冠心病课件(大医英)PPT.ppt

Determinants of Plaque Vulnerability Lipid-rich core size Cap thickness Cap inflammation and repair Alternative Diagnoses to Angina for Patients with Chest Pain Non-Ischemic CV aortic dissection pericarditis Pulmonary pulmonary embolus pneumothorax pneumonia pleuritis Chest Wall costochondritis fibrositis rib fracture sternoclavicular arthritis herpes zoster Gastrointestinal Esophageal esophagitis spasm reflux Biliary colic cholecystitis choledocholithiasis cholangitis Peptic ulcer Pancreatitis Psychiatric Anxiety disorders hyperventilation panic disorder primary anxiety Affective disorders depression Somatiform disorders Thought disorders fixed occlusions Investigation 12 Lead Resting ECG should be recorded in all patients with symptoms suggestive of angina pectoris normal in ? 50% of patients a normal ECG does not exclude severe CAD; however, it does imply normal LV function with favorable prognosis CHD At rest: ECG 冠心病 Episode of angina:ST-segment depression ECG CHD Holter Exercise testing Angina: Exercise TestingHigh Risk Patients Significant ST-segment depression at low levels of exercise and/or heart rate130 Fall in systolic blood pressure Diminished exercise capacity Complex ventricular ectopy at low level of exercise Exercise TestingContraindications MI—impending or acute Unstable angina Acute myocarditis/pericarditis Acute systemic illness Severe aortic stenosis Congestive heart failure Severe hypertension Uncontrolled cardiac arrhythmias Investigation Echocardiography. The stress echocardiogram is a widely performed test used to assess patients for coronary disease. Baseline echocardiographic images are obtained at rest to evaluate left ventricular function, wall motion, and valve function. Images are then acquired during peak stress (that is, during a GXT or with dobutamine) and compared with those at rest. Regional wall-motion abnormalities with stress indicate areas of hypoperfusion or ischemia. Investigation Isotope scanning:ob