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[Morphogenesis of coronarosclerosis in rheumatism]
Insights
Rheumatism causes complex vascular changes, including atherosclerosis, hyalinosis, and fibrillogenesis. The specific sclerotic changes depend on the rheumatic disease
Area of Science:
- Cardiovascular Pathology
- Rheumatic Heart Disease
- Vascular Biology
Context:
- Post-mortem examination of 72 human hearts from individuals with a history of rheumatism.
- Investigation into the complex sclerotic processes affecting vascular walls in rheumatic conditions.
Purpose:
- To elucidate the genesis of vascular sclerotic changes in rheumatism.
- To correlate specific vascular pathologies with the clinical course of rheumatic disease.
- To determine the relationship between myocardial functional burden and atherosclerotic lesion extent.
Summary:
- Observed complex vascular wall sclerosis resulting from connective tissue disorganization, hemodynamic adaptation failure, and atherosclerosis development.
- Found distinct sclerotic patterns: hyalinosis in highly active rheumatism with increased permeability, and increased fibrillogenesis in slow-progressing cases.
- Noted smooth muscle cell degeneration in the media, replaced by connective tissue.
- Established that atherosclerotic lesions in coronary arteries correlate with the functional demands of the supplied myocardium.
- Documented higher lipolytic enzyme activity in vessels and cardiac muscle of individuals with rheumatism compared to controls and atherosclerosis patients.
Impact:
- Provides insights into the pathomechanisms of vascular damage in rheumatic heart disease.
- Highlights the influence of clinical presentation on the type and severity of vascular pathology.
- Establishes a link between myocardial workload and coronary atherosclerosis severity in rheumatic individuals.
- Suggests altered enzymatic activity may contribute to vascular and cardiac pathology in rheumatism.
Abstract:
Post-mortem studies of 72 hearts of persons who when alive had suffered from rheumatism were carried out. A complex genesis of sclerotic processes in the vascular walls was noted. They were occurring as a result of the desorganization of the connective tissue, as well as of "wearing out" of hemodynamic adaptation structures and development of atherosclerosis. The dependence of the character of sclerotic changes in vessels upon the peculiar features of the clinical course of the disease is shown. In cases with a high activity of the rheumatic process and considerable increase in the vascular-tissue permeability the development of hyalinosis was noted, and in cases with a slow course of rheumatism an increased fibrillogenesis was observed. Simultaneously, lesion and perish of the smooth-muscle fibres of the media with outgrowth therein of the connective tissue occurred. The dependence of the extent of atherosclerosis in various branches of the coronary arteries upon a morphofunctional characteristics of this defect was established. The most extensive atherosclerotic lesions were found in those vessels which supplied with the blood the functionally burdened regions of the myocardium. A higher activity of lipolitic enzymes in the vessels and the cardiac muscle was observed in persons with rheumatism, as compared with that in persons free from cardiovascular diseases, and particularly in patients with atherosclerosis.