冠心病課件(大醫(yī)英)-免費(fèi)閱讀
【正文】 repeat ECG, markers at 48 hrs No recurrent pain。 September 1993 Coronary revascularisation ? Invasive treatment: coronary angioplasty (PTCA)。 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。86(suppl):12H17H 不穩(wěn)定斑塊 斑塊破裂 血栓形成 穩(wěn)定斑塊 斑塊體積增加 管腔狹窄 Stable angina pectoris ETIOLOGY – .Ischemia is secondary to coronary artery disease in 95% of patients. The leading cause is certainly atherosclerotic coronary artery disease – .A decreased oxygen supply or an increase in oxygen demand can lead to a worsening of symptoms. – .Ischemia can occur in patients with normal coronary arteries Clinical menifestation chest disfort ? Quality squeezing, griplike, pressurelike, suffocating and heavy”。163:23452353. **Eagle K, at al. JAMA. 2022。 ? LV function if ischemia (–) test: outpt followup (+) test Admit, Use Acute Ischemia Pathway ST ? Use MI Guidelines No ST ? STT ?’s, chest pain, ? markers Initial Chest Pain Evaluation Symptoms Suggestive of ACS Acute Coronary Syndromes M a n a g e m e n tS T E l e v a t i o n M IT h r o m b o l y t i c t h e r a p yP r i m a r y i n t e r v e n t i o nN o n S T E l e v a t i o n M I a n d U S AL M W HP l a t e l e t i n h i b i t o r sR o l e o f ca t h e t e r i za t i o nASAA n t i t h r o m b i nB e t a b l o ck e rN i t r a t e sPreparation for Discharge After UA/NSTEMI ? Antiplatelet Rx – ASA 75 162 mg/day – Clopidogrel 75 mg/day ? Beta Blocker ? ACEI / ARB – Especially if DM, HF, EF 40%, HTN ? Statin – LDL 100 mg/dL (ideally 70 mg/dL) ? Secondary Prevention Measures – Smoking Cessation – BP 140/90 mm HG or 130/80 mm HG for DM or chronic kidney disease – HbA1C 7% – BMI – Physical Exercise 3060 min at least 5 days/wk No ST Elevation ST Elevation Acute Coronary Syndrome Unstable Angina NQMI Qw MI NST
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