Atherosclerosis, Ischemia and infarction, Rheumatic heart disease and infective endocarditis

1. Cardiovascular System:
Atherosclerosis, Ischemia and Infarction, Rheumatic Heart
Disease and Infective Endocarditis.

2. Atherosclerosis
• Progressive disease of intima
involving large and medium
sized elastic and muscular
arteries.
• It is characterized by focal lipid
rich intimal lesion called
atheroma.

3. Risk factors for atherosclerosis

4. Pathogenesis of atherosclerosis

5. Morphology- Gross and Microscopy.

6. Complications of atherosclerosis

7. Ischaemic Heart Disease
• Group of diseases due to myocardial ischaemia caused by an
imbalance between the supply and demand of the heart for
oxygenated blood.
• Four diseases included under IHD are:
• Myocardial Infarction
• Angina Pectoris
• Chronic IHD
• Sudden Cardiac death

8. Angina Pectoris
• Paroxysmal and recurrent attacks of substernal or precordial chest
discomfort due to transient myocardial ischaemia which falls short of
inducing necrosis of myocardial cells.
• 1. Stable or typical angina
• 2. Prinzmetal variant angina
• 3. Unstable or crescendo angina.
• Stable angina, typical-d/t atherosclerosis of coronary artery, relieved
by rest or nitroglycerin.

9. Contd…
• Prinzmetal variant angina: Uncommon, atypical due to spasm of
coronary artery, occurs at rest and responds to vasodilators.
• Unstable or crescendo angina: Prolonged duration, occurs with
minimal physical activity or at rest. Caused by rupture of
atherosclerotic plaque, may lead to MI, called pre-infarction angina.

10. Myocardial Infarction(MI)
• Coagulative type of necrosis of cardiac muscle and is due to
prolonged severe ischaemia.
• Risk factors: Age, sex, same as atherosclerosis.

11. Pathogenesis- MI

12. Types of Infarct

13. Morphology- MI

14. Diagnosis- MI

15. Complications of MI

16. Rheumatic Heart Disease
• Acute Rheumatic Fever manifests as acute rheumatic carditis which
may progress to chronic RHD.

17. ACUTE RHD- Morphology

18. Endocarditis in acute RHD
• May be valvular or mural.
• Valves show small, nodular vegetations called verrucae.
• Mural lesions- thickening in posterior wall of left atrium, Mccallum
patch.
• Pericarditis: Fibrinous pericarditis- bread and butter pericarditis.
• Myocarditis.

19. Chronic RHD

20. Extracardiac lesions in RF/Jones Criteria

21. Jones Criteria

22. Infective endocarditis
• Infection of the endocardium by microbial agents. Usually involve
valvular endocarditis and produce lesions called vegetations.
• Vegetations are composed of platelets, fibrin, micro colonies of
microorganisms.
• IE may be acute or subacute.

23. Acute/Subacute IE

24. Etiology and Pathogenesis- IE

25. Most common organisms causing IE

26. Complications of IE
• Cardiac complications
• Valvular stenosis or insufficiency
• Perforation, rupture and aneurysm of valve leaflets
• Abscess in the valve ring
• Myocardial abscesses
• Suppurative pericarditis
• Cardiac failure from one or more of the foregoing complications

27. Contd…

28. • Thankyou