ATHEROSCLEROSIS & other
HART-VESSLES DISEASES
V. Voloshyn
(By Ya.Ya. Bodnar et al.,
Rubin & Farber,
1
Serov et al.)
Atherosclerosis is a disease of large and
medium-sized arteries that results in the
progressive accumulation within the
intima of smooth muscle cells and lipids.
2
The major complications of atherosclerosis,
including ischemic heart disease,
myocardial infarction, stroke,
and gangrene of the extremities,
account for more than half of the annual mortality
in the United States.
2
According to definition of WHPO?,
atherosclerosis is the “varied combinations
of changes of internal shell of arteries,
which show up as the nidus (hearths)
deposits of lipids, complex compounds of
carbonhydratess, elements and matters of
blood, formations of connecting tissue and
calcium deposits”.
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2
Risk Factors:
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
Hypertension;
High cholesterol level in blood;
Cigarette smoking;
Diabetes;
Increasing age and male sex.
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Pathogeny of atherosclerosis
Nosotropic essence of atherosclerosis consists
in the hearths deposits in intima of arteries socalled atherogenic lipoproteins. Lipoproteides
show itself spherical particles which consist of
nucleus and external shell. Triglyceride and
ethers of cholesterol formed the complement of
nucleus. The external shell consist of the
apoproteins, phospholipids and unethered
cholesterol.
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5
2
Cholesteryl ester 16 %
High density lipoproteins (HDL)
Apoprotein 55 %
low density lipoproteins (LDL)
Cholesteryl ester 45 %
Very low density lipoproteins
(VLDL)
A
t
h
e
r
o
g
e
n
i
c
antiAthe
roge
nic
(LDL) is the
form of lipid in
the plasma that
has been most
closely
associated
with
accelerated
atherosclerosis
chylomicrons
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Pathogeny of atherosclerosis
They considered lipoproteids of very
low and low density are atherogenic,
which contain the large supply of
cholesterol (to 45%) and albumen a little.
Lipoproteids of high density, opposite,
have a lot of albumen (55%) and
comparatively little cholesterol (16%).
They execute a antiaterogenic function,
that
prevent
development
of
atherosclerosis.

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Pathogeny of atherosclerosis
In the modern time well-proven that not
natively lipoproteids of low density act
leading part in genesis of atherosclerosis, but
them modified varieties:
a) glucolisic lipoproteids (which added glucose);
 b) peroxide-modified lipoproteids, which
appeared under act of free radicals and products of
peroxide oxidization of lipids;
 c) autoimmune complexes of lipoproteidantibody;
 d) lipoproteids, which suffered partial
degradation under act of proteolitic enzymes.

