缺血性心脏病Ischemicheartdisease--华西.ppt

Ischemic heart disease IHD refers to a group of closely related syndromes by an imbalance between the myocardial oxygen demand and the blood supply. The most common cause is narrowing of the lumen of the coronary arteries by atherosclerosis (Coronary heart disease ) Syndromes: 1.angina pectoris 2.acute myocardial infarction 3.sudden cardiac death 4.chronic IHD Myocardial Infarction Definition An area of myocardial necrosis caused by local ischemia. Location Determined by the site of the vascular occlusion and by the anatomy of the coronary circulation. Type Transmural infarct subendocardial infarct pathogenesis Mostly caused by coronary artery thrombosis subendocardial infarct often caused by diffuse coronary atherosclerosis Chronic IHD The development of progressive heart failure as a consequence of long-term ischemic myocardial injury (ischemic cardiomyopathy) The heart is enlarged,dilation of all cardiac chamber,foci of transmural scar,hypertrophy of the remaining myocardium Sudden Cardiac Death Sudden death caused by heart disease, the most common cause is IHD. Lethal ventricular fibrillation caused by acute plaque rupture,coronary thrombosis and vasospasm is the most common cause Summary of IHD a group of closely related syndromes caused by an imbalance between the myocardial oxygen demand and the blood supply angina pectoris(stable,variant and unstable),myocardial infarct, sudden cardiac death and chronic IHD The most common cause is coronary atherosclerosis Rheumatic Fever and Rheumatic Heart Disease Rheumatic Fever Definition RF is an acute, immunologically mediated multisystem inflammatory disease that follows an episode of group A streptococcal pharyngitis after an interval of a few weeks. pathologic changes Edema of connective tissue Fibrinoid necrosis of collagen Small aggregates of lymphocytes and macrophages (Aschoff bodies) Fibrosis(chronic sequelae) Effects Heart: pericarditis, myocarditis