ischemic heart disease - med study group：缺血性心脏病医学研究组ppt课件.pptx

Heart disease remains the leading cause of morbidity and mortality in industrialized nations. It accounts for nearly 40% of all deaths in the United States, totaling about 750,000 individuals annually (nearly twice the number of deaths caused by all forms of cancer combined). The yearly economic burden of ischemic heart disease (IHD) alone is in excess of $100 billion. ;IHD is also frequently called coronary artery disease (CAD) IHD is a generic description for a group of related syndromes resulting from myocardial ischemia (an imbalance between cardiac blood supply (perfusion) and myocardial oxygen demand. ;1- increased demand (e.g., tachycardia or hypertension) 2- diminished oxygen-carrying capacity (e.g., anemia, carbon monoxide poisoning), 3- reduction in coronary blood flow caused by obstructive atherosclerotic disease ? 90 % of cases ;1-Angina pectoris ischemia causes pain but is insufficient to lead to death of myocardium ;1-stable angina (occur after certain levels of exertion) 2-variant angina or Prinzmetal angina ( due to vessel spasm ) 3-Unstable angina occurring with progressively less exertion or even at rest. ;2-Acute myocardial infarction (MI) the severity or duration of ischemia is enough to cause cardiac muscle death 3-Chronic IHD progressive cardiac decompensation (heart failure) following MI 4-Sudden cardiac death (SCD) can result from a lethal arrhythmia following myocardial ischemia. ;atherosclerotic occlusion of coronary arteries and new superimposed thrombosis and/or vasospasm -lesion obstructing 70% to 75% or more of a vessel lumen = critical stenosis → cause angina only in the setting of increased demand -a fixed 90% stenosis can lead to inadequate coronary blood flow even at rest. ;;- Chronic coronary occlusion when a coronary artery develops atherosclerotic occlusion at a sufficiently slow rate, it may be able to stimulate collateral blood flow from other major epicardial vessels → protection against MI even