Hypertensive Heart Disease

BAGIAN PATOLOGI ANATOMI FAKULTAS KEDOKTERAN UISU MEDAN - 2009
Markedly by left ventricle hypertrophy due to continous systemic hypertensive.

Incidence : Female >> 2x male Middle age and old age Genetically inherited Etiology : Hypertensive occur if arterial peripheral resistence
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vasoconstriction blood vessel arteriole, small arteries. diffuse organic blood vessel disease
Hypertensive hyperthrophy myocardium coronary arteriosclerotic Peripheral resistence heart will compensated cardiac output to normal hyperthrophy myocardium swelling left ventricel dilatation
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Muscle hyperthrophy caused by : activity >> anoxia myocard weakness hypertension coronary arteriosclerosis myocardium anoxia. hypertension damage renal blood vessel Renin NaCl + H2O retention
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left ventricle wall >> ( 2,5 cm ) heart weight >> without other heart disorders microscopic : normal cardiac muscle thickened arterial wall
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Compensatory stadium : asymptom Hypertensive symptom : headache, palpitation, retinopathy Left decompensatio cordis :
dyspnoe, cough, hemoptysis
Coronary arteriosclerose symptoms
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Arteries Ischaemia Veins/lymphatic congestive edema Symptoms : - Functional disorders - Pain, due to : - Infarction - Trophic disorder - Skin ulceration
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= arterial hardening
Atherosclerotic lipid deposition under the intima Monckeberg sclerosis calcification on tunica media Arteriolosclerosis in small arteries
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1.
2.
3.
4.
The developmental of focal areas of chronic endothelial injury Increased insudation of lipoproteins into the vessel wall, mainly LDL or modified LDL with its high cholesterol content A series of cellular interactions in the foci of injury involving ECs, monocytes/ macrophage, T lymphocytes, and SMCs of intimal or medial origin Proliferation of smooth muscle cells in the intima with formation of extracellular matrix by the SMCs.
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INFLAMMATION OF ARTERIES
1.
Acute Infectious Arteritis Etio : - Perivascular inflammation : acute meningitis, cellulitis, pneumonia - Intravascular : septicaemia, septic embolism.
2. Periarteritis nodosa = polyarteritis = panarteritis
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Clinical manifestations :
intermitten fever malaise, lethargy loss of body weight peripheral neuritis myalgia, progressive arthralgia
Male >> female At all age Body organs which are involved : kidney, brain, heart, skin, lung
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Macroscopic finding : protruding mass 2-4 mm along the arteries specially in a. mesenteric, GIT, pancreas, kidney, striated muscle.
Microscopic : Oedema with fibrinous exudate Fibrinous necrotic media Damage of internal elastic lamina WBC infiltration in arterial wall Fibroblast proliferation
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Luminal obliteration Thrombosis Aneurysm Infarct
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1.
2.
3. 4.
Syphylitic arteritis Tuberculosis arteritis with tubercle central necrosis surrounded by lymphocyte cells, epitheloid cells, plasma cells, and Langhans datia cells. Rheumatoid arteritis fibrinoid necrosis Datia Cells arteritis = Giant cell arteritis temporalis arteritis
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Clinical appearance : - pulseless disease - chronic and progressive - occurs especially in young women - visual disturbances - upper extremities parasthesia - lethargy (general weakness)-syncope
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Microscopic : - pan-arteritis - thickening of the intima - coagulative necrosis - plasma cells , lymphocyte and datia cells inflitration - fibrosis - perivascular infiltration
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I. Arteriosclerosis = arteriosclerosis obliterans

Clinical findings : - ischemic atrophy - cold and painful - cyanotic - extremities soft tissue gangrene from distal toes to the proximal legs - muscle spasm - pale lower extremities when elevated
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occurs in midlife and elders luminal narrowing thrombotic obstruction uneven thickening of the artery, hardening but fragile - Iliac artery, femoral artery, poplitea artery, tibial artery. - complicated in diabetes mellitus, hypertension and artherosclerotic patients.
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A vasospastic syndrome caused by freezzing , restricted on fingers only. Young women

Etiology : blood vessels spasm
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young male , heavy smokers persistent painful legs, cause by distal arterial obstruction and occlusion persistent ischemia of 1 or more toes superficial thrombophlebitis
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Macroscopic :
Wire like blood vessels (hardening) Blood vessels occluded by yellow/ grayish mass due to thrombosis Perivascular fibrosis
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Microscopic :
- thrombus filled lumen - intact elastic lamina - lymphocyte infiltration of media & adventitia - widening of vasa vasorum - fibrosis of adventitia - granulomatous focal with datia cell or supurative milier focal
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local abnormal dilatation of the artery due to wall defect.

: artheriosclerosis syphilis , bacterial or fungal infection congenital trauma
Etiology
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Localization : - aortic arch - abdominal aorta - popliteal artery - femoral artery - carotid artery or subclavia artery
Complication : - rupture - hemorrhage - compression to other organ - erosion
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Acute phlebitis :

Purulent phlebitis : abcess, meningitis, pneumonia Non Purulent phlebitis : dermatitis, rheumatoid fever, drug allergy, rheumatoid arthritis
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Microscopic : - inflammation cell infiltration - oedema - hyperemia - blood vessel wall destruction
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1.
2.
Phlebothrombosis Vein thrombosis without regional blood vessel destruction. Thrombophlebitis Thrombosis cause vessel wall destruction.
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3.
4.
V. Cava Superior Obstruction due to : bronchogenic Carcinoma mediastinal lymphoma aortic aneurysm causing : cyanotic and congestion of cephalic v, neck and upper extremities v. Vena Cava Inferior Obstruction due to : liver tumor and renal cell Ca. aneurysm ascites and inflammation
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5. Portal vein Obstruction due to : thrombosis intrahepatic diseases splenectomy polycytemia vera
6.
Varicose vein = Varix abnormal vein dilatation which restricted due to intraluminal pressure increasment and loss of surrounding tissue support.
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Etio : hereditary weakness vein obstruction intraabdominal pressure >> elderly people standing too much, hard work vein inflammation chronic constipation
Portal hypertension hemorrhoid oesophageal varices

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Hypertensive Heart Disease

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BAGIAN PATOLOGI ANATOMI FAKULTAS KEDOKTERAN UISU MEDAN - 2009

Markedly by left ventricle hypertrophy due to continous systemic hypertensive.

dyspnoe, cough, hemoptysis

Coronary arteriosclerose symptoms

2. Periarteritis nodosa = polyarteritis = panarteritis

Luminal obliteration Thrombosis Aneurysm Infarct

I. Arteriosclerosis = arteriosclerosis obliterans

A vasospastic syndrome caused by freezzing , restricted on fingers only. Young women

local abnormal dilatation of the artery due to wall defect.

Portal hypertension hemorrhoid oesophageal varices

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