1. 1 ATHEROSCLEROSIS & other HART-VESSLES DISEASES V. Voloshyn (By Ya.Ya. Bodnar et al., Rubin & Farber, Serov et al.)

2. 2 2 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. 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.

3. 3 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”.

4. 4 2 Risk Factors: Hypertension; Hypertension; High cholesterol level in blood; High cholesterol level in blood; Cigarette smoking; Cigarette smoking; Diabetes; Diabetes; Increasing age and male sex. Increasing age and male sex.

5. 5 5 Pathogeny of atherosclerosis Nosotropic essence of atherosclerosis consists in the hearths deposits in intima of arteries so- called 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.

6. 6 2 Cholesteryl ester AtherogenicAtherogenic low density lipoproteins (LDL) High density lipoproteins (HDL) anti- Athe roge nic chylo­microns 16 % Very low density lipoproteins (VLDL) Cholesteryl ester 45 % (LDL) is the form of lipid in the plasma that has been most closely associated with accelerated atherosclerosis Apoprotein 55 %

7. 7 2 rubbish rubbish receptor apo B, E receptors

8. 8 7 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. 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.

9. 9 2 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); a) glucolisic lipoproteids (which added glucose); b) peroxide-modified lipoproteids, which appeared under act of free radicals and products of peroxide oxidization of lipids; b) peroxide-modified lipoproteids, which appeared under act of free radicals and products of peroxide oxidization of lipids; c) autoimmune complexes of lipoproteid- antibody; c) autoimmune complexes of lipoproteid- antibody; d) lipoproteids, which suffered partial degradation under act of proteolitic enzymes. d) lipoproteids, which suffered partial degradation under act of proteolitic enzymes.

10. 10 The vascular endothelium interacts with macro-molecules and formed elements of the blood and plays a role in the transport of plasma proteins. 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 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. 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. 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. 9

11. 11 2 Phases of ATHEROSCLEROSIS: till lipid; till lipid; lipid blots (ribbons); lipid blots (ribbons); lipoidosis or atheromatic plate; lipoidosis or atheromatic plate; liposclerosis or liposclerotic plates; liposclerosis or liposclerotic plates; stage of complication (clots, calcifications, ulcers...) stage of complication (clots, calcifications, ulcers...)

12. 12 2

13. 13 2 Hystogenesis of atherosclerosis (scheme)

14. 14 13 Hystogenesis of atherosclerosis

15. 15 2 Endothelial cell Smooth muscle cell Lipid-laden macrophage Extracellular lipid Necrotic cell

16. 16 2

17. 17 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.

18. 18 2 Pathoanatomical research of aorta scissors

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20. 20 2

21. 21 2

22. 22 2

23. 23 Clinic morphological forms and displays of atherosclerosis Clinic morphological forms Clinic morphological displays AcuteChronic Atherosclerosis of aorta Removing a layer by the layer of mid-dle shell from intima or adventi-tias ( розшаровуюча aneurysm). Rup-tures and bleeding. Thrombosis. Thrombembolism with develop-ment of heart attacks and gangre-ne. Acute ischemic heart trouble (stenocardia, heart attack of myocardium). Atrophy of breastbone and vertebral bodies from pressure at presence of aneurysm (sack, cylindrical, fusiform) Atherosclerosis of the coronary arteries Acute ischemic heart trouble (stenocardia, heart attack of myocardium). Chronic ischemic heart trouble (cardiosclerosis, chronic aneurysm of heart) Atherosclerosis of the cerebrum arteries Haematoma, hemorragic infiltration, infarcts of cerebrum A transitory ischemia – atrophy of brain, oligophrenia, cysts Atherosclerosis of the kidney's arteries Infarcts of kidneys Atherosclerotic nephrosclerosis Atherosclerosis of the intestine arteries Abdominal quinsy, gangrene, peritonitis Atrophy of mucous plate of intestine Atherosclerosis of the lower limb arteries Gangrene Atrophy of muscles, alternating lameness

24. 24 2 Atherosclerosis of aorta

25. 25 2 Atherosclerosis of cerebrum arteries

26. 26 2 Gangrene of foot

27. 27 Atherosclerotic nephrosclerosis

28. 28 2 The end