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The vascular endothelium interacts with macro-molecules
and formed elements of the blood and plays a role in the
transport of plasma proteins.
The arterial smooth muscle cell is important in (1) the
control of artery wall tone, (2) maintenance and repair, (3)
the metabolism of various blood-borne substances,
including lipids, and (4) the secretion of ! various cytokines.
The mononuclear phagocyte has many functions,
including the uptake of low-density lipoproteins (LDL) and
the secretion of various hydrolases and cytokines.
Lymphocytes and neutrophils are involved in the response
to tissue injury and may participate in auto- I immune
reactions, such as may occur with viral infections in vessels
of transplanted organs.
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2
Phases of ATHEROSCLEROSIS:
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till lipid;
lipid blots (ribbons);
lipoidosis or atheromatic plate;
liposclerosis or liposclerotic plates;
stage of complication (clots, calcifications,
ulcers ...)
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2
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2
Hystogenesis of atherosclerosis (scheme)
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Hystogenesis of atherosclerosis
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2
apo B, E receptors
rubbish receptor
rubbish
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2
Endothelial cell
Smooth muscle cell
Lipid-laden macrophage
Extracellular lipid
Necrotic cell
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2
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2
The fibrous cap is a layer of fibrous connective
tissue that is much thicker and less cellular than
the normal intima and contains fat-filled
macrophages (foam cells) and smooth muscle cells.
The atheroma is a necrotic mass of lipid that forms
the middle part of the characteristic lesion of
atherosclerosis. The term atheroma originally
referred only to the fatty mass, but it is now used
for the entire atherosclerotic lesion.
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2
Pathoanatomical research of aorta
scissors
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Clinic morphological forms and displays of atherosclerosis
Clinic morphological
forms
Clinic morphological displays
Acute
Chronic
Removing a layer by the layer of mid-dle
shell from intima or adventi-tias
Atrophy of breastbone and
(розшаровуюча aneurysm). Rup-tures
vertebral bodies from
and bleeding. Thrombosis.
Atherosclerosis of aorta
pressure at presence of
Thrombembolism with develop-ment
aneurysm (sack,
of heart attacks and gangre-ne. Acute
cylindrical, fusiform)
ischemic heart trouble (stenocardia,
heart attack of myocardium).
Chronic ischemic heart trouble
Atherosclerosis of the Acute ischemic heart trouble (stenocardia,
(cardiosclerosis, chronic
coronary arteries
heart attack of myocardium).
aneurysm of heart)
A transitory ischemia –
Atherosclerosis of the
Haematoma, hemorragic infiltration,
atrophy of brain,
cerebrum arteries
infarcts of cerebrum
oligophrenia, cysts
Atherosclerosis of the
Atherosclerotic
Infarcts of kidneys
kidney's arteries
nephrosclerosis
Atherosclerosis of the
Atrophy of mucous plate of
Abdominal quinsy, gangrene, peritonitis
intestine arteries
intestine
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Atherosclerosis of the
Atrophy of muscles,
Gangrene
lower limb arteries
alternating lameness
2
Atherosclerosis of aorta
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2
Atherosclerosis of cerebrum
arteries
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2
Gangrene of foot
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2
Atherosclerotic nephrosclerosis
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2
Hypertensive illness
Hypertensive illness is one of the most
widespread diseases of vessels& heart system,
which is characterized by stable essence
hyperpressure (systole – higher 140 mm.Hg,
and diastole – higher 90 mm.Hg) with the
defeat of organs-targets.
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Glossary

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2
Arterial Hyperpressure (according to definition of
Committee of experts of WHPO, is constantly
enhanceable systole and/or diastole arterial
pressure.
essence hypertension is enhanceable arterial
pressure in default of reliable cause of its increasing
Secondary hypertension (symptomatic) is the
hypertension, reason of which can be found out.
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2
Etiology of hypertensive illness


Etiology of hypertensive illness exactly is not
found out.
Sympatic hyperactivity is one of the strongest
factors of development of essence
hypertension. This state is reflected on the
function of some organs which can be
considered the targets of the sympatic
influencings. Except for a heart, arterioles,
veins and kidneys belongs here .
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2
Stages of development of hypertensive illness
Flowing of hypertensive illness can be of
benign and malignant. In first case select three
clinic-morphological stages:

till clinical, or transitory;

stage of widespread changes of arteries, or
organic;

stage of the secondary changes, or organ .
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2
Defeat of vessels at hypertensive illness
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2
Defeat of heart at hypertensive illness
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2
Primary wrinkled kidney
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2
Cerebro-vascular illness
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2
Ischemic heart trouble

Ischemic heart trouble is acute or chronic
disfunction of cardiac muscle which arises
up as a result of the relative or absolute
diminishing of coronal blood supplying of
myocardium by arterial blood.
(The experts committee of WHPO)
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2
Classification of ischemic heart
trouble (WHPO, 1979)
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Coronal oxymortia.
Stenocardia
Infarct of myocardium
Post-infarctic cardiosclerosis
Violation of cardiac rhythm
Cardiac insufficiency
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2
Heart attack of myocardium
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2
Infarct of myocardium classification
According to time of
origin
Primary
According to
localization
According to
spread
According to
passing
Subendocardial
Smallnidus
Stage of
ischemic
dystrophy
Intramuralic
Intrawall
Largenidus
Repeated
(thou 8 weeks
after first)
Subepicardial
Extensive
Recurrent
(to 8 weeks
after first)
Stage of
necrosis
Stage of
organization
Transmuralic
Transwall
Cardiosclerosis
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2
Acute heart attack
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2
Cardiosclerosis
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2
The end
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