13_动脉粥样硬化和高血压精要.ppt

(2) 对缩血管物质反应性增强 (3) 扩血管物质减少 Ca2+ → 血管舒张 2．血管重塑 Vascular remodeling (一）总外周阻力增高 血管重塑分类 非肥厚性血管重塑 (vascular non-hypertrophic remodeling) 肥厚性血管重塑 (vascular hypertrophic remodeling) 根据形态学分为： （二）心输出量增多 三、原发性高血压的发病机制 （二）心输出量增多 2. 心脏因素 交感兴奋→肾上腺素和去甲肾上腺素↑→ 对心脏产生正性变力和正性变时作用→ 心肌收缩力↑ 心率↑ （二）心输出量增多 四、对机体的影响 左心室肥大 心力衰竭 冠心病 脑血管病 肾功能障碍 周围血管疾病 四、对机体的影响 (一)脑卒中（Stroke) Haemorrhagic Necrosis (二)高血压性心脏病 Left Ventricular Hypertrophy (三) 肾功能衰竭 Leathery Granularity Nephrosclerosis 五、防治原则 （一）培养健康的生活方式 （二）抗高血压药物治疗 （三）保护靶器官 * Atherosclerotic plaque has 2 main components: a soft, lipid-rich core and a hard, collagen-rich fibrous cap. In stable plaques, a thick fibrous cap may represent 70% of plaque volume. It stabilizes the plaque and prevents it from undergoing rupture. In contrast, unstable plaque has a thin fibrous cap and is at greater risk for rupture. In unstable plaque, the lipid-rich core may represent the majority of the plaque volume. The core is rich in extracellular lipids, which are formed by trapping blood-derived lipids, notably low-density lipoprotein, or by lipid-filled macrophages, known as foam cells. The plaque destabilizes due to inflammation by foam cells and other inflammatory mediators that make the plaque more vulnerable to rupture. This commonly occurs at the junction of the plaque and the less diseased vessel wall. As a result, the lipid core may be exposed to flowing blood leading to platelet-mediated thrombus formation. Falk reviewed the work of other investigators regarding the severity of stenosis and its association with the risk of MI. Results showed that 86% of MIs resulted from lesions that were 70% stenosed. Most experts prior to Falk thought that patients had heart attacks because of blockages that increased in size until they blocked the blood vessel and caused a heart attack.1 Based on the findings of Falk, we now know the primary cause of a heart attack is the rupture of unstable