cardio vasular system blood vessels

CARDIO VASCULAR SYSTEM: BLOOD VESSELS:

CARDIO VASCULAR SYSTEM: BLOOD VESSELS

Blood Vessels:

Blood Vessels Normal Structure Tunica intima Tunica media Tunica adventitia

Normal structure of artery:

Normal structure of artery

Types of Vessels:

Types of Vessels Large arteries Medium sized arteries Arterioles Capillaries

Normal artery & vein:

Normal artery & vein

Function of endothelial cells:

Function of endothelial cells Maintence of permeability barrier Elaboration of anticoagulant, antithrombotic, fibrinolytic regulators Elaboration of prothrombotic molecules. ECM production. Regulation of inflammation, immunity & cell growth Oxidation of LDL.

Normal arteriole & venule:

Normal arteriole & venule

Response to vascular intimal injury:

Response to vascular intimal injury Migration of smooth muscles to the intima Smooth muscle Cell mitosis Elaboration of extracellular matrix Endothelium

Arteriosclerosis:

Arteriosclerosis Thickening and loss of elasticity of arteries Types- Senile arteriosclerosis Hypertensive arteriosclerosis Monckeberg’s arteriosclerosis Atherosclerosis

Senile Arteriosclerosis:

Senile Arteriosclerosis Ageing Intimal & medial thickening Pathological – Fibroelestosis Elastic reduplication Elevation of systolic blood pressure.

Hypertensive Arteriosclerosis:

Hypertensive Arteriosclerosis Hyaline arteriosclerosis- Deposition of eosinophilic material in intima & media Hyperplastic arteriosclerosis Onion skin lesion- Mucinous intimal thickening Fibrous intimal thickening Necrotizing Arteriolitis Hyaline sclerosis Fibrinoid necrosis & acute inflammation in adventitia Malignant HTN

Hyaline arteriosclerosis:

Hyaline arteriosclerosis

Hyperplastic arteriosclerosis:

Hyperplastic arteriosclerosis

Atherosclerosis:

Atherosclerosis Intimal lesion-atheroma Earliest lesion-fatty streaks Site-elastic arteries -large & medium sized muscular arteries

Atherosclerosis gross:

Atherosclerosis gross

Atherosclerosis :

Atherosclerosis

Atherosclerosis gross with ulceration:

Atherosclerosis gross with ulceration

Consequences of atherosclerosis:

Consequences of atherosclerosis MI Cerebral infarction Aortic aneurysm Peripheral vascular ds. Mesentric occlusion Sudden cardiac death Chronic ischemic heart ds. Ischemic encephelopathy

Etiology:

Etiology Age Sex Genetic Hyperlipidemia HTN Cigarette smoking Diabetes

Classification of the human atherosclerotic lesion:

Classification of the human atherosclerotic lesion

Pathogenesis of atherosclerosis:

Pathogenesis of atherosclerosis

Pathogenesis:

Pathogenesis Chronic endothelial injury Endothelial dysfunction Smooth muscle immigration Macrophage & smooth muscle cells Engulf lipid Smooth muscle proliferation

Morphological feature of atherosclerosis:

Morphological feature of atherosclerosis 3 COMPONENTS Cells-SMC, Macrophages, & Leucocytes ECM-Collagen elastic fibers & prokaryocytes Intracellular & extra cellular lipid

Atherosclerosis :

Atherosclerosis

Atherosclerosis :

Atherosclerosis

Atherosclerosis coronary artery cross section:

Atherosclerosis coronary artery cross section

Coronary artery severe occlusive atherosclerosis:

Coronary artery severe occlusive atherosclerosis

CT scan - atherosclerosis:

CT scan - atherosclerosis

Angiogram :

Angiogram

Complication of advanced lesion:

Complication of advanced lesion Rupture,ulceration or excision. Hemorrhage Superimposed thrombosis Aneurysmal dilation

Hypertension:

Hypertension Diastolic pressure > 90mm Hg Systolic pressure > 140mm Hg

Type of hypertension:

Type of hypertension Essential idiopathic ( Benign ) Accelerated ( malignant ) rapid increase in BP leads to death

Etiology :

Etiology Essential HTN Secondary HTN Renal Endocrine Cardiovascular Neurological

Pathogenesis :

Pathogenesis BLOOD VOLUME Sodium Mineralocorticoids Atriopeptin Constrictors Angiotensin ii Catecholamines thromboxone leukotrienes Dilators Prostaglandins Kinins NO CARDIAC OUTPUT X PERIPHERAL RESISTANCE BP= LOCAL FACTORS Autoregulation Ionic (pH,hypoxia) CARDIAC FACTORS Heart rate Contractility NEURAL FACTORS CONSTRICTORS DILATORS a-adrenergic b-adrenergic HUMORAL FACTORS

Kidney play important role in BP regulation:

Kidney play important role in BP regulation

Pathogenesis of essential hypertension:

Pathogenesis of essential hypertension + GENETIC INFLUENCES ENVIRONMENTAL FACTORS DEFECTS IN RENAL SODIUM HEMOSTASIS FUNCTIONAL VASOCONSTRICTION DEFECTS IN VASCULAR SMOOTH MUSCLE GROWTH AND STRUCTURE INADEQUATE SODIUM EXCRETION SALT AND WATER RETENTION INC. PLASMA AND ECF VOLUME INC. cardiac output (autoregulation) Inc. Total peripheral Resistance HYPERTENSION INC. VASCULAR REACTIVITY INC. VASCULAR WALL THICKNESS

