醫(yī)學(xué)傳媒cardiology-英文教學(xué)1AS課件

CoronaryHeartDiseaseBianBo,DongShaozhuangCardiovascularCenterTianjinMedicalUniversityGeneralHospital2CompanyLogoNo.1KillerWorldChinaUSA3CompanyLogoIndifferentcountries,25-45%deatharecausedbycardiovasculardisease.

Mortalityofcardiovasculardisease(per100,000）：male,highestinRussia，1310，lowestinJapan,201；female,highestinRussia,581，lowestinFrance,84.4CompanyLogoChinaInChina,1year,10millionnewCHDpatients.InChina,per15seconds1peoplewilldiebecauseofCVD.InChina,1year2.6millionpeoplewilldiebecauseofCVD.5CompanyLogoUSA1995，USA,960,000diebecauseofCVD,

42%oftotalmortality，No.1causeinmale>45y,andinfemale>65yTotalCVDpatientsinUSA,58million，20%oftotalpopulation6CompanyLogoCausesofCVDmajorcauseatherosclerosis(AS)7CompanyLogoOtherCausesInflammation---KawasakisyndromeEmboli-----------youngmale,dehydrationSpasm-----------Prinzmetal'sanginaInjury-------------traumaⅠAtherosclerosisAkindofclinicalvasculardisease9CompanyLogoatherosclerosisCerebrovasculardiseaseCoronaryarterydiseasePeripheralarterydisease10CompanyLogoAtherosclerosisAtherosclerosisisanongoingprocessaffectingmainlylarge-andmedium-sizedarteries;itcanbegininchildhoodandprogressthroughoutaperson’slifetime.11CompanyLogoAtherosclerosisUnstableatheroscleroticplaquesmayrupture,leadingtotheformationofaplatelet-richthrombusthatpartiallyorcompletelyoccludesthearteryandcausesacuteischemicsymptoms.12CompanyLogo13CompanyLogoprogressiveanginaPlaqueruptureUnstableanginaAcuteMIstableanginaPathophysiologyofCAD14CompanyLogoWhatAretheResultsofAtherosclerosis?Results:silenceischemia---anginapectoris,TIA,claudication...necrosis---MI,stroke...fibrosis---ischemiacardiomyopathy/nephropathy/dementia...Ⅱ

RisksFactors16CompanyLogoⅡRisksofAtherosclerosisAgeFamilyhistoryGenderCigarettesmokingLow-densitylipoproteincholesterol(dyslipidemia)HypertensionDiabetesmellitusEstrogendeficiencyInactivityObesityothers:A-typecharacter,highTG,highhomocysterine...17CompanyLogoUnmodifiablerisksModifiablerisks18CompanyLogo2.1UnmodifiablerisksAgeFamilyhistoryGender19Age-unmodifiablerisks(1)Chancesofapersonhavingatherosclerosisaredirectlyproportionaltoage.peakincidenceofclinicalmanifestation,male,50-60y;female,60-70y20CompanyLogoHeredityorFamilyHistoryunmodifiablerisks(2)chancesofdevelopingatherosclerosisaremuchhigherifyouhaveadirectfamilymember(parentorsibling)whohasatherosclerosis,especiallybefore50y.21CompanyLogoHeredityorFamilyHistory-immigrationresearchNi-Hon-Sanresearch：Japanese,livinginJapan,CVDmortalitylowest;livinginHawaii,middle;livinginSanFrancisco,highestbutstilllowerthanAmerican,onlyhalfofAmerican's

