148. Chronic ischemic heart disease (hihd): definition, causes, forms. Pathological anatomy of cihd, complications, outcomes, clinical significance.

Chronic ischemic disease (HIBS) is morphologically represented by small-focal diffuse and postinfarction (large-focal) cardiosclerosis, sometimes complicated by chronic heart aneurysm.

Etiology. The main cause of the disease is atherosclerosis of the coronary arteries. Angina attacks are much less likely to occur with unchanged coronary arteries. The factors contributing to the development of the disease include functional overload of the heart, the histotoxic effect of catecholamines, changes in the coagulation and anticoagulation systems of the blood, insufficient development of collateral circulation.

Pathological anatomy. Myocardial changes in chronic ischemic heart disease are characterized by atherosclerotic small-focal cardiosclerosis (the morphological equivalent of a chest toad) or postinfarction large-focal cardiosclerosis and the resulting chronic heart aneurysm (postinfarction changes).

Cardiosclerosis as a manifestation of chronic ischemic heart disease can be atherosclerotic diffuse small-focal or postinfarction large-focal, on the basis of which a chronic heart aneurysm is formed.

Chronic heart aneurysm is usually formed at the end of an extensive transmural infarction, when the scar connective tissue that replaced the infarction becomes the wall of the heart. It becomes thinner and bulges out under blood pressure, forming an aneurysmal sac filled with layered thrombotic masses. Chronic heart failure (residual blood is constantly in the heart), thromboembolic complications and rupture of the aneurysm wall with tamponade of the pericardial cavity are associated with chronic aneurysm — more common causes of death in chronic coronary heart disease. A patient with chronic ischemic heart disease is constantly in danger of having a second heart attack with all possible complications.

Complications of HIBS 1. Chronic heart failure. 2. Cardiac arrhythmias, most often atrial fibrillation. 3. Thromboembolism of the arteries: Brain, kidneys, intestines, etc.

Outcomes: development of cardiovascular insufficiency, repeated myocardial infarctions, death.

149. Cerebrovascular diseases: definition, etiology, types, morphological characteristics. Changes in the brain in hypertension and related complications.

Cerebrovascular diseases are characterized by acute disorders of cerebral circulation, the background for the development of which are atherosclerosis and hypertension.

Etiology and pathogenesis. Among the immediate causes of acute cerebral circulatory disorders, the main place is occupied by spasm, thrombosis and thromboembolism of the cerebral and precerebral (carotid and vertebral) arteries. Psychoemotional overstrain, leading to angioedema, is of great importance.

Classification. Transient cerebral ischemia and stroke. A stroke is an acutely (suddenly) developing local disorder of cerebral circulation, accompanied by damage to the brain substance and impaired its function. They distinguish: 1) hemorrhagic stroke, represented by a hematoma or hemorrhagic impregnation of the brain substance; subarachnoid hemorrhage is also included in it; 2) ischemic stroke, the morphological expression of which is a heart attack Pathological anatomy. The morphology of transient cerebral ischemia is represented by vascular disorders and focal changes in brain tissue. These changes are reversible; perivascular deposits of hemosiderin can be detected at the site of former small hemorrhages. With the formation of a brain hematoma, which occurs in 85% of hemorrhagic stroke, there is a pronounced alteration of the walls of arterioles and small arteries with the formation of microaneurysms and rupture of their walls. At the site of the hemorrhage, the brain tissue is destroyed, a cavity is formed filled with blood clotts and softened brain tissue. Hemorrhage is localized most often in the subcortical nodes of the brain and cerebellum.