penyakit kelainan pembuluh darah
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aoTRANSCRIPT
![Page 1: Penyakit Kelainan Pembuluh Darah](https://reader031.vdocument.in/reader031/viewer/2022020403/577c7e8a1a28abe054a19be2/html5/thumbnails/1.jpg)
DelyuzarBlood Vessels
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• Blood Vessels• Heart I• Heart II
Cardiac Pathology Outline
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• Blood Vessels• Atherosclerosis• Hypertension• Aneurysms• Vasculitis• Tumors
Cardiac Pathology Outline
![Page 4: Penyakit Kelainan Pembuluh Darah](https://reader031.vdocument.in/reader031/viewer/2022020403/577c7e8a1a28abe054a19be2/html5/thumbnails/4.jpg)
• Blood Vessels• Heart I
• Heart Failure• Congenital Heart Disease• Ischemic Heart Disease• Hypertensive Heart Disease
Cardiac Pathology Outline
![Page 5: Penyakit Kelainan Pembuluh Darah](https://reader031.vdocument.in/reader031/viewer/2022020403/577c7e8a1a28abe054a19be2/html5/thumbnails/5.jpg)
• Blood Vessels• Heart I• Heart II
• Valvular Heart Disease• Cardiomyopathies• Pericardial Disease• Tumors
Cardiac Pathology Outline
![Page 6: Penyakit Kelainan Pembuluh Darah](https://reader031.vdocument.in/reader031/viewer/2022020403/577c7e8a1a28abe054a19be2/html5/thumbnails/6.jpg)
• Blood Vessels• Atherosclerosis
Cardiac Pathology Outline
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Normal blood vessel
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• Large (elastic) arteries• aorta, common carotid, iliac• lots of elastic fibers• pulsatile
• Medium (muscular) arteries• coronary, renal arteries• mostly smooth muscle cells
• Small arteries/arterioles• all smooth muscle cells• blood pressure controlled here
Normal Blood Vessels
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• Capillaries• diameter of RBC• tons of them, with thin walls, slow flow• great for exchanging oxygen, nutrients
• Venules/veins• large diameter, thin walls• compressible, penetrable by tumor• valves
• Lymphatics• drain excess interstitial fluid• pass through nodes, checking for infection• return bugs (and tumor cells) to circulation
Normal Blood Vessels
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• Characterized by atheromas• Half of deaths in US!• Coronary artery disease (MI)• Carotid atherosclerotic disease (stroke)
Atherosclerosis
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Non-modifiable• Increasing age• Gender• Family history• Genetic abnormalities
Potentially modifiable• Hyperlipidemia• Hypertension• Cigarette smoking• Diabetes• C-reactive protein level
Atherosclerosis: Major Risk Factors
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• Obesity• Physical inactivity• Stress• Postmenopausal estrogen deficiency• High carbohydrate intake• Lipoprotein (a)• Trans-fat intake• Chlamydia pneumoniae infection
Atherosclerosis: Lesser Risk Factors
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Chronic endothelial “injury”
How to Make an Atheroma
1
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Endothelial dysfunctionMonocyte adhesion and emigration2
How to Make an Atheroma
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Macrophage activationSmooth muscle recruitment3
How to Make an Atheroma
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Macrophages and smooth muscle cells engulf lipid4
How to Make an Atheroma
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Fatty streaks
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Smooth muscle proliferationCollagen and extracellular lipid deposition5
How to Make an Atheroma
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Contents of a plaque
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Mild (L) and severe (R) atherosclerosis
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Atheromatous plaques
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Natural history of atherosclerosis
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• Primary prevention• Lessen risk factors• Statins
• Secondary prevention• Aspirin, statins, beta blockers• Surgery
Prevention of Atherosclerosis
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• Blood Vessels• Atherosclerosis• Hypertension
Cardiac Pathology Outline
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• Common problem (25% of population)• Asymptomatic until late• Contributes to coronary artery disease,
stroke, cardiac hypertrophy, heart failure• Mechanisms largely unknown - called “essential hypertension”
• >140/90
Hypertension
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• Benign hypertension• Essential (idiopathic) hypertension• Secondary hypertension
• Malignant hypertension
Types of Hypertension
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• Idiopathic! But probably related to…• Reduced renal sodium excretion• Vascular changes• Genetic factors• Environmental factors
Essential Hypertension
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• Accelerates atherogenesis• Potentiates aortic dissection and stroke• Causes small blood vessel disease:
• Hyaline arteriolosclerosis• Hyperplastic arteriolosclerosis
Essential Hypertension
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Hyaline (L) and hyperplastic (R) arteriolosclerosis
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• Blood Vessels• Atherosclerosis• Hypertension• Aneurysms
Cardiac Pathology Outline
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• Aneurysm: localized abnormal vessel dilation• “True” aneurysm: involves all three layers • “False” aneurysm: hole covered with hematoma
Aneurysms
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True and false aneurysms
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• Atherosclerosis• Cystic medial degeneration of wall• Trauma• Congenital defects (berry aneurysm)• Infection (mycotic aneurysms)
Causes of Aneurysms
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• Males >50• Atherosclerosis, genetic defects (Marfan)• Below renal arteries, above bifurcation• May present as pulsating abdominal mass• May rupture, obstruct branches or embolize
Abdominal Aortic Aneurysm
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Abdominal aortic aneurysm
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Abdominal aortic aneurysm
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Abdominal aortic aneurysm repair
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• Blood tracks up through media, creating a channel
• Hypertensive men, 40-60 (most cases)• Sudden onset excruciating pain• Can rupture massive hemorrhage or
cardiac tamponade • Rapid diagnosis, surgery = 65-75% of
patients survive
Aortic Dissection
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Types of aortic dissection
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• Blood Vessels• Atherosclerosis• Hypertension• Aneurysms• Vasculitis
Cardiac Pathology Outline
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• Inflammation of vessel walls• Many possible symptoms• Constitutional signs/symptoms common• Immune-mediated or infectious
Vasculitis
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Vessel Disease ROS *
Large Giant-cell arteritis >50. Arteries of head.
