Cardiovascular System Pathology 2.pdf

Objectives o Atherosclerosis Cardiovascular System Pathology 2022-2023 DR. RAZAN BALOUSH o Ischemic heart diseases: o Angina pectoris o Myocardial infarction o Systemic hypertension o Valvular heart disease: o Rheumatic heart disease: Acute - chronic o Infective endocarditis o Mitral valve prolaps...

Objectives o Atherosclerosis Cardiovascular System Pathology 2022-2023 DR. RAZAN BALOUSH o Ischemic heart diseases: o Angina pectoris o Myocardial infarction o Systemic hypertension o Valvular heart disease: o Rheumatic heart disease: Acute - chronic o Infective endocarditis o Mitral valve prolapse o Cardiomyopathy: o Dilated cardiomyopathy o Hypertrophic cardiomyopathy o Restrictive cardiomyopathy o Pericardial effusion o Congenital heart disease: o Coarctation of the aorta o Tetralogy of Fallot o Transposition of the great vessels o Ventricular septal defect o Atrial septal defect o Cardiac tumors: o Cardiac myxoma o Cardiac rhabdomyoma Atherosclerosis (ATH) Definition: ◦ Atherosclerosis is derived from the Greek word “athero”, meaning gruel or paste, and sclerosis, meaning hardening, and “osis” is a Greek suffix that describes a diseased condition ◦ A disease of elastic arteries & medium sized muscular arteries characterized by patchy deposition of yellowish plaques within the intima known as “atheroma” (the hallmark of atherosclerosis), leading to narrowing of the vessel lumen. :‫ﻒ‬EF‫اﻟﺘﻌ‬ ‫ﻀﺔ‬EF‫ﺔ ﺗﺼﻒ ﺣﺎﻟﺔ ﻣ‬R‫" ﻫﻲ ﻻﺣﻘﺔ ﻳﻮﻧﺎﻧ‬osis"‫ و‬،‫ﻤﻌﻨﻰ اﻟﺘﺼﻠﺐ‬b ،‫ واﻟﺘﺼﻠﺐ‬،‫ﺐ أو اﻟﻠﺼﻖ‬e‫ اﻟﺘﻲ ﺗﻌﻨﻲ اﻟﻌﺼ‬،"athero" ‫ﺔ‬R‫ﻠﻤﺔ اﻟﻴﻮﻧﺎﻧ‬g‫ﺸﺘﻖ ﺗﺼﻠﺐ اﻟﺸﺮاﻳﻴﻦ ﻣﻦ اﻟ‬k .‫ﺔ‬Em‫ﺔ اﻟﺪﻣ‬R‫ﻒ اﻷوﻋ‬Em‫ﻴﻖ ﺗﺠ‬r‫ ﻣﻤﺎ ﻳﺆدي إﻟﻰ ﺗﻀ‬،(‫ﺎﺳﻢ "اﻟﻮرم" )اﻟﺴﻤﺔ اﻟﻤﻤﻴﺰة ﻟﺘﺼﻠﺐ اﻟﺸﺮاﻳﻴﻦ‬b ‫ﻤﺎ اﻟﻤﻌﺮوﻓﺔ‬R•‫ﺤﺎت اﻟﺼﻔﺮاء داﺧﻞ اﻹﻧ‬Em‫ﺔ ﻣﺘﻮﺳﻄﺔ اﻟﺤﺠﻢ ﺗﺘﻤﻴﺰ ﺑﺘﺮﺳﺐ ﻏﻴﺮ ﻣﻜﺘﻤﻞ ﻟﻠﻠ‬R‫ﻣﺮض اﻟﺸﺮاﻳﻴﻦ اﻟﻤﺮﻧﺔ واﻟﺸﺮاﻳﻴﻦ اﻟﻌﻀﻠ‬ Risk Factors Major A. Non-modifiable “Constitutional”: 1. Age: Atheroma progress slowly with advancing in age. 2. Sex: Males > females 3. Genetics: Family history is the most important independent risk factor for atherosclerosis – certain familial disorders (e.g., familial hypercholesterolemia) B. 1. 1. 2. 3. Modifiable risk factors Hyperlipidemia The strongest risk factor for atherosclerosis in patients under the age of 45. • Increased levels of low-density lipoproteins (LDL) • Cholesterol is the most important abnormality which predispose to Atherosclerosis • Hypertension Cigarette smoking Diabetes Mellitus Minor 1. 