Diseases of the Heart

Atherosclerosis
and Myocardial Infarction

Dr Manjiri Karandikar
Professor of Pathology
BVDTBU Medical College
Pune
 Atherosclerosis
Disease of large and medium sized arteries
characterized by
intimal lesions called atheromas
(atherosclerotic plaques)

that protrude into vessel lumens.

Plaque
 Common Sites
Large elastic arteries like
• Aorta, Carotid & Iliac

Medium sized muscular arteries like

• Coronary
• Internal carotid, Circle of Willis
• Popliteal
• Renal
• Mesenteric
 Major Risk Factors

• Hyperlipidemia

• Hypertension Multiplicative effect

• Cigarette Smoking

• Diabetes Mellitus
 Hyperlipidemia/Dyslipidemia
• Hypercholesterolemia
• LDL – Increases the risk Bad
Delivers cholesterol to tissues
• HDL – lowers the risk Good
Mobilizes cholesterol from tissues
to liver
 Hypertension

B.P. >169/95 mm Hg - 5 fold greater risk

(Normal up to 139/89 mm Hg)
Cigarette Smoking

• Well established risk factor

• One pack a day for a few

years increases the risk
• 200 folds
Atherosclerosis
 Pathogenesis
• Modified Reaction-to-injury hypothesis
• Atherosclerosis is a chronic inflammatory
and healing response of the arterial wall to
endothelial injury
 Chronic endothelial injury
• Hypertension, turbulence
• Chronic dyslipidemia
• Chemical agents, toxins
• CO, hypoxia, radiation
• Tobacco products
 Chronic endothelial injury
Effects
• Adhesion, aggregation & platelet
release reaction
• Infiltration of monocytes & T
lymphocytes into intima
• Entry of LDL into intima
 Morphology
• Fatty Dots & Streaks
• Gelatinous lesions
• Atheromatous Plaque
• Complicated plaque
– Ulceration, Rupture
– Calcification, Hemorrhage
– Thrombosis, Atheroembolism
– Aneurysm
.
Stages of Atheroma - Aorta
Early Advanced
Coronary Atherosclerosis
Coronary Narrowing in
Atherosclerosis
 Clinical consequences
• Heart attack – Myocardial infarction
• Stroke – Cerebral infarction
• Gangrene – tissue infarction
• Chronic renal failure – renal ischemia
• Aneurysms
• Rupture
• Thrombo embolism