dolaşım pratik 2014 deniz nart
TRANSCRIPT
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KARDİYOMİYOPATİ VE
ARTERİOSKLEROZ VE ATEROSKLEROTİK KALP
HASTALIKLARI PRATİK
Prof. Dr. Deniz NARTEge Üniversitesi Tıp Fakültesi
Patoloji Anabilim Dalı
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Kalp ağırlığı veya ventrikül kalınlıklarında artış Hipertrofi
Boşlukların genişlemesi Dilatasyon
Hipertrofi ve/veya dilatasyona bağlı kalp ağırlığı veya boyutunda artış Kardiyomegali
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KARDİYOMYOPATİ
Farklı etiyoloji aynı morfoloji
Klinik, fonksiyonel ve patolojik paternler
•Dilate kardiyomyopati (%90)
•Hipertrofik kardiyomyopati
•Restriktif kardiyomiyopati (en nadir)
•Tanı: endomyokardial biyopsi
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Dilate KMP
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Dilate KMP ve ventrikül duvarında mural trombüs
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Dilate KMPKas hücreleri (miyositler) hipertrofik
Nukleuslar irileşmişFarklı kesit çaplarına sahip
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Hipertrofik miyositler
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Mason trikrom boyası ile intersitisyel fibrozis
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Dilate KMPİntersitisyel ve
endokardiyal fibrozis
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Septum kası sol ventrikül çıkışını daraltıyor
Sol ventrikül kavitesi şekil olarak “muz- benzeri” görünümde
Sol atrium dilateVentrikül sistolünde ön mitral kapakçığın septumla temasına bağlı:
•endokard kalın (mural plak)
•ön mitral kapakçık kalın
HİPERTROFİK KMP
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Hipertrofik kardiyomiyopati
Kardiak transplantasyon yapılan hastadan çıkarılan kalp
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Belirgin miyosit hipertrofisi
Transvers miyosit çapı gen.le 40 µm (N = 15 µm )
Miyofibril düzensizliği
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Hipertrofik KMP’de transvers çapı çok artmış hipertrofik miyositler
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Miyofibril düzensizliği ve intersitisyel fibrozis
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RESTRİKTİF KARDİYOMİYOPATİ
• Ventrikül kompliansında primer azalmaya bağlı diastolde ventriküllerin dolamaması ile karakterli
• Ventrikülün kontraktil (sistolik) fonksiyonu normal
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RESTRİKTİF KMP
Normal Restriktif KMP şematik
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Miyokardda amiloidoz
Kongo red boyası
Polarize ışık mikroskobu
Işığı çift kıran amiloid maddesi
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Miyokard biyopsisinde sarkoidoza ait granülom yapıları ve dev hücreleri
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HİPERTROFİK KMP
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HİPERTROFİK KMP
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Dilate KMP
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HİPERSENSİTİVİTE MİYOKARDİT
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Multinüklee dev hücre
Epiteloid histiyositler
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GRANÜLOMATÖZ MİYOKARDİT(SARKOİDOZ?)
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ARİTMOJENİK SAĞ VENTRİKÜL DİSPLAZİSİ (KMP)
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Yağlı çizgi
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Yağlı çizgi Fibröz plak
Hafif Şiddetli
Komplike lezyon
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Kalsifiye aterosklerotik plak
Normal damar duvarı
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Kalsifiye plak
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Aterosklerotik plakta nekrotik içerik
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Fibröz kapsül
Nekrotik çekirdek
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Mediada incelme var, anevrizma gelişebilir
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Fibröz kapsül ve çekirdeğin bileşke yeri:
Yangı hücreleri, kalsifikasyon, yeni damar oluşumu
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Plak içi kanama
Tromboz
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Lümende daralma
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Koroner arterde ateroskleroz
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Koroner arterde plak içi kanama
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Koroner plakta tromboz
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Koroner aterosklerozda tromboz
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Plak rüptürü
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Plak rüptürü + tromboz
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Koroner aterosklerozda tromboz- tam olmayan tıkanma
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Koroner aterosklerozda tromboz- tam tıkanma
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10 gün – 2 hafta arasında enfarktüs alanı hiperemik bir zon ile çevrili sarı-ten renkli hiperemik alan şeklinde izlenir
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2 haftadan sonra fibröz skar
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1 günlük infarktüs: dalgalı fibriller halinde koagülasyon nekrozu
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3-4 günlük miyokard infarktüsünde infarktüs bölgesinde polimorfonükleer lökosit infiltrasyonu
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7-10. günlerde nekrotik myositlerin makrofaj fagositozu ile ortadan kaldırılması
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Gevşek kollajen ve bol kapillerler ile karakterli erken granülasyon dokusu
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Nekrotik myokard liflerinin yerini yoğun kollajenöz skar dokusunun aldığı tam iyileşmiş enfarktüs dokusu
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Nekrotik myokard liflerinin yerini yoğun kollajenöz skar dokusunun aldığı tam iyileşmiş enfarktüs dokusu