Hội chứng mạch vành cấp

HỘI CHỨNG
MẠCH VÀNH CẤP
HỘI CHỨNG
MẠCH VÀNH CẤP
TS. BS. Nguyễn Thò Hậu
Atherosclerosis Timeline
Foam
Foam
Cells
Cells
Fatty
Fatty
Streak
Streak
Intermediate
Intermediate
Lesion
Lesion
Atheroma
Atheroma
Fibrous
Fibrous
Plaque
Plaque
Complicated
Complicated
Lesion/Rupture
Lesion/Rupture
Endothelial Dysfunction
Smooth muscle
& collagen

From first decade
From first decade
From third decade
From third decade
From fourth decade
From fourth decade
Growth mainly by lipid accumulation
Thrombosis,
hematoma
Adapted from Stary HC et al. Circulation 1995;92:1355-1374.
Characteristics of Plaques
prone to rupture
Libby P. Circulation. 1995;91:2844-2850.
T lymphocyte
Macrophage
foam cell (tissue factor
+
)
“Activated” intimal SMC (HLA-DR
+
)
Normal medial SMC
“Stable” plaque
“Vulnerable” plaque
Lumen
area of
detail
Media
Fibrous cap
Lumen

Lipid
core
Lipid
core
Underlying Lesion: Plaque Rupture
Plaque Hemorrhage,
Plaque Hemorrhage,
Occlusive
Occlusive
or Non
or Non
-
-
occlusive
occlusive
Thrombus
Thrombus