2. 3. 4. 5. 6. Obesity Physical inactivity Stressful lifestyle Postmenopausal estrogen deficiency High carbohydrate intake High unsaturated fat intake ‫ﺪاﻧﺔ‬b ‫اﻟﺨﻤﻮل اﻟ˜ﺪﻧﻲ‬ ‫ﺎة ﻣﺮﻫﻖ‬R‫ﻧﻤﻂ ﺣ‬ ‫ﻌﺪ اﻧﻘﻄﺎع اﻟﻄﻤﺚ‬b ‫ﻧﻘﺺ ﻫﺮﻣﻮن اﻻﺳﺘﺮوﺟﻴﻦ‬ ‫ﺪرات‬R‫¡ﻮﻫ‬F¢‫ﺔ ﻣﻦ اﻟ‬R‫ﺎت ﻋﺎﻟ‬R‫ﻤ‬£ ‫ﺗﻨﺎول‬ ‫ﺔ ﻣﻦ اﻟﺪﻫﻮن ﻏﻴﺮ اﻟﻤﺸ˜ﻌﺔ‬R‫ﺔ ﻋﺎﻟ‬R‫ﻤ‬£ Atherosclerosis (ATH) Morphology: ◦ Early “fatty streak” stage (first years of life): Soft yellow intimal discoloration which are slightly elevated. ◦ Later “fibrofatty atheromatous plaque” stage: Yellow fatty center covered by fibrous cap elevated above surface. :‫ﺎ‬R‫اﻟﻤﻮرﻓﻮﻟﻮﺟ‬ .‫ﻼ‬R‫ﻢ أﺻﻔﺮ ﻧﺎﻋﻢ ﻣﺮﺗﻔﻊ ﻗﻠ‬R‫ ﺗﻠﻮن ﺣﻤ‬:(‫ﺎة‬R‫ﻣﺮﺣﻠﺔ "اﻟﺨﻂ اﻟﺪﻫﻨﻲ" اﻟﻤ˜ﻜﺮة )اﻟﺴﻨﻮات اﻷوﻟﻰ ﻣﻦ اﻟﺤ‬ .‫ﻔﻲ ﻣﺮﺗﻔﻊ ﻓﻮق اﻟﺴﻄﺢ‬R‫ﻐﻄﺎء ﻟ‬b ‫ ﻣﺮﻛﺰ دﻫﻨﻲ أﺻﻔﺮ ﻣﻐﻄﻰ‬:"‫ﺔ‬R‫ﻔ‬R‫ﺤﺎت ﺗﺼﻠﺐ اﻟﺪﻫﻮن اﻟﻠ‬Em‫ﻓﻲ وﻗﺖ ﻻﺣﻖ ﻣﺮﺣﻠﺔ "ﻟ‬ Complications: ◦ Ulceration, rupture or erosion of the atheromatous plaque. ◦ Thrombosis. ◦ Aneurysm . :‫اﻟﻤﻀﺎﻋﻔﺎت‬ .‫ﻞ اﻟ˜ﻼك اﻟﺘﺼﻠﺒﻴﺜﻲ‬±²‫ح أو ﺗﻤﺰق أو ﺗ‬F‫ﺗﻘ‬ .‫ﺗﺠﻠﻂ اﻟﺪم‬ ‫ﺔ‬Em‫ﺔ اﻟﺪﻣ‬R‫ﺗﻤﺪد اﻷوﻋ‬ ANGINA PECTORIS Ischemic Heart Diseases (IHD) MYOCARDIAL INFARCTION Definition: ◦ Closely related syndromes caused by imbalance between myocardial O2 demand and coronary blood supply. ◦ Angina Pectoris: Intermittent substernal or “precordial” chest pain (episodic, paroxysmal) caused by transient reversible myocardial ischemia ◦ Myocardial infarction (MI): A defined area of myocardial necrosis caused by prolonged irreversible local ischemia resulting in a loss of contractile and conductive properties of the affected myocardium. Epidemiology: ◦ Most common cause of death in Western countries. ◦ Males > females ◦ Usually manifest around 50s ◦ Peak around 60s ◦ Most common predisposing risk factor is atherosclerosis of the coronary arteries. ◦ Most acute MIs are caused by coronary artery occlusion due to thrombosis superimposed on atherosclerotic plaque. :‫ﻒ‬EF‫اﻟﺘﻌ‬ ‫ ﻋﻀﻠﺔ اﻟﻘﻠﺐ‬O2 ‫ﻘﺔ اﻟﺼﻠﺔ ﻧﺎﺟﻤﺔ ﻋﻦ ﻋﺪم اﻟﺘﻮازن ﺑﻴﻦ اﻟﻄﻠﺐ ﻋﻠﻰ‬R‫ﻣﺘﻼزﻣﺎت وﺛ‬ .‫ﺔ‬R‫و¶ﻣﺪادات اﻟﺪم اﻟﺘﺎﺟ‬ ،‫ أﻟﻢ ﻣﺘﻘﻄﻊ ﺗﺤﺖ اﻟﻘﺺ أو "ﻣﺎ ﻗ˜ﻞ اﻟﻮدي" )اﻟﻈﻬﺮي‬:‫ﺔ‬E‫ﺔ اﻟﺼﺪر‬E‫ﺤﺔ اﻟﺼﺪر‬b‫اﻟﺬ‬ ‫ﻠﺔ ﻟﻼﻧﻌ»ﺎس اﻟﻌﺎﺑﺮ‬b‫ﺔ ﻋﻀﻠﺔ اﻟﻘﻠﺐ اﻟﻘﺎ‬E‫ﺎﺑﻲ( اﻟﻨﺎﺟﻢ ﻋﻦ ﻧﻘﺺ ﺗﺮو‬R•‫اﻻﻧ‬ ‫ ﻣﻨﻄﻘﺔ ﻣﺤﺪدة ﻣﻦ ﻧﺨﺮ ﻋﻀﻠﺔ اﻟﻘﻠﺐ اﻟﻨﺎﺟﻢ ﻋﻦ ﻧﻘﺺ‬:(MI) ‫اﺣ•ﺸﺎء ﻋﻀﻠﺔ اﻟﻘﻠﺐ‬ ‫ﻠﺔ ﻣﻤﺎ ﻳﺆدي إﻟﻰ ﻓﻘﺪان اﻟﺨﺼﺎﺋﺺ‬Em‫ﻪ ﻟﻔﺘﺮات ﻃ‬R‫ﺔ اﻟﻤﻮﺿﻌﻲ اﻟﺬي ﻻ رﺟﻌﺔ ﻓ‬E‫اﻟﺘﺮو‬ .‫ﺔ‬b‫ﺔ ﻟﻌﻀﻠﺔ اﻟﻘﻠﺐ اﻟﻤﺼﺎ‬R‫ﺔ واﻟﻤﻮﺻﻠ‬R‫اﻻﻧﻘ˜ﺎﺿ‬ :‫ﻋﻠﻢ اﻷو¡ﺌﺔ‬ .