144. Pathological anatomy of malignant hypertension, causes of death.

Hypertension is a chronic disease, the main clinical sign of which is a long-term and persistent increase in blood pressure (hypertension).

Etiology.

-Increased consumption of table salt

-Excessive nervous tension, leading to a disorder of autonomic nervous activity

Pathological anatomy.

In malignant hypertension, manifestations of a hypertensive crisis dominate, i.e. a sharp increase in blood pressure due to arteriole spasm. The morphological manifestations of a hypertensive crisis are quite characteristic and presented

-corrugation and destruction of the basement membrane of the endothelium

- arteriole spasm

-plasma impregnation or fibrinoid necrosis of its wall

- thrombosis

Changes in organs: In the malignant course of hypertension due to frequent crises, fibrinoid necrosis and thrombosis of arterioles of various organs leads to multiple heart attacks and hemorrhages. Malignant nephrosclerosis (Far) develops in the kidneys, which is manifested by necrosis and leukocyte infiltration of the renal glomeruli.

In the eyes - bilateral edema of the optic nerve with plasma effusion and retinal hemorrhages.

Hypertensive encephalopathy may occur in the brain, manifested by loss of consciousness due to edema and multiple small hemorrhages (due to fibrinoid necrosis of arterioles) of the brain.

Causes of death:

-Acute heart failure

-Acute renal failure (arteriol necrosis – death of cells of the bearing arteriole, inflammation in the loops of the glomeruli, edema, cellular reaction, sclerosis of the glomerular stroma, protein dystrophy in the epithelium of the tubules).

- Cerebral infarction, stroke.

145. Ischemic heart disease (chd): definition, causes, forms. Risk factors, pathogenesis. The role of unstable atherosclerotic plaque in the morphogenesis of ihd.

Coronary heart disease (CHD) is a group of diseases caused by absolute or relative insufficiency of coronary circulation.

+Ischemic heart disease is a cardiac form of atherosclerosis and hypertension, manifested by ischemic myocardial dystrophy, myocardial infarction, and cardiosclerosis.

The causes of ischemic myocardial damage may be:

- coronary artery thrombosis;

- embolism;

- prolonged spasm;

- stenosis;

- functional overstrain of the myocardium in conditions of insufficient collateral blood supply.

Ischemic heart disease flows in waves, accompanied by coronary crises, i.e. episodes of acute (absolute) coronary insufficiency that occur against the background of chronic (relative insufficiency of coronary circulation). In this regard, the following forms of coronary heart disease are distinguished by the nature of the course:

- acute;

- chronic.

Acute ischemic heart disease is morphologically manifested by ischemic myocardial dystrophy and myocardial infarction, chronic ischemic heart disease (HIBS) – cardiosclerosis (diffuse small-focal and postinfarction large-focal), sometimes complicated by chronic heart aneurysm.

Risk factors for the development of coronary heart disease:

1. Hypercholesterolemia.

2. Smoking.

3. Arterial hypertension.

4. Physical inactivity.

5. Obesity.

6. Stress.

7. Reduced glucose tolerance.

8. Gender (men are more likely to get sick).

9. Age, etc.

Pathogenesis.

The role of unstable atherosclerotic plaque: due to the fact that unstable plaque is easily damaged, damage can be accompanied by the formation of blood clots of various sizes. At least a decrease in blood flow, as a maximum, thromboembolism of the coronary arteries.