HeartFailure心不全.pptVIP

Angina pectoris　狭心症 a syndrome characterized by paroxysmal, constricting pain below the sternum, most easily precipitated by exertion or excitement and caused by ischemia of the heart muscle, usually due to a coronary artery disease, as arteriosclerosis. Angina: (語源) any attack of painful spasms characterized by sensations of choking or suffocating. L angina quinsey, for * ancina Gk strangulation, hanging 病態 治療原則 心拍出量の分配率と酸素消費 Dynamic coronary obstruction This figure shows how the caliber of eccentric coronary artery stenoses may change, with considerable variation in the degree of stenosis resistance and the propensity to produce angina. Both increased vascular tone (first two examples, spasm tone ) and decreased vascular tone (third example) are depicted. Distribution of regional myocardial blood flow The distribution of regional myocardial blood flow in the myocardium is heterogeneous, i.e., there is less blood flowing in the ischemic myocardial bed (blue area) than in the normal myocardial bed. * 次の有名な絵を見て， 狭心症の発作につながる 因子を挙げよ 男性、中年 季節：冬 寒冷暴露 大食後 重い荷物 階段登り タバコ 前胸部痛 酸素 供給 酸素 需要 冠動静脈酸素含有量の較差 心筋酸素分布 冠血流量 大動脈圧 (拡張期) 冠血管抵抗 虚血 狭心痛 自覚症状 心電図異常 代謝障害 心室機能不全 ST下降（労作性狭心症） ST上昇（安静時狭心症） 不整脈 乳酸?Ｈ+ の産生 Ｋ　の漏出 + アデノシン遊離 壁運動異常 拡張終期圧上昇 心拍出量低下 収縮力 心拍数 壁張力 左心室圧 心室容積 血圧（後負荷） 静脈還流（前負荷） 図４-２　心筋酸素需要?供給と狭心症の病態 狭心痛の 部位と放散 動脈血には20 vol% の酸素が含まれている O2 extraction vol% CaO2 – CvO2 心臓11.5%，脳6.4、肝臓4.1、腎臓1.3、 骨格筋静止時4.3、最大運動時17.2 Lead V4 at rest (top) and after 4.5 min of exercise (bottom). There is 0.3 mV of horizontal ST-segment depression, indicating a positive test for ischemia. Damage to the intima due to atherosclerosis is a major cause of thrombosis in the arteries. The resultant ischemia of the myocardium can lead to ischemic necrosis, i.e., an infarct [Myocardial Infarction]. Coronary Angiography Stenosis: narrowing of the artery, due most likely to atherosclerosis. What therapeutic agent can be used to lyse the clots in coronary vessels? How do the various natural anti