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DEFINIIE
2. TIPURI DE LEZIUNI
3. FACTORI DE RISC
4. PATOGENIE
5. EVOLUTIVILATEA LEZIUNILOR
6. CONSECINE CLINICE
1. DEFINIIE: apariia n intima arterial a unor plci formate din lipide, celule
musculare netede, macrofage, esut fibros.
Atheros = terci
Plac de
Sclerosis = induraie
aterom avansat
- intereseaz arterele musculare medii (coronare, cerebrale, carotide, renale,
mezenterice, ale membrelor inferioare) i arterele elastice mari (aorta, n special
aorta abdominal)
-ASC: b.heterogen, multifactorial si complex cu determinri clinice diferite
-ASC cauzeaz manifestri clinice distincte ce depind de patul circulator afectat
si de caracteristicile leziunilor individuale:
-ASC arterelor coronariene: AP de efort si/sau IM
-ASC art.cerebrale: AIT sau stroke
-ASC art.periferice ale membrelor: claudicaia intermitent, gangren
-ASC art.splahnice: ISM mezenteric, infarct intestinal
.ASC art.renale: rinichiul este FR si sediu pentru b.ateroembolic, poate
participa la ap.HTA, etc.
Thrombus
Lipid core
Thin, Vulnerable,
Fibrous Cap
Large Lipid Core
Thrombus
Formation
Atherothrombosis: Thrombus
Superimposed on Atherosclerotic
Plaque
Adapted with permission from Falk E, et al. Circulation. 1998;92:657-671. Slide reproduced with permission
from Cannon CP. Atherothrombosis slide compendium. Available at: www.theheart.org.
Few
SMCs
Thin
fibrous cap
Stable
Inflammatory
cells
Eroded
endothelium
Activated
macrophages
More
SMCs
Thick
fibrous cap
Lack of
inflammatory
cells
Intact
endothelium
Foam cells
Adapted with permission from Libby P. Circulation. 1995;91:2844-2850. Slide reproduced with permission from
Cannon CP. Atherothrombosis slide compendium. Available at: www.theheart.org.
Process
Lipid core
Vulnerable plaque
Inflammation
TF Clotting
Cascade
Collagen
platelet
activation
Foam Cells
Macrophages Metalloproteinases
Marker
Plaque formation
Cholesterol
LDL
Inflammation
Multiple factors
? Infection
C-Reactive Protein
Adhesion Molecules
Interleukin 6, TNF
sCD-40 ligand
Plaque Rupture
MDA Modified LDL
? Macrophages
Metalloproteinases
Thrombosis
D-dimer,
Platelet Activation Complement,
Thrombin
Fibrinogen,
Troponin, CRP,
CD40L
Plaque
Fissure or
Rupture
Platelet
Adhesion
Pathogenesis of
Acute Coronary
Syndromes:
The integral role of
platelets
Platelet
Activation
Platelet
Aggregation
Thrombotic
Occlusion
Old
Terminology:
New
Terminology:
UA
NQMI
STE-MI
ST-Segment
Elevation
Acute
Coronary
Syndrome
(ACS)
Atherothrombosis* is the
Leading Cause of Death Worldwide1
6.3
Pulmonary Disease
Injuries
AIDS
9.7
Cancer
12.6
19.3
Infectious Disease
22.3
Atherothrombosis*
0
10
15
20
25
30
Transient
ischemic attack
Angina:
Stable
Unstable
Peripheral arterial
disease:
Intermittent claudication
Rest Pain
Gangrene
Necrosis
Atherothrombosis:
a generalized and progressive process
Normal
Fatty
streak
Fibrous
plaque
Atherosclerotic
plaque
Plaque
rupture/
fissure &
thrombosis
Unstable
angina
MI
ACS
Ischemic
stroke/TIA
Clinically silent
Stable angina
Intermittent claudication
Increasing age
Critical
leg
ischemia
Cardiovascular
death
CV Disease is a Continuum
Myocardial
Infarction
CAD
Atherosclerosis
CV Risk Factors
Diabetes
Hypertension
Hyperlipidemia
Smoking
Loss of
contractility
Remodeling
Ventricular
Dilation
Congestive
Heart Failure
End-Stage
Heart Disease
Death
Clinical Manifestations
of Atherosclerosis
Coronary heart disease
Stable angina, acute myocardial infarction, sudden death, unstable
angina
Cerebrovascular disease
Stroke, TIAs
Deaths From
Cardiovascular Disease
Stroke 17%
Rheumatic Fever/
Rheumatic Heart
Disease 0.4%
Coronary Heart
Disease 55%
Congenital
CV Defects
0.5%
Diseases of
the Arteries 2%
Congestive Heart
Failure 6%
High Blood
Pressure 5%
American Heart Association. 2002 Heart and Stroke Statistical Update. 2001.
Other 15%
Antiplatelet therapy
Anticoagulant therapy
Angiotensin converting enzyme inhibitor
Angiotensin receptor blocker
Cholesterol management
Cigarette smoking cessation
Exercise
Ejection fraction assessment
Endothelial
injury
High plasma
LDL
LDL
+
VLDL
Adherence
of platelets
LDL infiltration
into intima
Liver
Cholesterol
excreted
LCAT
APO-A1
Release
of PDGF
Advanced
fibrocalcific
lesion
Other
growth
factors
Oxidative
modification
of LDL
+
Macrophages
Foam cells
Fatty streak