AS及稳定型心绞痛 20150420.pptVIP

主动脉AS 弹性降低，脉压差增宽 形成动脉瘤时，向外膨出，紧张性消失 动脉瘤破裂 夹层 近年新的分型 稳定性冠心病：供给稳定。包括无症状型冠心病、稳定性心绞痛和缺血性心肌病 急性冠脉综合症：供给减少—血栓事件。包括不稳定性心绞痛、非ST段抬高型心肌梗死和ST段抬高型心肌梗死 谢谢大家！ 二级预防应全面综合考虑，为便于记忆归纳为A、B、C、D、E为符号的5个方面： A Aspirin 抗血小板聚集（或氯吡格雷） Anti－anginals 抗心绞痛硝酸类制剂 B Beta blocker 预防心律失常，减轻心脏负荷等 Blood pressure 控制好血压 C Cholesterol 控制血脂水平 Cigarette 戒烟 D Diet 控制饮食 Diabetes 治疗糖尿病 E Education 普及有关冠心病的教育（患者和家属） Exercise 鼓励有计划、适当的运动锻炼 Atherosclerosis is a complex disease. Atherosclerotic plaques can be subdivided in accordance with their age and state of development. It is the newly formed lesions with a large lipid core, thin capped, which are fragile and therefore likely to rupture and lead to an acute ischemic event. Slide 3 Atherothrombosis: a Generalized and Progressive Process Atherothrombosis is the common underlying disease process for MI, ischemia and vascular death. ACS are classic examples of atherothrombosis (plaque rupture and thrombus formation). ACS (in common with ischemic stroke and critical leg ischemia) are typically caused by rupture or erosion of an atherosclerotic plaque followed by formation of a platelet-rich thrombus. Atherosclerosis is an ongoing process affecting mainly large and medium-sized arteries, which can begin in childhood and progress throughout a person’s lifetime. Stable atherosclerotic plaques may encroach on the lumen of the artery and cause chronic ischemia, resulting in (stable) angina pectoris or intermittent claudication, depending on the vascular bed affected. Unstable atherosclerotic plaques may rupture, leading to the formation of a platelet-rich thrombus that partially or completely occludes the artery and causes acute ischemic symptoms. 三、分 型 （一）无症状型冠心病 （亦称隐匿性冠心病Latent CHD） 无症状，但静息时或负荷试验后 有心肌缺血心电图改变。 病理学检查： 心肌无明显组织形态改变。 (二)心绞痛型冠心病：有发作性胸骨后疼痛,为一过性心肌供血不 足所致。病理学检查：心肌无明显组织形态改变或有 纤维化改变。 （三）心肌梗死 症状严重，由冠状动脉闭塞致心肌急性缺 血性坏死所致。 （四）缺血性心肌病型 表现为心脏增大，心力衰竭和心律失常。