‫ﺔ‬R¡F‫ﺜﺮ ﺷﻴﻮﻋﺎ ﻟﻠﻮﻓﺎة ﻓﻲ اﻟﺪول اﻟﻐ‬Â‫ﺐ اﻷ‬Ã‫اﻟﺴ‬ ‫ذﻛﻮر < إﻧﺎث‬ ‫ﺎت‬R‫ﻨ‬r‫ﻈﻬﺮ ﺣﻮاﻟﻲ اﻟﺨﻤﺴ‬Ç ‫ﻋﺎدة ﻣﺎ‬ ‫ﺎت‬RÈ‫اﻟﺬروة ﺣﻮاﻟﻲ اﻟﺴ•ﻴ‬ .‫ﺔ‬R‫ﺜﺮ ﺷﻴﻮﻋﺎ ﻫﻮ ﺗﺼﻠﺐ اﻟﺸﺮاﻳﻴﻦ اﻟﺘﺎﺟ‬Â‫ﻋﺎﻣﻞ اﻟﺨﻄﺮ اﻟﻤﻬﻴﺊ اﻷ‬ ‫ﺐ ﺗﺠﻠﻂ اﻟﺪم‬Ã‫ﺴ‬Ê ‫ﺎن اﻟﺘﺎﺟﻲ‬E‫ﺴﺪاد اﻟﺸﺮ‬Ë‫ﺐ ا‬Ã‫ﺴ‬Ê ‫ اﻟﺤﺎدة‬MIs ‫ﺗﺤﺪث ﻣﻌﻈﻢ‬ .‫ﺐ ﻋﻠﻰ ﻟﻮﺣﺔ ﺗﺼﻠﺐ اﻟﺸﺮاﻳﻴﻦ‬Â‫اﻟﻤﺘﺮا‬ NORMAL BLOOD FLOW A THROMBUS Types of Angina Pectoris Typical (Stable) Unstable (Crescendo/Preinfarction) Pain Limited duration Induced by exertion & stress Pathology Fixed ATH narrowing Increased O2 demand Frequent, intense, longer Occurs at rest Fixed ATH narrowing Acute plaque change Partial thrombus Vasospasm Relieved by Rest Nitroglycerin Difficult to treat 20- 40 minutes after coronary occlusion >> CELL DEATH Infarct starts in subendocardial region Extending externally Reaching maximum size within 3-6 hours. Occurs at rest Vasospasm Nitroglycerin Progression of Myocardial Necrosis ◦ ◦ ◦ ◦ Prinzmetal's (Variant) ‫ﺔ‬b‫ﺎن اﻟﺘﺎﺟﻲ << ﻣﻮت اﻟﺨﻠ‬p‫ﺴﺪاد اﻟﺸﺮ‬v‫ﻌﺪ ا‬x ‫ﻘﺔ‬b‫ دﻗ‬40 -20 ◦ ‫◦ ﻳˆﺪأ اﻻﺣ„ﺸﺎء ﻓﻲ ﻣﻨﻄﻘﺔ ﺗﺤﺖ اﻟﺸﻐﺎف‬ ‫ﺎ‬b‫ﺪ ﺧﺎرﺟ‬Œ‫◦ اﻟﺘﻤﺪ‬ .‫ ﺳﺎﻋﺎت‬6-3 ‫◦ اﻟﻮﺻﻮل إﻟﻰ اﻟﺤﺪ اﻷﻗﺼﻰ ﻟﻠﺤﺠﻢ ﻓﻲ ﻏﻀﻮن‬ Myocardial Infarction Complications ◦ ◦ ◦ ◦ ◦ Arrhythmias Contractile dysfunction Myocardial rupture (A-B) Papillary muscle rupture (C) Fibrinous pericarditis (D) ◦ Mural thrombus (E) and thromboembolism ◦ Ventricular aneurysm (F) ‫ﻋﺪم اﻧﺘﻈﺎم ﺿﺮ›ﺎت اﻟﻘﻠﺐ‬ ‫ﺿﻌﻒ اﻻﻧﻘˆﺎض‬ (B-A) ‫ﺗﻤﺰق ﻋﻀﻠﺔ اﻟﻘﻠﺐ‬ (C) ‫ﺔ‬b‫ﻤ‬b‫ﺗﻤﺰق اﻟﻌﻀﻼت اﻟﺤﻠ‬ (D) ‫ﻔﻲ‬b‫اﻟﺘﻬﺎب اﻟﺘﺎﻣﻮر اﻟﻠ‬ ‫ﺔ‬p¨‫( واﻟﺠﻠﻄﺎت اﻟﺪﻣ‬E) ‫ﺔ‬p‫اﻟﺠﻠﻄﺔ اﻟﺠﺪار‬ (F) ‫ﺔ اﻟˆﻄﻴﻨﻲ‬p¨‫ﺔ اﻟﺪﻣ‬b‫ﺗﻤﺪد اﻷوﻋ‬ ◦ ◦ ◦ ◦ ◦ ◦ ◦ 30-40% 40-50% 15-20% Systemic Hypertension Systemic Hypertension (HTN) Blood Vessels: ◦ Atherosclerosis and its complications Definition: ◦ Sustained increase in resting blood pressure at levels above generally accepted normal values. Heart: ◦ Hypertensive heart disease: Hypertrophy of left ventricular wall ◦ Systolic >140 mmHg ◦ Diastolic > 90 mmHg Etiological Classification: ◦ Essential/Primary hypertension: ◦ 90-95% of cases ◦ The cause is UNKNOWN ◦ Secondary hypertension: ◦ Renal ◦ Endocrine ◦ Vascular Complications (Effects) of Hypertension :‫ﻒ‬EF‫اﻟﺘﻌ‬ ‫ﺎدة اﻟﻤﺴﺘﻤﺮة ﻓﻲ ﺿﻐﻂ اﻟﺪم أﺛﻨﺎء اﻟﺮاﺣﺔ‬EÓ‫اﻟ‬ ‫ﺔ‬R‫ﻌ‬R‫ﻢ اﻟﻄﺒ‬R‫ﺎت أﻋﻠﻰ ﻣﻦ اﻟﻘ‬Em‫ﻋﻨﺪ ﻣﺴﺘ‬ .‫اﻟﻤﻘﺒﻮﻟﺔ ﻋﻤﻮﻣﺎ‬ ‫ ﻣﻢ زﺋﺒﻖ‬140 < ‫اﻧﻘ˜ﺎﺿﻲ‬ ‫ ﻣﻢ زﺋﺒﻖ‬90 < ‫ﺴﺎﻃﻲ‬Ã‫اﻧ‬ :‫ﻒ اﻟﻤﺮﺿﻲ‬RÈ‫اﻟﺘﺼ‬ :‫اﻷﺳﺎﺳﻲ‬Ô‫ارﺗﻔﺎع ﺿﻐﻂ اﻟﺪم اﻷﺳﺎﺳﻲ‬ ‫ ﻣﻦ اﻟﺤﺎﻻت‬95٪-90 .