临床医学概要12冠心病心绞痛.pptVIP

* * * * * * * * * * * * 到目前为止，国内外大规模、多中心的临床药物干预试验结果相继揭晓，阿司匹林（aspirin)、?-受体阻止剂(?-receptor block) 及调脂疗法(cholesterol)，已成为世界公认的治疗和预防冠心病的疗效肯定的“ABC”三大疗法 。 * The most important contributor to the occurrence of acute cardiovascular events is atherosclerotic disease. Vasospasm, alone or on top of an atherosclerotic lesion not infrequently also precipitates an acute ischemic event. Recent observations have revealed that in 70-80 percent of an acute ischemic event such as a myocardial infarction, the acute occlusion occurs due to an acute thrombus formation ushered in by the rupture, hemorrhage and thrombosis of a young, unstable plaque with a fissured or thin cap and a large lipid core underneath. This observation has far-reaching implications in the prevention of such acute events like an AMI. * 左心室后壁和室间隔左室侧可见有心肌梗塞。坏死的心肌呈奶黄色，外周由肉芽肿组织组成的暗色条带包围，提示梗塞发生不超过两周。以外膜上的冠状动脉因粥样硬化而狭窄呈现黄色。 * * * * * * * As shown in this figure, coronary arteries are multilayered. The three layers of the coronary artery walls are the: Adventitia Outermost layer of the coronary artery Attaches the vessel to the surrounding tissue Provides support for the entire vessel, like the foundation of a house Media Middle layer of the coronary artery Provides support and regulates blood flow Consists mostly of thin, cylindrical smooth muscle cells (SMCs) Surrounded by two elastic layers: - external elastic lamina layer of elastic tissue that lies between the media and adventitia - internal elastic lamina layer of elastic tissue that lies between the media and intima Excessive proliferation of the SMCs of the media after injury leads to restenosis Intima Innermost layer of the coronary artery Composed of connective tissue and endothelium (single layer of epithelial cells) The cells of the endothelium line the inner surfaces of all blood vessels While the endothelium appears deceptively simple, it serves many vital and complex functions, which are reviewed in the next slide. * The composit