动脉粥样硬化与冠心病_1课件.ppt

动脉粥样硬化与冠心病 四川大学华西医院心内科 祝烨 斑块破裂，血栓形成，引发事件 Summary of Atherosclerotic Process Multifactorial process (risk factors) Initiated by endothelial dysfunction Up regulation of endothelial and leukocyte adhesion molecules Macrophage diapedesis LDL transcytosis LDL oxidation Foam cells Recruitment and proliferation of smooth muscle cells (synthesis of connective tissue proteins) Formation and organization of arterial thrombi Coronary Artery Disease Coronary artery disease is one of the most common and serious effects of aging. Fatty deposits build up in blood vessel walls and narrow the passageway for the movement of blood. The resulting condition, called atherosclerosis often leads to eventual blockage of the coronary arteries and a “heart attack”. Risk Factors(危险因素) Independent Risk Factors (独立危险因素,主要危险因素) Non-independent Risk Factors (非独立危险因素) Independent Risk Factors Age (年龄) Male sex (性别-男性) Dyslipidemia (血脂异常) Independent Risk Factors Hypertension (高血压) Diabetes (糖尿病) Smoking (吸烟) Non-independent Risk Factors  Obesity (肥胖) Physical inactivity (不爱运动) Psychological factors (心理-精神因素) Heredity (遗传) Risk Factors Independent Risk Factors Age Male sex Dyslipidemia Hypertension Diabetes Smoking Non-independent Risk Factors Obesity Physical inactivity Psychological factors Heredity  发病机制 当冠状动脉供血与心肌需血之间发生矛盾,冠状动脉血流量不能满足心肌代谢的需要,引起心肌急剧的、暂时的缺血缺氧时,即产生心绞痛。 临床表现 部位:胸骨后 性质:压迫紧缩感 持续时间:几分钟 诱因:体力劳动、情绪激动、饱食、寒冷、吸烟 缓解方式:休息、舌下含用硝酸甘油后可在几分钟内缓解。 OPQRST Onset When did it start? Provoking Factors What makes it worse or created the CC? Quality describe the pain Radiation Does the pain go anywhere else? Severity Pain scale 0-10, 10 being the worse Time How long has this been going on? Twave 诊断和鉴别诊断 诊断 临床表现 心电图 冠状动脉造影 鉴别诊断 心脏神经症 急性心肌梗死 肋间神经痛 消化性溃疡 胃食道反流 他 汀 类 内源性胆固醇合成步骤 硝酸酯的作用机制 抗心肌缺血治疗的原理 剂量依赖性的血管扩张剂 急性冠脉综合征(Acute Coronary Syndrome) 共同的机理 为粥样硬化斑块破裂，凝血过程激活，血小板粘附、激活、聚集，形成血栓。血栓可自溶，可反复形成。 NSTEMI and UA TIMI Risk Score Ag