【病理生理】心血管系统疾病2.pptx

Diseases of the Cardiovascular System心血管系统疾病 (2)Major Disorders of CVS Atherosclerosis Ischemic Heart Disease (IHD) Hypertension Rheumatic Heart Disease (RHD) Infective Endocarditis Valvular Heart Disease (VHD) Hypertension （HTN） 高血压 病Hypertension，高血压病IntroductionA sustained diastolic pressure >90 mmHg and/or a systolic pressure >140mmHg25% of general population, silent killer Chronic, end organ & vascular damageDisastrous late complicationsAtherosclerosis, IHD, Renal damage, StrokeRegulation of BPEndocrine Factors Renin, Angiotensin, ANP, ADH, AldosteroneNeural Factors Sympathetic & ParasympatheticBlood Volume Sodium, Mineralocorticoids Cardiac Factors Heart rate & ContractilitySeverity of HypertensionNormal<140 <90Stage 1 (mild) 140-159 90-99Stage 2 (mod.) 160-179 100-109Stage 3 (severe) 180-209 110-119Stage 4 (very severe) >210 >120Malignant Hypertension? Rapid & SevereClassificationPrimary or Essential HTN (95%) UnknownSecondary HTN (5-10 %) Renal – GN, Renin tumors Endocrine – Cushing, Pheochromocytoma Etiology 发病因素Genetic, familial Increased peripheral resistance stress, hormonal, neurallife styleBenign HTN良性高血压病Accounts for 95% of the cases of HTNMild to moderate elevations in blood pressureAsymptomatic silent diseaseHyaline arteriolosclerosisArteriosclerosisartery动脉硬化atheromaarterioleAtherosclerosisLarge BVIntimaM?nckeberg Medial SclerosisMedial BVAteriolosclerosisSmall BVFull Thickness动脉粥样硬化动脉中层钙化细动脉硬化HyalineHyperplasticHyaline ArteriolosclerosisHyaline ArteriolosclerosisOrgan DamageHeart: concentric left ventricular hypertrophy eccentric left ventricular hypertrophy heart failureKidney: benign nephrosclerosisBrain: Intracerebral hemorrhage , infarction splinter hemorrhages & Lacunar infarctsEyes: hypertensive retinopathy心脏变化Left ventricular Hypertrophy肾脏病变Primary Granular Atrophy of Kidney原发性颗粒固缩肾Arteriolar Nephrosclerosis细动脉性肾硬化脑病变脑水肿高血压脑病（Hypertensive encephalopathy）高血压危象（Hypertensive crisis）脑软化微梗死灶（Microinfarct）脑腔隙状梗死（Cerebral Lacunar Infarc