‫ﺐ ﻏﻴﺮ ﻣﻌﺮوف‬Ã‫اﻟﺴ‬ ◦ Neurogenic :‫ارﺗﻔﺎع ﺿﻐﻂ اﻟﺪم اﻟﺜﺎﻧﻮي‬ ‫ﻠﻮي‬£ ‫اﻟﻐﺪد اﻟﺼﻤﺎء‬ ‫وﻋﺎﺋﻲ‬ ‫ﺔ‬RØ‫ﺔ ﻋﺼ‬RÈ‫ﺟﻴ‬ ◦ Coronary atherosclerosis → Ischemic heart disease & myocardial infarction Brain: ◦ Hypertensive cerebral diseases: ◦ Atherosclerosis → Cerebral artery thrombosis ◦ Cerebral Hemorrhage :‫ﺔ‬Em‫ﺔ اﻟﺪﻣ‬R‫اﻷوﻋ‬ ‫ﺗﺼﻠﺐ اﻟﺸﺮاﻳﻴﻦ وﻣﻀﺎﻋﻔﺎﺗﻪ‬ :‫اﻟﻘﻠﺐ‬ ‫ﺴﺮ‬k‫ ﺗﻀﺨﻢ ﺟﺪار اﻟ˜ﻄﻴﻦ اﻷ‬:‫ﻣﺮض ارﺗﻔﺎع ﺿﻐﻂ اﻟﺪم ﻓﻲ اﻟﻘﻠﺐ‬ ‫ﺔ واﺣ•ﺸﺎء ﻋﻀﻠﺔ اﻟﻘﻠﺐ‬E‫ﺔ → أﻣﺮاض اﻟﻘﻠﺐ اﻹﻗﻔﺎر‬R‫ﺗﺼﻠﺐ اﻟﺸﺮاﻳﻴﻦ اﻟﺘﺎﺟ‬ :‫اﻟﺪﻣﺎغ‬ :‫أﻣﺮاض اﻟﺪﻣﺎغ ارﺗﻔﺎع ﺿﻐﻂ اﻟﺪم‬ ‫ﺎن اﻟﺪﻣﺎﻏﻲ‬E‫ﺗﺼﻠﺐ اﻟﺸﺮاﻳﻴﻦ → ﺗﺠﻠﻂ اﻟﺸﺮ‬ ‫ﻒ دﻣﺎﻏﻲ ﻓﻲ اﻟﺪم اﻟﻔﻘﺮي‬EÓ‫ﻧ‬ Valvular Heart Disease (VHD) R H E U M AT I C H EA RT D I S EA S E ( A C U T E / C H RO N I C ) I N F EC T I V E E N D O C A R D I T I S M I TR A L VALVE P RO L A P S E General considerations: ◦ They can be either: ◦ Congenital. ◦ Acquired: ◦ Rheumatic heart disease (acute/chronic) ◦ Infective endocarditis ◦ Mitral valve prolapse ◦ Mitral valve is the most commonly affected valve. ◦ They cause major hemodynamic burden on the heart by: ◦ Obstruction (stenosis): Failure of valve to open completely leading to obstruction of forward flow. :‫اﻋﺘˆﺎرات ﻋﺎﻣﺔ‬ :‫ﻜﻮﻧﻮا إﻣﺎ‬Œ ‫ﻤﻜﻦ أن‬Œ .‫ﺔ‬b‫اﻟﺨﻠﻘ‬ :‫ﺗﻢ اﻟﺤﺼﻮل ﻋﻠﻴﻬﺎ‬ (‫ﻣﺰﻣﻨﺔ‬±‫ﺔ )ﺣﺎدة‬b‫أﻣﺮاض اﻟﻘﻠﺐ اﻟﺮوﻣﺎﺗﻴﺰﻣ‬ ‫اﻟﺘﻬﺎب اﻟﺸﻐﺎف اﻟﻤﻌﺪي‬ ‫ﻫﺒﻮط اﻟﺼﻤﺎم اﻟﺘﺎﺟﻲ‬ .‫اﻟﺼﻤﺎم اﻟﺘﺎﺟﻲ ﻫﻮ اﻟﺼﻤﺎم اﻷ¸ﺜﺮ ﺗﻀﺮرا‬ :‫ﺔ ﻋﻠﻰ اﻟﻘﻠﺐ ﻣﻦ ﺧﻼل‬p¨‫إﻧﻬﺎ ¼ﺴ»ﺐ ﻋﺒﺌﺎ ﻛﺒﻴﺮا ﻋﻠﻰ اﻟﺪورة اﻟﺪﻣ‬ .‫ﺴﺪاد اﻟﺘﺪﻓﻖ اﻷﻣﺎﻣﻲ‬v‫ ﻓﺸﻞ اﻟﺼﻤﺎم ﻓﻲ اﻟﻔﺘﺢ ﺗﻤﺎﻣﺎ ﻣﻤﺎ ﻳﺆدي إﻟﻰ ا‬:(‫ﺴﺪاد )اﻟﺘﻀﻴﻖ‬v‫اﻻ‬ .‫ﻌﻜﺲ اﻟﺘﺪﻓﻖ‬x ‫ﺴﻤﺢ‬ ‫ ﻓﺸﻞ اﻟﺼﻤﺎم ﻓﻲ اﻹﻏﻼق ﺗﻤﺎﻣﺎ ﻣﻤﺎ‬:(‫ﻔﺎءة أو اﻟﻘﺼﻮر‬Ä‫ﻗﻠﺲ )ﻋﺪم اﻟ‬ .‫ ــﺞ ﻣﻦ اﻻﺛﻨﻴﻦ ﻓﻲ ﻧﻔﺲ اﻟﺼﻤﺎم‬pÈ‫ﻣ‬ ◦ Regurgitation (incompetence or insufficiency): Failure of valve to close completely allowing flow reverse. ◦ Combination of the two in the same valve. Acute Rheumatic Heart Disease (Rheumatic fever) Definition: Acute, immunologically mediated, multi-system inflammatory disease following an episode of group A ß-hemolytic streptococcal pharyngitis after an interval of 2-3 weeks :‫ﻒ‬EF‫اﻟﺘﻌ‬ ‫ﻌﺪ ﺣﻠﻘﺔ ﻣﻦ اﻟﺘﻬﺎب اﻟ˜ﻠﻌﻮم اﻟﻌﻘﺪي اﻻﻧﺤﻼﻟﻲ ﻣﻦ‬b ‫ﺔ وﻣﺘﻌﺪدة اﻷﻧﻈﻤﺔ‬R‫ﻣﺮض اﻟﺘﻬﺎﺑﻲ ﺣﺎد ﺑﻮﺳﺎﻃﺔ ﻣﻨﺎﻋ‬ ‫ أﺳﺎﺑﻴﻊ‬3-2 ‫ﻌﺪ ﻓﺘﺮة‬b A ß ‫اﻟﻤﺠﻤﻮﻋﺔ‬ Pathogenesis: Host antibodies directed against proteins of certain sterptococcal strains cross-react with normal tissue glycoprotein antigens in the heart, joints & other tissues. :‫ﺐ ﻓﻲ اﻷﻣﺮاض‬Ã‫اﻟ•ﺴ‬ ‫ﺔ ﺗﺘﻘﺎﻃﻊ ﻣﻊ‬Ç‫ﻌﺾ ﺳﻼﻻت اﻟﻤﻜﻮرات اﻟﻌﻨﻘﻮد‬b ‫ﻨﺎت‬r‫ﻔﺔ اﻟﻤﻮﺟﻬﺔ ﺿﺪ ﺑﺮوﺗ‬R‫اﻷﺟﺴﺎم اﻟﻤﻀﺎدة اﻟﻤﻀ‬ .