Takayasu arteritis F <40. “Pulseless disease”
MediumPolyarteritis nodosa Young adults. Widespread.
Kawasaki disease <4. Coronary disease. Lymph nodes.
Small
Wegener granulomatosis Lung, kidney. c-ANCA.Churg-Strauss syndrome Lung. Eosinophils. Asthma. p-ANCA.
Microscopic polyangiitis Lung, kidney. p-ANCA.
* Ridiculously oversimplified summary
Summary of Vasculitides
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• Most common type of vasculitis• Patients >50 • Chronic, granulomatous inflammation of
large to small arteries, especially in head• Symptoms vague (fever) or localized
(headache, vision loss)• Treatment: corticosteroids
Giant-Cell (Temporal) Arteritis
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Giant cell (temporal) arteritis
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• Women <40 • Granulomatous vasculitis of aortic arch• Severe narrowing of major branches• Weakening of pulses in upper extremities
(“pulseless disease”)• Ocular disturbances
Takayasu Arteritis
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Takayasu arteritis
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• Young adults• Necrotizing vasculitis in many different organs• Different stages coexist even in same artery• Puzzling, varied symptoms• Fatal if untreated, but steroids and
cyclophosphamide are curative
Polyarteritis Nodosa
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PAN: fibrinoid necrosis and thrombotic occlusion
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• Children <4• Acute, febrile, usually self-limiting• Danger: involvement of coronary arteries• “Mucocutaneous lymph node syndrome”• Delayed-type hypersensitivity reaction?• Treatment: intravenous Ig
Kawasaki Disease
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Kawasaki Disease: hand edema, mouth lesions
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Kawasaki Disease: “strawberry” tongue
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• Most common age = 40s• Triad: respiratory tract granulomas, vasculitis,
renal disease• c-ANCA positive • T-cell mediated hypersensitivity response?• Untreated: fatal in 1 year• Churg-Strauss: similar, but associated with
allergies and asthma, and no renal disease
Wegener Granulomatosis
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Wegener granulomatosis: cavitating lung lesions
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Wegener granulomatosis: palatal ulceration
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Wegener granulomatosis: palatal destruction
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• Widespread, necrotizing vasculitis of smaller vessels
• Lung and kidney especially• Antibody response to drugs or bugs• Neutrophils in vessels• Type III hypersensitivity reaction?• Removing offending agent usually works
Microscopic (Leukocytoclastic) Polyangiitis
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Leukocytoclastic polyangiitis: vessel with fragmented PMNS
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• Blood Vessels• Atherosclerosis• Hypertension• Aneurysms• Vasculitis• Tumors
Cardiac Pathology Outline
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• Very common benign tumor of blood vessels• Capillary hemangioma
• Skin, oral mucosa, sometimes organs• “Strawberry” type present at birth, regresses
• Cavernous hemangioma• Organs, sometimes skin • Cosmetic problem (unless in brain)
• Pyogenic granuloma• Rapidly growing red nodule on skin, in mouth • Microscopically resembles granulation tissue
Hemangioma
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Capillary hemangioma
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Pyogenic granuloma
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• Benign but very painful• Arise from glomus body cells • Distal digits, especially under fingernails• Excision is curative
Glomus Tumor
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Glomus tumor
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• Low-grade malignancy of endothelial cells• Four forms: Chronic (older Ashkenazi
Jewish males), African, transplant-associated, AIDS-associated
• Clinical course varies (chronic = best)• Excision can be curative
Kaposi Sarcoma
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Kaposi sarcoma
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Kaposi sarcoma
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Kaposi sarcoma
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• Malignancy of endothelial cells• Prefers skin, soft tissue, breast, liver• Arsenic and PVC increase risk• Well-differentiated to anaplastic• Metastasize rapidly. 5ys 30%.
Angiosarcoma
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Angiosarcoma
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Angiosarcoma cells positive for CD31 (an endothelial marker)
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• Blood Vessels• Atherosclerosis• Hypertension• Aneurysms• Vasculitis• Tumors
• Heart I• Heart II
Cardiac Pathology Outline