冠心病課件(大醫(yī)英)(已修改)
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【正文】 冠狀動(dòng)脈粥樣硬化性心臟病 (coronary atherosclerotic heart disease) 大連醫(yī)科大學(xué)附屬二院心內(nèi)科 牛 楠 動(dòng)脈粥樣硬化 atherosclerosis Introduction Arteriosclerosis ? Thickening and loss of elasticity of arterial walls ? Hardening of the arteries ? Greatest morbidity and mortality of all human diseases via Narrowing Weakening Plaque That Has Been Surgically Removed from Coronary Artery Courtesy Ronald D. Gregory and John Riley, MD. Non Modifiable Risk Factors Age A dominant influence Atherosclerosis begins in the young, but does not precipitate an injury until later in life Gender Men more prone than women, but by age 6070 about equal frequency Family History Familial cluster of risk factors Geic differences Modifiable Risk Factors (potentially controllable) ? Hyperlipidemia ? Hypertension ? Cigarette smoking ? Diabetes Mellitus ? Elevated Homocysteine ? Factors that affect hemostasis and thrombosis ? Infections: Herpes virus。 Chlamydia pneumoniae ? Obesity, sedentary lifestyle, stress Pathogenesis of Atherosclerosis Response to injury hypothesis ? Injury to the endothelium(dysfunctional endothelium) ? Chronic inflammatory response ? Migration of SMC from media to intima ? Proliferation of SMC in intima ? Excess production of ECM ? Enhanced lipid accumulation Response to injury Endothelia dysfunction Initiation of Fatty Streak Fatty Streak Fibrofatty Atheroma Atherosclerosis Timeline Foam Cells Fatty Streak Intermediate Lesion Atheroma Fibrous Plaque Complicated Lesion/ Rupture Adapted from Pepine CJ. Am J Cardiol. 1998。82(suppl 104). From First Decade From Third Decade From Fourth Decade Endothelial Dysfunction AHA Classification of atherosclerosis 動(dòng)脈粥樣硬化血栓形成 : 具 共同病理基礎(chǔ)的進(jìn)展性過程 正常 脂肪條紋 纖維斑塊 粥樣硬化斑塊 斑塊破潰 / 裂隙和血栓形成 心肌梗死 缺血性中風(fēng) /TIA 嚴(yán)重的 下肢缺血 臨床無癥狀 心血管死亡 年齡增長 穩(wěn)定性心絞痛 間歇性跛行 不穩(wěn)定性 心絞痛 }ACS *ACS, 急性冠脈綜合征 。 TIA, 一過性腦缺血發(fā)作 缺血性腎病 缺血性腸病 Coronary Artery Disease 冠心病 Clinical classification(1979 WHO) Asymptomatic CHD(隱匿型） Angina pectoris CHD（心絞痛型） Myocardial infarction CHD(心肌梗死型） Ischemic cardiomyopathy CHD（缺血性心肌病型） Sudden death CHD（猝死型） Classification of IHD ? Chronic ischemic syndrome: stable angina asymptomatic CHD ischemic cardiomyopathy CHD ? Acute coronary syndrome:
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