Morphological feature of HTN:

Morphological feature of HTN Hyaline arteriosclerosis Hyperplastic arterisclerosis

Aneurysm:

Aneurysm Localised abnormal dilation of blood vessels or the wall of heart . Type- True - bounded by arterial wall or heart False - breach in vascular wall

Abdominal aortic aneurysm:

Abdominal aortic aneurysm Cause – Atherosclerosis Site – frequent in abdominal aorta & common iliac artery Morphological features-saccular Inflammotory type – dense periaortic fibroma & lymphocyte & plasma cells. Mycotic type – infective ( salmonella ) suppurative

Syphilitic aneurysm:

Syphilitic aneurysm Obliterative endarterits – tertiary stage of syphilis Small vessels – vasovasoram of thoracic aorta Complications in-thoraacic aorta & nervous system Morphology – inflamation,lymphocyte & plasma cells. -narrow lumen -loss of median elastic fibres -Gross-tree bark appearence

Aortic dissection:

Aortic dissection Charecterised by dissection of blood between the media with formation of blood filled channels with in the aortic wall Rupture Hemorrhage Morphology-intimal tear -HTN -common cause of death-rupture of dissection in body cavity

Aortic dissection gross:

Aortic dissection gross

Vasculitis:

Vasculitis Etiology Direct infection Immunological – immune complex med. anti neutrophilic cytoplasmic antibody direct antibody mediated cell mediated Unknown – giant cell arteritis - Takayasu arteritis - polarteritis nodosa

Vasculitis :

Vasculitis

Giant cell arteritis:

Giant cell arteritis Adults Granulomatous inflammation of arteries Large small size arteries ( temporal ) Morphological - nodular thickening, multinucleated cells & fragmentation of internal elastic lamina Immunological reaction against arterial wall

Giant Cell Arteritis Clinical presentation :

Giant Cell Arteritis Clinical presentation

Giant cell arteritis:

Giant cell arteritis

Takayasu arteritis:

Takayasu arteritis Granulomatous vasculitis Medium to large vessels Ocular disturbances Marked weakening of pulse in upper extremities Female < 40 yr Morphology – irregular thickening -mononuclear inflammation in media -granulomatous inflammation Clinical feature – weak pulse - blindness -decrease BP in upper extremities

Takayasu arteritis:

Takayasu arteritis

Angiogram Takayasu Arteritis:

Angiogram Takayasu Arteritis

Polyarteritis nodosa:

Polyarteritis nodosa Small to medium sized ( renal & visceral ) Morphology – transmural necrotizing inflammation, fibrinoid necrosis & non specific infection Clinical feature – young adults - HTN, abdominal Pain, peripheral neuritis

Polyarteritis nodosa classical :

Polyarteritis nodosa classical

Polyarteritis nodosa:

Polyarteritis nodosa

Kawasaki disease ( Mucocutaneous lymph node syndrome ):

Kawasaki disease ( Mucocutaneous lymph node syndrome ) Coronary artery Young children Erosion ,erythema & edema of hands,feet & palm Enlargement of cervical lymph node MORPHOLOGY – fibrinoid necrosis & inflammation in vessel wall

Microscopic polyangitis:

Microscopic polyangitis Necrotizing vasculitis Arterioles, capillaries, & venules Palpable purpura - skin,mucous membrane of lungs, brain heart Necrotizing glomerulonephritis P-ANCA MORPHOLOGY- fibrinoid necrosis of media

Polyangitis:

Polyangitis

Wegener Granulomatasis:

Wegener Granulomatasis Acute necrotising granulation of URT Focal necrotising crescentric glomerulitis Necrotising vasculitis – small to medium sized arteries MORPHOLOGY mucosal necrotising granuloma granulomatous vasculitis C-ANCA

Wegeners granulomatasis:

Wegeners granulomatasis

Buergers Disease:

Buergers Disease Thromboangitis obliterans Acute & chronic vasculitis of medium sized & small sized arteries Microabscess formation

Vein & Lymphatic:

Vein & Lymphatic Varicose vein Thrombophlebittis Superior & inferior vena caval syndrome Lymphangitis lymphedema

Tumours :

Tumours BENIGN Hemangioma Capillary hemangioma Cavernous hemangioma Lymphangioma Glomous tumour MALIGNANT Kaposi sarcoma Angiosarcoma

Hemangioma gross:

Hemangioma gross

Congenital hemangioma:

Congenital hemangioma

Microscopic :

Microscopic

Lymphangioma :

Lymphangioma

Microscopic :

Microscopic

Kaposi sarcoma :

Kaposi sarcoma HIV Four forms- Chronic –multiple red to purple skin plaques or nodules in arms/legs slowly inc. in size spreading proximally Lymhadenopayhic – HIV associated localised/generalised lymphadenopathy Transplant ass.-on immuno supressive treatment. Ks –most comman AIDS ass. Cancer in USA

Slide 72:

MORHOLOGY- THREE STAGES Patches , plaqies & nodules

Angiosarcoma:

Angiosarcoma Hepatic angiosarcoma Etiology- arsenic -thorotrast -PVC Lymphangiosarcoma- ass. With radical mastectomy MORPHOLOGY – small multiple red nodules changes to large , flesh masses of pale grey white soft tissue masses

THANK YOU:

THANK YOU DR RAVI JAIN