Cushing,PheochromocytomaEtiology发病因素Genetic,familialIncreasedperipheralresistancestress,hormonal,neurallifestyleBenignHTN良性高血压病Accountsfor95%ofthecasesofHTNMildtomoderateelevationsinbloodpressureAsymptomaticsilentdiseaseHyalinearteriol

5、osclerosisArteriosclerosisAtherosclerosisLargeBVIntimaHyalineMőnckebergMedialSclerosisMedialBVAteriolosclerosisSmallBVFullThicknessHyperplasticatheromaarteryarteriole细动脉硬化动脉硬化动脉粥样硬化动脉中层钙化HyalineArteriolosclerosisHyalineArteriolosclerosisOrganDamageHeart:concentricleftventricular

6、hypertrophyeccentricleftventricularhypertrophyheartfailureKidney:benignnephrosclerosisBrain:Intracerebralhemorrhage,infarctionsplinterhemorrhages&LacunarinfarctsEyes:hypertensiveretinopathy心脏变化LeftventricularHypertrophy肾脏病变PrimaryGranularAtrophyofKidney原发性颗粒固缩肾ArteriolarNephrosc

7、lerosis细动脉性肾硬化脑病变脑水肿高血压脑病（Hypertensiveencephalopathy）高血压危象（Hypertensivecrisis）脑软化微梗死灶（Microinfarct）脑腔隙状梗死（CerebralLacunarInfarct）脑出血微小动脉瘤（Microaneurysm）NormalRetinavsHypertensiveRetinopathyMalignantHTN恶性高血压病Accountsfor5%ofthecasesofHTNMarkedlyelevatedpressuresArterynecrosiswitht

8、hrombosisRapidlyprogressiveendorgandamageRapidl