General Pathology

1
General Pathology

• Circulation
• Disorders - I
• Heart FailureManifestations Causes

Jaroslava Dušková Inst. Pathol. ,1st Med.
Faculty, Charles Univ. Prague
2
Manifestations of Circulatory Failure

• in the heart
• outside heart

3
Manifestations of Circulatory Failure

• in the heart
• acute failure - dilation
• chronic insuficiency - hypertrophy
• concentric,
  excentric
• outside heart

4
Manifestations of Circulatory Failure outside
heart

• Acute
• capilarovenous congestion
• acute venostasis
• cyanosis (5g of red. hemoglobin!)
• cardial hydrops edema

• Chronic
• cyanotic induration (spleen, liver, kidney)
• red induration
  (lung)
• venostatic catarrh
• vessels hypertrophy
• cardial hydrops edema

5
Cardiac Failure

• venous pressure
• capillary pressure

• cardiac output
• arterial volume ADH
• renin
• Na H2O retention
• plasma volume
• transudation
• EDEMA

6
Hypertrophic Heart

• mechanic and paracrine stimuli
• changed geometry concentric excentric
  hypertrophy
• decreased capillary myocytes ratio
• myocytes interstitial tissue composition
  changes
• fetal proteins synthesis beta myosin
• early genes induction c-myc, c-fos, c-jun
• decreased beta- adrenergic receptors
• increased oxygen consumption
• HEART FAILURE

7
Causes of Circulatory Failure (1)

• in the heart
• endocardium (malformations, fibroelastosis)
• myocardium (cardiomyopaties,infl
  ammations, hypoxia, tumor, trauma)
• pericardium
• (inflammations, synechiae, tumors,
  hemopericardium)
• neurological reflex (syncopa)
• in pulmonary circulation
• in body circulation (cont.)

8
Causes of Circulatory Failure (1)

• in the heart
• endocardium
• myocardium
• pericardium
• neurological reflex (syncope)
• pressure changes
• in pulmonary circulation
• in body circulation
• hypertension
• hypotension shock, collapse

9
Cardiomyopathy
Def. specific (non ischaemic, non inflammatory)
heart muscle disease leading to heart failure

• hypertrophic (obstructive)
• dilated (congestive)
• restrictive (obliterative)

10
Causes of Circulatory Failure (2)

• in pulmonary circulation
• acute pulmonary hypertension
  (pneumonia, pleuritis, embolism)
• chronic pulmonary hypertension (emphysema,
  fibrotising processses)
• COR PULMONALE acutum seu chronicum
• in body circulation
• (cont.)

11
Causes of Circulatory Failure (3)

• in body circulation
• hypertension
• essencial
• renal
• endocrine
• COR HYPERTONICUM
• COR BILATERALE
• changed blood composition (cont.)

12
Causes of Circulatory Failure (4)

• changed blood composition

• anaemia
• plethora
• oligemia
• hyperphydremia
• anhydria (exsicosis)
• hyperproteinemia
• hypoproteinemia

13
Shock

• Def.
• hypoperfusion of cells and tissues due to
  decrease of effective circulating volume

14
Shock - pathogenesis

• decreased amount of blood
• decreased cardiac output
• redistribution of blood

15
Shock - types causes

• cardiogenic
• hypovolemic (hemorrhage, fluid loss
  burns, vomiting)
• septic (bacterial infections
• G- endotoxic, G septicemia)
• neurogenic (anesthesia,spinal cord injury)

16
Shock - stages

• early (non progressive - reversible)
• progressive cell derangement
• irreversible cell death

17
Shock - morphology

• ischaemic encephalopathy
• shock lung
• shock kidney
• adrenal hypolipoidosis
• liver centroacinar necroses
• pancreas focal necroses

18
Collapse

• Def.
• temporary disproportion of the blood vessels
  volume due to vasodilation (heat, psychogenic
  stimuli)
• mostly self limited, can proceed to shock