22CompanyLogoGender-unmodifiablerisks(3)Untilmiddleage,itismuchmorelikelytooccurinmenthaninwomen.Afteragefifty,however,thedifferencebetweenthesexesnearlydiminished.23CompanyLogoGender(2)menaremoreoftenaffectedthanwomanbyanoverallrationof4:1<40y,theration8:1>70y,theration1:124CompanyLogo2.2ModifiablerisksLow-densitylipoproteincholesterol(dyslipidemia)CigarettesmokingHypertensionDiabetesmellitusEstrogendeficiencyInactivityObesity25CompanyLogoCholesterollevels——lipoproteinLDL:low-densitylipoproteinHDL:high-densitylipoproteinCM:chylomicronVLDL:very-low-densitylipoprotein26CompanyLogoLDL:carrycholesteroltoarteriesHDL:carrycholesterolbacktolivermostdangerous:lipoprotein(a),samllanddensityLDLinCADpatients,alwalyshighLDL-c,lowHDL-c27CompanyLogo各組兔主動(dòng)脈動(dòng)脈粥樣硬化病變情況：上條和中條：高膽固醇組；下條：對照組28CompanyLogoSmoking-Modifiablerisks(2)Researchdemonstratesthatsmokingcausestransientandreversibleprothromboticincreasesinfibrinogenlevelsandplateletadhesion,increasedbloodcarboxyhemoglobinlevels,reducedhigh-densitylipoprotein(HDL)cholesterol,andcoronaryarteryvasoconstriction.29CompanyLogoSmokingsmokersaretwiceaslikelytodevelopatherosclerosisandcoronaryarterydiseaseasarenon-smokers.

收縮壓和脈壓對冠心病危險(xiǎn)性的聯(lián)合影響

TheFraminghamHearStudy；入選者年齡>50歲

StanleyS,etal.Circulation1999;100:354304050607080901001100.51.01.52.02.53.0血壓(mmHg)冠心病危險(xiǎn)率SBP170mmHg(P=.0487)SBP150mmHg(P=.0194)SBP130mmHg(P=.0086)SBP110mmHg(P=.2076)Hypertension-Modifiablerisks(3)31CompanyLogo

急診入院

擇期患者29%22%31%3%15%34%22%30%4%10%NGTIFG（6.1mmol/L）IGTKnownDMNewDMTheEuroHeartSurveyondiabetesandtheheart，EuropeanHeartJournal(2004)25,1880–1890Diabetesmellitus-Modifiablerisks(4)

ⅢTreatmentofAS33CompanyLogoⅢTreatmentofASeducationlifestylechangedrugsinterventionorsurgery34CompanyLogo3.1Educationmakepatientsknow:whatisAS,whatarerisks,whatisresultsofAS,HowtocontrolAS,Whattheycandoforthemselves35CompanyLogo3.2LifeStyleChangebodyweightcontrol:lessfood,moreexercise;morevegetable,lessfat管住嘴，邁開腿BMI=24moderatelyintensephysicalactivity,atleast30minuteseverytime,atleast3timesaweek.36CompanyLogo3.2LifeStyleChangenosmokinggoodemotionregularlifestyle37CompanyLogo3.3Drugsanti-platelet---preventthrombosisstatins---decreaseLDL,stabilizeplaque,anti-inflammation,improveendotheliafunction,anti-oxygenstress...dilateartery---nitrate,CCB,ACEIcontrolrisks---hypertension,DM38CompanyLogo3.4InterventionorSurgerytotreatseverestenosis(>70%)PTCA（percutaneoustransluminalcoronaryangioplasty）StentCABG（coronaryarterybypassgrafting）CADorCHDanatomyofheartandcoronaryarteries40CompanyLogo41CompanyLogo42CompanyLogo43CompanyLogoDefinitionCoronaryArteryDiseasemeanscoronaryarterynarrowingorobstructionthatleadstomyocardialischemiaornecrosis,oftencausedbyatherosclerosis.44CompanyLogoDefinitionCoronaryHeartDiseasemeansmyocardialischemia,necrosis,arrhythmia,functionabnormality,structuralandelectricalremodelingcausedbycoronaryarterynarrowingorobstruction.45CompanyLogoCAD:coronaryarterydiseasecauseCHD:coronaryheartdiseaseresult46CompanyLogoClassificationCHD:5typeslatentorsilence

anginapectorismyocardialinfarctionheartfailureandarrhythmiacardiacsuddendeathkeypoint:clinicalpresentation47CompanyLogoClassificationnewtrendofclassificationstable:stableanginapectorisunstable:ACSunstableanginapectorisST-elevatedAMInonST-elevatedAMIcardiacsuddendeathkeypoint:pathophysiology48CompanyLogoDefinitionACS:acutecoronarysyndromeACSincludeUAP,NSTEAMI,STEAMI,andsuddendeath.ACShasthesamepathophysiology,thatiscausedbysuddenly