THE HEART

THE DISEASES OFCARDIOVASCULER SYSTEMMuhammad RozikhinFaculty of Health, Majoring of NursingUniversity of Esa Unggul

Types of Heart Disease2IHD

Hypertensive HD (systemic & pulmonary)

Rheumatic Heart Disease

Nonischemic (primary) myocardial disease

Congenital HDCORONARY HEART DISEASECORONARY HEART DISEASEARTERIOSCLEROTIC HEART DISEASEANGINA PECTORISMYOCARDIAL INFARCTION4Atherosclerotic coronary arteryDiffuse myocardial fibrotic occasionally cardiac valve fibrotic ARTERIOSCLEROTIC HEART DISEASEMORPHOLOGYBrownish-yellow granular diffusely (accumulates in the heart muscle) contained lipofuscin (complexes of lipid & protein)Atherosclerotic Ischaemic Myocardial fibrotic Marked as Brown Atrophy5ARTERIOSCLEROTIC HEART DISEASEThe heart is become:SmallNormalEnlarged

Disorder of cardiac valve :Mitral valve fibroticChordae tendineae fibrotic or calcification6ANGINA PECTORISIntermittent chest pain caused by transient, reversible myocardial ischaemicTYPICAL / STABLEANGINA PECTORISPRINZMETAL / VARIANT, ANGINAUNSTABLEANGINA PECTORIS(cressendo angina )7PathogenesisHypoxia caused of:Occlusion of arteries Coronary artery vasospasmMyocardial hypoxiaArtherosclerotic coronary arteriSyphilis heart diseasePolyarthritis nodosaAorta valve insufficiencyAnemiaParoxismal myocadial hypoxia imposed by exercise1/28/20148Departemen Pathology Anatomy - CardiovascularMYOCARDIAL INFARCTIONDevelopment of an area of myocardial necrosis caused by local ischaemiaPopularly called heart attack Coronary atherosclerosis (99%) Thrombosis & EmboliVascular diseases Osteum occlusion caused by syphillis Arteriosclerosis occlusion & HypotensionCoroner insufficiency caused by :1/28/20149Departemen Pathology Anatomy - CardiovascularTypes1/28/2014Departemen Pathology Anatomy - Cardiovascular10Any age, risk age : protected during reproductive ageEstrogen (after menopause) HD Transmural(full/nearly full)Sub-endocardial (non-transmural)Inner 1/3 wallIncidence & Risk Factor Pathogenesis Basic : Coronary Arterial Occlusion Severe coronary atherosclerosis Acute atherosclerotic plaque change (rupture) Superimposed pletelet activation Thrombosis & vasospasmConsequence: Myocardial Response Cessation of aerobic glycolysis anaerobic glycolysis Inadequate product of phosphate (Creatine phos & ATP) acc lactid acidDistribution of infarctsRight coronary artery(30-40 %)Left anterior descending artery(40-50 %)Left circumflexartery(15-20 %)1/28/201412Departemen Pathology Anatomy - CardiovascularComplicationsPapillary muscle dysfunction (infarcted papillary muscle may rupture)External rupture of the infarct cardiac tamponade Rupture of the intraventricular septumMural thrombi potential sources for systemic emboliVentricular fibrotic & aneurysms

1/28/201413Departemen Pathology Anatomy - CardiovascularHYPERTENSIVE HEART DISEASEHYPERTENSIVE HEART DISEASEAortic stenosisPrimary hypertropic cardiomyopathyDiagnosis based on:Left ventricular hypertrophy with a history of hypertensionExcluded1/28/201415Departemen Pathology Anatomy - CardiovascularMorphologyConcentric hypertrophy (symetric, circumferential> 450 gm)Size:Early: Normal dilatedMicroscopic Myocytes > Nuclei: large, hyperchrom, boxcar shaped1/28/201416Departemen Pathology Anatomy - CardiovascularRHEUMATIC HEART DISEASERHEUMATIC HEART DISEASEAcute, immunologically mediated, multisystem inflammatory disease group A streptococcal pharyngitis after an interval of a few weeks1/28/201418Only 3% group A streptococcal pharyngitis RFInitial reactivation with subsequent pharyngeal infections

Ab >< M protein cross reaction with glycoprotein :Heart Joints & others

Onset : 2-3 weeks after infection Streptococci (-) in lesionChronic valvular deformitiesHD in acute phase(Acute rheumatic carditis)Rheumatic Fever may cause1/28/201419Departemen Pathology Anatomy - CardiovascularMorphologyInflammatory infiltrates in : SynoviumJoint SkinHeart (most importantly) fibrosis deformitiesLung

Initial tissue reaction : focal fibrinoid necrosisAcute Rheumatic Fever1/28/201420Characteristic : Inflammatory in 3 layers of heart (Pancarditis)

