循环课件-冠心病-心绞痛2.pptVIP

搭桥治疗(Bypass surgery) 对“冠心病”诊断最有价值的检查（诊断金标准）是：(??) A．胸透??B．心脏平片C．心电图??D．超声心动图E．选择性冠状动脉造影 女性，65岁，3个月来因体力活动诱发左前胸及肋骨后压榨样疼痛，并向左肩放射，停止活动后3～5?min内疼痛均可逐渐缓解.最可能是：?(??)?? 变异型心绞痛 ?不稳定型心绞痛 ?主动脉瘤?? 稳定型心绞痛 ?心肌劳损 男性，75岁，1个月来因劳累后诱发胸骨后压榨样疼痛，伴有咽部紧缩感以及后背疼痛，含服硝酸甘油1～2min内疼痛均可逐渐缓解。近一星期以来，轻微活动后就可诱发胸骨后疼痛，疼痛时间较之前延长，含服硝酸甘油3~5分钟可缓解。 1、该患者最可能的诊断是：（ ） 急性心肌梗死 ?不稳定型心绞痛 ?主动脉瘤?? 稳定型心绞痛 ?心肌劳损 冠心病 稳定型心绞痛 WHO将冠心病分为哪五种类型？ 心电图负荷试验阳性的标准是什么？ 运动中出现典型心绞痛，心电图改变主要以ST段水平型或下斜型压低)0. 1 mV ( J点后60-80ms)持续2分钟为运动试验阳性标准 试论述稳定型心绞痛的疼痛特点。 不稳定型心绞痛的分型。 不稳定型心绞痛的危险分层。 * 加一个WHO的LOGO * * 近年来的研究发现，ACS多发生于冠脉轻～中度狭窄的患者中，急性心肌梗死前近期冠脉造影显示： 65％的患者冠脉内径狭窄＜50％，85％的患者冠脉内径狭窄＜70％。 * * * 斑块的易损性受局部因素及全身因素的影响： 局部因素：脂质核心，包括其大小和密度 纤维帽的厚度及密度 斑块内炎症 全身因素：吸烟、血脂异常、糖尿病、高纤维蛋白原水平、高半胱氨酸、纤维蛋白溶解受损 * Slide 3 In patients with chronic stable angina pectoris, blood flow to the myocardium is reduced as a result of stenoses in one or more coronary arteries. These stenoses result from stable atherosclerotic plaques that encroach upon the lumen. When the patient is at rest, myocardial oxygen supply usually meets demand. If myocardial oxygen consumption increases significantly, however, myocardial ischemia and angina can occur in patients who have a critical degree of coronary stenosis; this angina is usually relieved by rest. By contrast, in the majority of patients with acute coronary syndromes, there is an acute increase in coronary obstruction. This may occur at rest, and is due to rupture of an unstable fibrous plaque covering an atheroma with consequent platelet adhesion [1]. Reference 1. Braunwald E et al. J Am Coll Cardiol 2000;36:970–1062. * * * The common link between UA/NSTEMI and STEMI is that thrombus formation occurs secondary to the rupture or fissuring of an atherosclerotic plaque in the coronary arteries1 This leads to thrombotic occlusion of the coronary artery with interruption of blood flow, resulting in myocardial ischemia and/or necrosis (death of myocardial cells)2,3 Patients with ACS ar