授课ppt课件老年冠心病和老年综合评估.ppt

老年冠心病 ;重点内容： 普通成人冠心病 老年冠心病的特点 相关文献阅读;Cardiovascular Diseases;Coronary heart disease;Atherosclerosis Stable angina pectoris(SAP) Acute coronary syndrome Unstable angina(UAP) and non-STEMI (UA/NSTEMI) ST elevation myocardial infarction(STEMI) ];General manifestation Aortic atherosclerosis Coronary artery atherosclerosis Cerebral atherosclerosis RA atherosclerosis Mesenteric atherosclerosis Peripheral artery atherosclerosis;炎症 细胞;Intravascular ultrasound[?ltr?.saund ;Atheroma evolution and complications;Classicification of atherosclerotic lesion using IVUS;Factors effect myocardial oxygen supply and demand;老年人循环系统解剖结构的退行性改变 心脏稍大； 心肌细胞减少； 心内膜增厚，瓣膜钙化； 起搏与传导细胞减少； 冠状动脉扭曲，硬化； 小血管内径减小（内膜增厚中层胶原增多）;老年人循环系统生理功能的退行性改变 CO↓生理储备能力减少、心肌收缩力下降； HR↓、心音减弱、10%有S1分裂、A2亢进、25%可听到 S4； 冠脉血流量↓； 血压调节能力↓、变化显著。;Coronary heart disease (CHD);Risk factors ;老年冠心病的危险因素 ;老年冠心病的危险因素 ;Coronary heart disease (CHD);definition: acute and transient myocardial ischemia and anoxaemia usually caused by coronary insufficiency during exertion Characteristics: paroxysmal precordial squeezing-like chest pain, behind the mid sternum， radiated to left shoulder and upper arm precipitated by stress or exertion relieved rapidly by rest or nitrates ; hypoxia ;in angiography Significant coronary lesion with diameter stenosis 70% in 75% pts No significant stenosis in about 5-10% pts, Ischemia may be related to coronary spasm or microvascular dysfunction. ;pathophysiology;symptom：chest pain or oppression location behind or slightly to the left of the mid sternum no definite borderline radiated to the left shoulder and upper arm Atypical location: lower jaw, the back of neck;chest pain characteristics： tightness, squeezing, burning, pressing, choking, bursting,rarely sharp, not spasmodic force the patient stop the activity till the symptom relieved precipitation exertion or emotional agitation。 duration： 3－5 mins pain relief: within several mins after rest or usi