‫ﺴﺠﺔ اﻷﺧﺮى‬Ë‫ﺔ ﻓﻲ اﻟﻘﻠﺐ واﻟﻤﻔﺎﺻﻞ واﻷ‬R‫ﻌ‬R‫ﺴﺠﺔ اﻟﻄﺒ‬Ë‫ﻣﺴﺘﻀﺪات اﻟﺒﺮوﺗﻴﻦ اﻟﺴﻜﺮي ﻟﻸ‬ Morphology: Multisystemic: Inflammatory lesions found in various tissues throughout the body (heart, joints “synovium”, and skin) Carditis: Inflammation of valves, myocardium, or pericardium. :‫ﺎ‬R‫اﻟﻤﻮرﻓﻮﻟﻮﺟ‬ ‫ﺴﺠﺔ اﻟﻤﺨﺘﻠﻔﺔ ﻓﻲ ﺟﻤﻴﻊ أﻧﺤﺎء اﻟﺠﺴﻢ )اﻟﻘﻠﺐ‬Ë‫ﺔ اﻟﻤﻮﺟﻮدة ﻓﻲ اﻷ‬R‫ اﻵﻓﺎت اﻻﻟﺘﻬﺎﺑ‬:‫ﻣﺘﻌﺪد اﻷﻧﻈﻤﺔ‬ (‫ واﻟﺠﻠﺪ‬،"‫ﻨﻮﻓﻴﻮم‬r‫واﻟﻤﻔﺎﺻﻞ( "ﺳ‬ .‫ اﻟﺘﻬﺎب اﻟﺼﻤﺎﻣﺎت أو ﻋﻀﻠﺔ اﻟﻘﻠﺐ أو اﻟﺘﺎﻣﻮر‬:‫اﻟﺘﻬﺎب اﻟﻘﻠﺐ‬ Acute Rheumatic Pericarditis Acute Rheumatic Endocarditis Fibrinous or serofibrinous exudate. Generally, resolves with no sequalae. Affected valve develops small (1-2 mm), irregular, vegetations (fibrin thrombi) along the lines of valve closure. Absence of streptococci .sequalae ‫ﺪون‬x ‫ ﻳﺘﻢ ﺣﻠﻪ‬،‫ﻞ ﻋﺎم‬Î‫ﺸ‬Ï .‫ﺔ‬b‫ﺔ أو اﻟﻤﺼﻠ‬b‫ﻔ‬b‫اﻹﻓﺮازات اﻟﻠ‬ ‫ ﻏﻴﺮ ﻣﻨﺘﻈﻤﺔ )ﺟﻠﻄﺎت‬،(‫ ﻣﻢ‬2-1) ‫ﻳﺘﻄﻮر اﻟﺼﻤﺎم اﻟﻤﺼﺎب إﻟﻰ ﻧˆﺎﺗﺎت ﺻﻐﻴﺮة‬ ‫ﺔ‬Œ‫ﺎت اﻟﻌﻘﺪ‬Œ‫ﺎب اﻟﻌﻘﺪ‬b‫ ﻏ‬.‫ﻦ( ﻋﻠﻰ ﻃﻮل ﺧﻄﻮط إﻏﻼق اﻟﺼﻤﺎم‬p‫اﻟﻔﻴﺒﺮ‬ Chronic Rheumatic Heart Disease Definition: The acute inflammation may organize causing significant dense scarring and functional consequences: :‫ﻒ‬EF‫اﻟﺘﻌ‬ :‫ﺔ‬R‫ﻔ‬R‫ﻔﺔ ﻛﺒﻴﺮة وﻋﻮاﻗﺐ وﻇ‬R‫ﺎت ﻛﺜ‬b‫ﺐ ﻧﺪ‬Ã‫ﺴ‬k ‫ﻗﺪ ﻳﻨﻈﻢ اﻻﻟﺘﻬﺎب اﻟﺤﺎد ﻣﻤﺎ‬ - Stenosis: ↓ of valve orifice ‫ ↓ ﻣﻦ ﻓﺘﺤﺔ اﻟﺼﻤﺎم‬:‫اﻟﺘﻀﻴﻖ‬ ‫ﺸﻮرات‬È‫ﻢ ﻟﻠﻤ‬R‫ اﻹﻏﻼق ﻏﻴﺮ اﻟﺴﻠ‬:‫ﻗﻠﺲ‬ - Regurgitation: Improper closure of leaflets Mitral stenosis is the most common lesion Cardinal morphologic changes in mitral valve: Leaflet thickening, commissural fusion ,fibrous bridging across commissures & calcification → slit-like channel "fish-mouth" or “buttonhole” stenosis. ‫ﺜﺮ ﺷﻴﻮﻋﺎ‬4‫اﻟﺘﻀﻴﻖ اﻟﺘﺎﺟﻲ ﻫﻮ اﻵﻓﺔ اﻷ‬ : ‫ﺔ ﻓﻲ اﻟﺼﻤﺎم اﻟﺘﺎﺟﻲ‬D‫ﺎردﻳﻨﺎﻟ‬I‫ﺔ اﻟ‬D‫اﻟﺘﻐﻴﺮات اﻟﻤﻮرﻓﻮﻟﻮﺟ‬ .‫ﻪ اﻟﺸﻖ "ﻓﻢ اﻟﺴﻤﻜﺔ" أو ﺗﻀﻴﻖ "ﺛﻘﺐ اﻟﺰر‬Z‫ﻠﺲ → ﻗﻨﺎة [ﺸ‬a‫ﻔﻲ ﻋﺒﺮ اﻟﺼﻮاﺳﻴﺮ واﻟﺘ‬D‫ اﻟﺘﺠﺴﻴﺮ اﻟﻠ‬،‫ اﻻﻧﺼﻬﺎر اﻻﻧﺼﻬﺎري‬،‫ﺸﺮة‬k‫ﺔ اﻟ‬4‫"ﺳﻤﺎ‬ : ‫اﻟﺘﺄﺛﻴﺮ‬ Effect: Left atrium: Progressive dilatation Mural thrombi may be form → systemic emboli ‫ﺠﻲ‬m‫ اﻟﺘﻤﺪد اﻟﺘﺪر‬:‫ﺴﺮ‬o‫اﻷذﻳﻦ اﻷ‬ ‫ﺔ‬m‫ﻼ → اﻟﺼﻤﺎت اﻟﺠﻬﺎز‬a‫ﺔ ﺷ‬m‫ﻗﺪ ﺗﻜﻮن اﻟﺠﻠﻄﺔ اﻟﺠﺪار‬ Infective Endocarditis Definition: Microbial invasion of the heart valves or mural endocardium with the destruction of underlying cardiac tissues & formation of friable, bulky masses “vegetations” (necrotic debris, thrombus & organisms) ‫ﺎﻣﻨﺔ‬Ò‫ﺴﺠﺔ اﻟﻘﻠﺐ اﻟ‬v‫ﻜﺮوﺑﻲ ﻟﺼﻤﺎﻣﺎت اﻟﻘﻠﺐ أو اﻟﺸﻐﺎف اﻟﺠﺪاري ﻣﻊ ﺗﺪﻣﻴﺮ أ‬b‫اﻟﻐﺰو اﻟﻤ‬ (‫ﺔ‬b‫ﺎﺋﻨﺎت اﻟﺤ‬Ò‫ﺖ واﻟﺠﻠﻄﺎت واﻟ‬b‫ﺖ )اﻟﺤﻄﺎم اﻟﻤ‬b‫ﻠﺔ ﻟﻠﺘﻔﺘ‬x‫ﻞ "ﻧˆﺎﺗﺎت" ﻛﺘﻞ ﺿﺨﻤﺔ ﻗﺎ‬b‫و¼ﺸﻜ‬ Types: Organism Valves Progression of Infection Prognosis Acute Endocarditis High virulence Staphylococcus aureus Normal or damaged Rapid