Hallmark of ARC : (Aschoff bodies)Acute Rheumatic Carditis (ARC)Multiple foci of inflammation within connective tissue of heart Central focus fibrinoid necrosis Surrounded by : Mononucleous Anitschkow cells (large histiocyte, vesicular nuclei, abundant basophilic cytoplasm)1/28/201421Departemen Pathology Anatomy - CardiovascularPericardial involmentFibrinous pericarditisSerous/Sero-sanguineous effusion

Manifested grossly & microscopically :1/28/201422Departemen Pathology Anatomy - CardiovascularEndocardiumValvular inflammation tends to : mitral & aortic valvesThe valve predisposes : Small vegetations (valve closure) = verrucous endocarditis

1/28/201423Departemen Pathology Anatomy - CardiovascularSubcutaneous nodules / erythema marginatumPulmonaryManifested by chronic inflmmation & fibrinous inflammation of pleural surface

Skin Arthritis of the large joints Self limited, does not chronic deformity

1/28/201424Departemen Pathology Anatomy - Cardiovascular

1/28/201425Departemen Pathology Anatomy - CardiovascularInfective EndocarditisCaused by bacteria AcuteSub-acuteHigh virulence(Staph. Aureus)Previously abnormal valveLow virulence(-Hemolytic Streptococcus)Infection of the cardiac valve /mural surface of the endocardium thrombotic (debris+organism) [term vegetation] 1/28/201426Departemen Pathology Anatomy - CardiovascularEtiologyBacteriemia IV Drug AbuseDental SurgeryCatheter Brushung teethRiskPreexisting cardiac abnormal Prosthetic heart valvesI V drug abuser1/28/201427Departemen Pathology Anatomy - CardiovascularMorphologyVegetations : Bacteria or other organism Single / multipleMay involved : > 1 valveMost common : Aortic & MitraRV valve drug abuserFungal 1/28/201428Departemen Pathology Anatomy - CardiovascularAcute EndocarditisClassic vegetation Begins : small excrescences indistinguishable from NBTE (Non Bacterial Thrombotic Endocarditis) Infection may extend through : Valve myocardium abscess peri-valvular (ring abscess)

Microscopic : Bacterial, fibrin, bloodExtends beyond avasc valve neutrophil responseSystemic emboli brain, kidney, myocard infarct abscesses

1/28/201429Departemen Pathology Anatomy - Cardiovascular

1/28/201430Departemen Pathology Anatomy - CardiovascularPERICARDIAL DISEASEPERICARDITISVirus, pyogenic bacteria, mycobacteria, fungiSecondary to : Acute myocard infarctCardiac surgeryRadiation to the mediastinumUremiaRF, SLE, metastatic malignancies

Cause :1/28/201432Departemen Pathology Anatomy - CardiovascularImmediate hemodynamic complicationsResolve sequelae (-)Progress to chronic fibrosing processPericarditis may :1/28/201433Departemen Pathology Anatomy - CardiovascularMorphologyPatients with uremia / acute RF : fibrinous, shaggy (bread & butter pericarditis)Viral : fibrinousAcute Bacterial : fibrinopurulentTuberculous : caseousMetastases : shaggy fibrinousAcute pericarditis Acute fibrinous / fibrinopurulent resolve, sequelae (-)Extensive suppuration / caseation chronic pericarditis1/28/201434Departemen Pathology Anatomy - CardiovascularChronic pericarditisAppearance ranges : Delicate adhesions dense, fibbrotic scars that obbliterate the pericardial spaceConstrictive pericarditis35ComplicationsConstrictive pericarditisObliterate pericarditis (Focally / diffuse)V. Cava compression, causes : AscitesHepatosphlenomegalyDC

36Pericardial EffusionsSerousSerosanguineousChylousCvHDHypoalbumiemiaBlunt chest traumaMalignancyMediastinal lymphatic obstruction37HemopericardiumSeparately from hemorrhagic pericardium effusion

Pure blood :Ruptured aortic aneurismaRuptured myocar infarctPenetrating trauma inj

cardiac tamponade death38CARDIAC TUMORSMore common than primary10% of disseminated cancer Most involves : Pericardium caused : pericarditis & hemorrhagic effusion

Metastatic Neoplasms Lymphatic Venous Arterial channelsVia: Carcinoma lung & breast Melanoma Lymphoma, leukemiaMost common primary neoplasms that metastasize :40Large metastatic carcinoma in left atrium that was continuous with tumor in left pulmonary veinThis mass simulated an atrial myxoma by echocardiography.

The primary tumor was mucoepidermoid carcinoma of left submaxillary gland.41RareMost common: MyxomaLipoma Papillary elastofibromas Rhabdomyomas AngiosarcomasRhabdomyosacomasPrimary Neoplasms42

Thank you43