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Science

1. Diseases of the Heart Atherosclerosis and Myocardial Infarction Dr Manjiri Karandikar Professor of Pathology BVDTBU Medical College Pune

2. Atherosclerosis D isease of large and medium sized arteries characterized by intimal lesions called atheromas ( atherosclerotic plaques ) that protrude into vessel lumens.

3. Plaque

4. Common Sites Large elastic arteries like Aorta, Carotid & Iliac Medium sized muscular arteries like Coronary Internal carotid, Circle of Willis Popliteal Renal Mesenteric

5. Major Risk Factors Hyperlipidemia Hypertension Cigarette Smoking Diabetes Mellitus Multiplicative effect

6. Hyperlipidemia / Dyslipidemia Hypercholesterolemia LDL – Increases the risk Bad Delivers cholesterol to tissues HDL – lowers the risk Good Mobilizes cholesterol from tissues to liver

7. Hypertension B.P. > 169/95 mm Hg - 5 fold greater risk (Normal up to 139/89 mm Hg)

8. Cigarette Smoking Well established risk factor One pack a day for a few years increases the risk 200 folds

9. Atherosclerosis

10. Pathogenesis Modified Reaction-to-injury hypothesis Atherosclerosis is a chronic inflammatory and healing response of the arterial wall to endothelial injury

11. Chronic endothelial injury Hypertension, turbulence Chronic dyslipidemia Chemical agents, toxins CO, hypoxia, radiation Tobacco products

12. Chronic endothelial injury Effects Adhesion, aggregation & platelet release reaction Infiltration of monocytes & T lymphocytes into intima Entry of LDL into intima

13. Morphology Fatty Dots & Streaks Gelatinous lesions Atheromatous Plaque Complicated plaque Ulceration, Rupture Calcification, Hemorrhage Thrombosis, Atheroembolism Aneurysm .

14. Stages of Atheroma - Aorta

15. Early Advanced

16. Coronary Atherosclerosis

17. Coronary Narrowing in Atherosclerosis

18. Clinical consequences Heart attack – Myocardial infarction Stroke – Cerebral infarction Gangrene – tissue infarction Chronic renal failure – renal ischemia Aneurysms Rupture Thrombo embolism