Death within days to weeks in 50% despite antibiotics & surgery Morphology: ◦ In both acute & subacute forms, characteristic friable, bulky & potentially destructive vegetations are present on the heart valves. ◦ Aortic & Mitral valves are most common sites of involvement Subacute Endocarditis Low virulence ɑ-hemolytic streptococci Damaged Slowly Majority recover with appropriate antibiotics :‫اﻟﻤﻮرﻓﻮﻟﻮﺟ<ﺎ‬ ‫ﻠﺔ ﻟﻠﺘﻔﺘ<ﺖ‬I‫ﺎﺗﺎت ﻣﻤﻴﺰة ﻗﺎ‬Q‫ ﺗﻮﺟﺪ ﻧ‬،‫ﺎل اﻟﺤﺎدة وﺗﺤﺖ اﻟﺤﺎدة‬Y‫ﻓﻲ ^ﻞ ﻣﻦ اﻷﺷ‬ .‫ﻤﺎ ﻣﺪﻣﺮة ﻋﻠﻰ ﺻﻤﺎﻣﺎت اﻟﻘﻠﺐ‬f‫وﺿﺨﻤﺔ ور‬ ‫ﺜﺮ ﻣﻮاﻗﻊ اﻟﻤﺸﺎرﻛﺔ ﺷﻴﻮﻋﺎ‬m‫اﻟﺼﻤﺎﻣﺎت اﻷﺑﻬﺮي واﻟﺼﻤﺎﻣﺎت اﻟﺘﺎﺟ<ﺔ ﻫﻲ أ‬ Myxomatous Mitral Valve (Mitral Valve Prolapse) Epidemiology: ◦ MVP is the most common cause of isolated mitral regurgitation. ◦ Most cases discovered between the ages of 20-40 ◦ Women > men (7:1) Morphology: ◦ Affected leaflets are enlarged, redundant, thick & rubbery →characteristic ballooning of the valve leaflets into the left atrium during systole. :‫ﻋﻠﻢ اﻷو¡ﺌﺔ‬ .‫ﺲ اﻟﺘﺎﺟﻲ اﻟﻤﻌﺰول‬e‫ﺜﺮ ﺷﻴﻮﻋﺎ ﻟﻠﻘ‬Â‫ﺐ اﻷ‬Ã‫ ﻫﻮ اﻟﺴ‬MVP 40-20 ‫ﻣﻌﻈﻢ اﻟﺤﺎﻻت اﻟﻤﻜ•ﺸﻔﺔ ﺑﻴﻦ ﺳﻦ‬ (7:1) ‫ﺴﺎء < اﻟﺮﺟﺎل‬È‫اﻟ‬ :‫ﺎ‬R‫اﻟﻤﻮرﻓﻮﻟﻮﺟ‬ .‫ﺴﺮ أﺛﻨﺎء اﻻﻧﻘ˜ﺎض‬k‫ﺸﻮرات اﻟﺼﻤﺎم ﻓﻲ اﻷذﻳﻦ اﻷ‬È‫ﺔ → ﻣﻨﻄﺎد ﻣﻤﻴﺰ ﻟﻤ‬R‫ﻜﺔ وﻣﻄﺎﻃ‬R‫ ﺳﻤ‬،‫ زاﺋﺪة ﻋﻦ اﻟﺤﺎﺟﺔ‬،‫ﺸﻮرات اﻟﻤﺘﺄﺛﺮة ﻣﺘﻀﺨﻤﺔ‬È‫اﻟﻤ‬ Cardiomyopathies DILATED CARDIOMYOPATHY HYPERTROPHIC CARDIOMYOPATHY RESTRICTIVE CARDIOMYOPATHY Dilated Cardiomyopathy (DCM) Dilated cardiomyopathy (DCM) is characterized by: ◦ Progressive cardiac dilation ◦ Contractile (systolic) dysfunction Morphology: ◦ Enlarged flabby heart ◦ Dilation of all chambers ◦ Mural thrombi Pathogenesis: ◦ Viral infection ◦ Alcohol and its metabolites ◦ Genetic influence: ◦ Mutation in the dystrophin gene ◦ Unknown (idiopathic dilated cardiomyopathy) :‫ﻠﻲ‬Œ ‫ﻤﺎ‬x (DCM) ‫ﻳﺘﻤﻴﺰ اﻋﺘﻼل ﻋﻀﻠﺔ اﻟﻘﻠﺐ اﻟﻤﺘﻮﺳﻊ‬ ‫ﺠﻲ‬p‫ﺗﻤﺪد اﻟﻘﻠﺐ اﻟﺘﺪر‬ (‫ﻔﻲ اﻻﻧﻘˆﺎﺿﻲ )ال اﻧﻘˆﺎﺿﻲ‬b‫اﻟﺨﻠﻞ اﻟﻮﻇ‬ :‫ﺎ‬b‫اﻟﻤﻮرﻓﻮﻟﻮﺟ‬ ‫ﺗﻀﺨﻢ اﻟﻘﻠﺐ اﻟﻤﺘﺮﻫﻞ‬ ‫ﺗﻤﺪد ﺟﻤﻴﻊ اﻟﻐﺮف‬ ‫ﺔ‬p‫اﻟﺠﻠﻄﺔ اﻟﺠﺪار‬ :‫اﻟ„ﺴ»ﺐ ﻓﻲ اﻷﻣﺮاض‬ ‫ﺔ‬b‫اﻟﻌﺪوى اﻟﻔﻴﺮوﺳ‬ ‫ﺤﻮل وﻣﺴﺘﻘﻠˆﺎﺗﻪ‬Ä‫اﻟ‬ :‫اﻟﺘﺄﺛﻴﺮ اﻟﻮراﺛﻲ‬ ‫ﺴﺘﺮوﻓﻴﻦ‬Â‫ﻃﻔﺮة ﻓﻲ ﺟﻴﻦ اﻟﺪ‬ (‫ﻏﻴﺮ ﻣﻌﺮوف )اﻋﺘﻼل ﻋﻀﻠﺔ اﻟﻘﻠﺐ اﻟﻤﺘﻮﺳﻊ ﻣﺠﻬﻮل اﻟﺴ»ﺐ‬ Hypertrophic Cardiomyopathy (HCM) Hypertrophic cardiomyopathy (HCM) is characterized by: ◦ Myocardial hypertrophy ◦ Abnormal diastolic filling ◦ Systolic function is usually preserved Hypertrophic cardiomyopathy (HCM) is characterized by: ◦ Primary decrease in ventricular compliance ◦ Impaired ventricular filling during diastole ◦ The contractile (systolic) function