北京积水潭医院精品课件-冠心病.ppt

病例三 患者：男72岁，间断心前区不适3天，口含硝酸甘油2分钟可缓解，3小时前再次发作，口含硝酸甘油不缓解，伴胸闷、心慌、恶心，来医院就诊，做心电图示广泛导联S-T下移，T波倒置，化验心肌酶及肌钙蛋白（--），生命体征尚可。 问题：下一步怎么办？ * To Cure Sometimes (有时，会治愈) To Relieve Often (常常，是帮助) To Comfort Always (总是，去安慰) 纽约医生特鲁多的墓志铭 * 谢谢！ 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. 幻灯片3 这张幻灯片说明了动脉粥样硬化血栓形成在全身不同器官的不同临床表现。在脑血管，它引起一过性脑缺血发作或缺血性中风；冠状动脉粥样硬化血栓形成可以引起稳定性或不稳定性心绞痛、Q波或非Q波心梗甚至心源性猝死；在外周动脉，动脉粥样硬化基础上的血栓形成可以引起间歇性跛行（行走时患肢发生严重的疼痛，休息时缓解）、缺血性坏死甚至截肢。 Slide Objective Lipid-laden plaques with thin fibrous caps are more likely to rupture and lead to CHD events. Narrative Now it is recognized that the lesion leading to events is not the one that occludes the vessel, it is the one with a large lipid core, a thin fibrous cap, and numerous macrophage cells filled with lipids. At the point of rupture, a clot can form that occludes the vessel and causes a clinical manifestation of the disease. Because the type of plaque likely to lead to events is not occluding the vessel lumen to a great deg