心绞痛 1演示讲稿.ppt

Chapter 28;为 健 康 的 心 脏 一 起 努 力！ ;冠心病临床表现 心绞痛 心肌梗死 心功能不全 严重的心律失常 猝死;Section I Introduction;Angina pectoris;Angina pectoris;Classifications of angina (WHO);Clinical Classifications of angina;1.Stable angina;2.Unstable angina(不稳定型);Therapeutic: Decrease cardiac load and vasospasm of coronary arteries Inhibit platelet aggregation and thrombus formation ;Pathophysiology of angina;Pathophysiology; Pathophysiology ;心肌供氧和耗氧主要影响因素及药物作用;Treatment of angina;Section II Antianginal Drugs;1.Nitrate ester Nitroglycerin (硝酸甘油） Isosorbide dinitrate （硝酸异山梨酯） Isosorbide mononitrate （单硝酸异山梨酯） ; Nitroglycerin(硝酸甘油);Alfred Bernhard Nobel 1833.10.21—1896.12.19;Nitroglycerin;Pharmacological actions;Pharmacological actions;Pharmacological actions;Pharmacological actions;Pharmacological actions;Mechanisms of action;Nobel prize 1998：发现一氧化氮在心脏血管中的信号传递功能;;Mechanisms of action;Clinical Uses;Adverse reactions;3.Tolerance Probable mechanism: (1)Blood vessel tolerance: -SH depletion (2)Dilate blood vessels BP RAAS Management: (1)Dose (2)Interval:a nitrate-free period of at least 8 hours (3)Diet: (rich in -SH) (4)Composed with ACEI or diuretics ; 硝酸酯类药代动力学特点比较;Nitroglycerin;Isosorbide dinitrate ;Isosorbide mononitrate;Section III β-adrenoceptor Blockers;Antianginal effects;Antianginal effects;Antianginal effects;Clinical uses; Disadvantage ; Nitrates β-blokers alone alone Heart rate reflex increase decrease End-diastolic volume decrease increase Contractility reflex increase decrease Ejection time decrease increase Arterial pressure decrease decrease Propranolol