of the left ventricle is usually unaffected Morphology: ◦ The heart is thick-walled, heavy, and hypercontracting ◦ Massive myocardial hypertrophy ◦ Asymmetrical septal hypertrophy (HCM) ‫ﻳﺘﻤﻴﺰ اﻋﺘﻼل ﻋﻀﻠﺔ اﻟﻘﻠﺐ اﻟﻀﺨﺎﻣﻲ‬ Pathogenesis: ◦ Most frequently caused by missense point mutations in β-myosin heavy chain gene Restrictive Cardiomyopathy :‫ﻠﻲ‬Œ ‫ﻤﺎ‬x ‫ﺗﻀﺨﻢ ﻋﻀﻠﺔ اﻟﻘﻠﺐ‬ ‫ﺔ‬b‫ﻌ‬b‫ﺔ ﻏﻴﺮ ﻃﺒ‬b‫ﺣﺸﻮة اﻧ»ﺴﺎﻃ‬ ‫ﺔ‬b‫ﻔﺔ اﻻﻧﻘˆﺎﺿ‬b‫ﻋﺎدة ﻣﺎ ﻳﺘﻢ اﻟﺤﻔﺎظ ﻋﻠﻰ اﻟﻮﻇ‬ :‫ﺎ‬b‫اﻟﻤﻮرﻓﻮﻟﻮﺟ‬ ‫ﻤﺎش‬Î‫ﻞ وﻣﻔﺮط اﻻﻧ‬b‫ﻚ اﻟﺠﺪران وﺛﻘ‬b‫اﻟﻘﻠﺐ ﺳﻤ‬ ‫ﺗﻀﺨﻢ ﻋﻀﻠﺔ اﻟﻘﻠﺐ اﻟﻬﺎﺋﻞ‬ ‫ﺗﻀﺨﻢ اﻟﺤﺎﺟﺰ ﻏﻴﺮ اﻟﻤﺘﻤﺎﺛﻞ‬ :‫اﻟ„ﺴ»ﺐ ﻓﻲ اﻷﻣﺮاض‬ ‫ﺒﻬﺎ ﻃﻔﺮات ﻧﻘﻄﺔ اﻟﺨﻄﺄ ﻓﻲ ﺟﻴﻦ‬ß‫ﻏﺎﻟˆﺎ ﻣﺎ ¼ﺴ‬ myosin-β ‫ﻠﺔ‬b‫اﻟﺴﻠﺴﻠﺔ اﻟﺜﻘ‬ Pathogenesis: ◦ Idiopathic ◦ Associated with: ◦ Radiation ◦ Amyloidosis ◦ Hemochromatosis ◦ Sarcoidosis ‫ﻳﺘﻤﻴﺰ اﻋﺘﻼل ﻋﻀﻠﺔ اﻟﻘﻠﺐ اﻟﻀﺨﺎﻣﻲ‬ :‫ﻠﻲ‬Œ ‫ﻤﺎ‬x (HCM) ‫اﻻﻧﺨﻔﺎض اﻷﺳﺎﺳﻲ ﻓﻲ اﻻﻣﺘﺜﺎل ﻟﻠˆﻄﻴﻦ‬ ‫ﺴﺪاد‬v‫ﺿﻌﻒ ﻣﻞء اﻟˆﻄﻴﻦ أﺛﻨﺎء اﻻ‬ ‫ﺔ‬b‫ﻔﺔ اﻻﻧﻘˆﺎﺿ‬b‫ﻋﺎدة ﻣﺎ ﻻ ﺗﺘﺄﺛﺮ اﻟﻮﻇ‬ ‫ﺴﺮ‬Â‫)اﻻﻧﻘˆﺎﺿﻲ( ﻟﻠˆﻄﻴﻦ اﻷ‬ :‫اﻟ„ﺴ»ﺐ ﻓﻲ اﻷﻣﺮاض‬ .‫ﻣﺠﻬﻮل اﻟﺴ»ﺐ‬ :‫ﻣﺮﺗˆﻂ ب‬ ‫إﺷﻌﺎع‬ ‫ﺸﻮاﻧﻲ‬ä‫داء اﻟ‬ ‫ﺔ‬p¨‫داء ﺗﺮﺳﺐ اﻷﺻˆﻐﺔ اﻟﺪﻣ‬ ‫ﺪ‬p¨‫اﻟﺴﺎرﻛ‬ Pericardial Effusion Definition: ◦ Pericardial effusion is excess of pericardial sac fluid ◦ Normally, there is about 30 to 50 mL of thin, clear, straw-colored (serous) fluid in the pericardial sac The consequences of pericardial effusions depend on the ability of the parietal pericardium to stretch ◦ This, in turn, depends on: ◦ The amount of fluid ◦ The tempo of its accumulation ◦ Slowly accumulating effusions even as large as 1000 mL can be tolerated without clinical manifestation ◦ Rapidly developing collections of as little as 250 mL (e.g., ruptured MI or ruptured aortic dissection) can restrict diastolic cardiac filling to produce fatal cardiac tamponade The major types and some of their more common causes include: ◦ Serous: ◦ Congestive heart failure ◦ Hypoalbuminemia of any cause ◦ Serosanguinous: ◦ Blunt chest trauma ◦ Malignancy ◦ Ruptured MI ◦ Aortic dissection ◦ Chylous: ◦ Mediastinal lymphatic obstruction :‫ﻒ‬EF‫اﻟﺘﻌ‬ ‫ﺲ اﻟﺘﺎﻣﻮري‬e¢‫اﻻﻧﺼ˜ﺎب اﻟﺘﺎﻣﻮري ﻫﻮ ﻓﺎﺋﺾ ﻣﻦ ﺳﺎﺋﻞ اﻟ‬ ‫ﻠﻮن‬b (‫ ﻣﻞ ﻣﻦ اﻟﺴﺎﺋﻞ اﻟﺮﻗﻴﻖ واﻟﻮاﺿﺢ )اﻟﻤﺼﻠﻲ‬50 ‫ إﻟﻰ‬30 ‫ ﻫﻨﺎك ﺣﻮاﻟﻲ‬،‫ﻋﺎدة‬ ‫ﺲ اﻟﺘﺎﻣﻮر‬e‫اﻟﻘﺶ ﻓﻲ ﻛ‬ ‫ﺗﻌﺘﻤﺪ ﻋﻮاﻗﺐ اﻻﻧﺼ˜ﺎب اﻟﺘﺎﻣﻮري ﻋﻠﻰ ﻗﺪرة اﻟﺘﺎﻣﻮر اﻟﺠﺪاري ﻋﻠﻰ اﻟﺘﻤﺪد‬ :‫ﻌﺘﻤﺪ ﻋﻠﻰ‬Ç ،‫ﺪورە‬b ،‫ﻫﺬا‬ (‫ﺔ اﻟﺴﻮاﺋﻞ )اﻟﺴﺎﺋﻞ‬R‫ﻤ‬£ ‫ﻤﻬﺎ؟‬±‫وﺗﻴﺮة ﺗﺮا‬ ‫ ﻣﻞ دون ﻣﻈﻬﺮ‬1000 ‫ﺎن ﺣﺠﻤﻪ‬£ ‫ﻢ ﺑ˜ﻂء ﺣﺘﻰ ﻟﻮ‬±‫ﻤﻜﻦ ﺗﺤﻤﻞ اﻻﻧﺼ˜ﺎب اﻟﻤﺘﺮا‬Ç ‫ﺮي‬E‫ﺳﺮ‬ ،‫ﻞ اﻟﻤﺜﺎل‬RØ‫ ﻣﻞ )ﻋﻠﻰ ﺳ‬250 ‫ﻌﺔ اﻟﺘﻄﻮر اﻟﺘﻲ ﻻ ﺗﺼﻞ إﻟﻰ‬E‫ﻤﻜﻦ ﻟﻠﻤﺠﻤﻮﻋﺎت ﺳﺮ‬Ç ‫ﺎك‬£‫ﺴﺎﻃﻲ ﻹﻧﺘﺎج د‬Ã‫ﺪ ﻣﻞء اﻟﻘﻠﺐ اﻻﻧ‬R‫ـ ــﺢ اﻷﺑﻬﺮ( أن ﺗﻘ‬E‫ﺸﺮ‬ï ‫ أو ﺗﻤﺰق‬MI ‫ﺗﻤﺰق‬ ‫ﻗﻠﺒﻲ ﻗﺎﺗﻞ‬ :‫ﻠﻲ‬Ç ‫ﺜﺮ ﺷﻴﻮﻋﺎ ﻣﺎ‬Â‫ﺔ و¡ﻌﺾ أﺳ˜ﺎﺑﻬﺎ اﻷ‬R‫ﺴ‬e‫ﺸﻤﻞ اﻷﻧﻮاع اﻟﺮﺋ‬ï :‫ﻣﺼﻞ‬ ‫ﻗﺼﻮر اﻟﻘﻠﺐ اﻻﺣﺘﻘﺎﻧﻲ‬ ‫ﺐ ﻣﻦ اﻷﺳ˜ﺎب‬Ã‫ﻧﻘﺺ أﻟﺒﻮﻣﻴﻦ اﻟﺪم ﻷي ﺳ‬ :Serosanguinous ‫ﺻﺪﻣﺔ ﺣﺎدة ﻓﻲ اﻟﺼﺪر‬ ‫ﺚ‬R‫اﻟﻮرم اﻟﺨﺒ‬ MI ‫ﺗﻤﺰﻋﺎ‬ ‫ـ ــﺢ اﻷﺑﻬﺮ‬E‫ﺸﺮ‬ï :‫ﻠﻮ‬R‫ﺷ‬ ‫ﺴﺪاد اﻟﻤﻨﺼﻒ اﻟﻠﻤﻔﺎوي‬Ë‫ا‬ Congenital Heart Diseases Coarctation of the aorta: Segmental narrowing of the aorta. Tetralogy of Fallot: ◦ The most common cause of congenital cyanotic heart disease. ◦ The classic tetrad: C O A R C TAT I O N O F T H E A O R TA T E T R A L O G Y O F FA L L O T T R A N S P O S I T I O N O F T H E G R E AT V E S S E L S V E N T R I C U L A R S E P TA L D E F E C T AT R I A L S E P TA L D E F E C T .‫ﻴﻖ اﻟﻘﻄﺎﻋﻲ ﻟﻸورﻃﻲ‬J‫ اﻟﺘﻀ‬:‫ﺎن اﻷورﻃﻲ‬O‫ﺗﻀﻴﻖ اﻟﺸﺮ‬ :‫ﺔ ﻓﺎﻟﻮت‬W‫ﺎﻋ‬X‫ر‬ .‫ﺔ‬W‫ﺜﺮ ﺷﻴﻮﻋﺎ ﻷﻣﺮاض اﻟﻘﻠﺐ اﻟﺰرﻗﺎء اﻟﺨﻠﻘ‬c‫ﺐ اﻷ‬d‫اﻟﺴ‬ :‫ﻜﻲ‬W‫ﻼﺳ‬i‫اﻟﺘﻴﺘﺮاد اﻟ‬ ‫ﻤﻦ‬m‫ﻄﻴﻦ اﻷ‬n‫ﺗﻀﻴﻖ ﺗﺪﻓﻖ اﻟ‬p‫ﺴﺪاد‬q‫ا‬ ◦ Right ventricular outflow obstruction/stenosis ◦ Right ventricular hypertrophy ‫ﻤﻦ‬m‫ﻄﻴﻦ اﻷ‬n‫ﺗﻀﺨﻢ اﻟ‬ ◦ Ventricular septal defect ‫ﻄﻴﻨﻲ‬n‫ﺐ اﻟﺤﺎﺟﺰ اﻟ‬W‫ﻋ‬ ◦ Overriding aorta ‫ﺎن اﻷورﻃﻲ اﻟﻤﺘﺠﺎوز‬O‫اﻟﺸﺮ‬ Transposition of the great vessels: An abnormal development whereby the aorta arises from the right ventricle, and the pulmonary artery arises from the left ventricle. Ventricular septal defect (VSD): Direct communication between the ventricular chamber. Atrial septal defect (ASD): Direct communication between the atrial chambers. .‫ﺴﺮ‬k‫ﺎن اﻟﺮﺋﻮي ﻣﻦ اﻟ˜ﻄﻴﻦ اﻷ‬E‫ﺸﺄ اﻟﺸﺮ‬ÈE‫ و‬،‫ﻤﻦ‬Ç‫ﺎن اﻷورﻃﻲ ﻣﻦ اﻟ˜ﻄﻴﻦ اﻷ‬E‫ﺸﺄ اﻟﺸﺮ‬È‫ﺚ ﻳ‬R‫ﻌﻲ ﺣ‬R‫ ﺗﻄﻮر ﻏﻴﺮ ﻃﺒ‬:‫ﺒﻴﺮة‬¢‫ﺔ اﻟ‬Em‫ﺔ اﻟﺪﻣ‬R‫ﻧﻘﻞ اﻷوﻋ‬ .‫ اﻻﺗﺼﺎل اﻟﻤ˜ﺎﺷﺮ ﺑﻴﻦ ﻏﺮﻓﺔ اﻟ˜ﻄﻴﻦ‬:(VSD) ‫ﺐ اﻟﺤﺎﺟﺰ اﻟ˜ﻄﻴﻨﻲ‬R‫ﻋ‬ .‫ﺔ‬RÈ‫ اﻻﺗﺼﺎل اﻟﻤ˜ﺎﺷﺮ ﺑﻴﻦ اﻟﻐﺮف اﻷذﻳ‬:(ASD) ‫ﺐ اﻟﺤﺎﺟﺰ اﻷذﻳﻨﻲ‬R‫ﻋ‬ Cardiac Tumors Primary cardiac tumors are rare. The majority are benign: ◦ Cardiac myxoma: ◦ Arise within the left atrium ◦ Morphology: Soft, polypoid left atrial mass ◦ Complications: Tumor emboli - “ball-valve” obstruction of the valves ◦ Cardiac rhabdomyoma: ◦ Arise within the myocardium ◦ Morphology: Firm white tumor mass .‫أورام اﻟﻘﻠﺐ اﻷوﻟ<ﺔ ﻧﺎدرة‬ :‫اﻷﻏﻠﺒ<ﺔ ﺣﻤ<ﺪة‬ :‫اﻟﻮرم اﻟﻤﺨﺎﻃﻲ ﻟﻠﻘﻠﺐ‬ ‫ﻗﻢ داﺧﻞ اﻷذﻳﻦ اﻷ‡ﺴﺮ‬ ‫ﻐ<ﺔ‬Q‫ ﻣﺘﻌﺪدة اﻷﺻ‬،‫ اﻟ’ﺘﻠﺔ اﻷذﻳ‘<ﺔ اﻟ•ﺴﺮى اﻟﻠﻴﻨﺔ‬:‫اﻟﻤﻮرﻓﻮﻟﻮﺟ<ﺎ‬ "‫ ا”ﺴﺪاد اﻟﺼﻤﺎﻣﺎت "ﺻﻤﺎم اﻟ’ﺮة‬- ‫ ا”ﺴﺪاد اﻟﻮرم‬:‫اﻟﻤﻀﺎﻋﻔﺎت‬ :‫ورم رﺣﺎﺑﻲ اﻟﻘﻠﺐ‬ .‫ﻗﻢ داﺧﻞ ﻋﻀﻠﺔ اﻟﻘﻠﺐ‬ ‫ ﻛﺘﻠﺔ اﻟﻮرم اﻷﺑ<ﺾ اﻟﺜﺎﺑﺘﺔ‬:‫اﻟﻤﻮرﻓﻮﻟﻮﺟ<ﺎ‬