非囊性硬化症athrosclerosis.pptVIP

Atherosclerosis ArteriosclerosisAtherosclerosis Arteriosclerosis Epidemiology 动脉粥样硬化血栓形成*是全球第一大死亡原因1? Risk Factors Non-modifiable age、sex、genetics Potentially Controllable hyperlipidemia、hypertension、diabetes、 cigarette smoking Additional Risk factors insulin resistance、Obesity、Physical inactivity、Postmenopausal estrogen deficiency、Alcohol、Lipoprotein (a)、Inflammation （Chlamydia pneumoniae） Thesis Pathogenesis Endothelial cell dysfunction(injury) →macrophage and LDL accumulation →Fatty streak(foam cell) →Smooth muscle cell migration→complex fatty streak→fibrous plaque →athroma Components Cells including SMCs,macrophagea and other leukocytes Extracellular matrix including collagen,elastic fibers and proteoglycans Intracellular and extracellular lipid complicated lesion Facal rupture,ulceration,or erosion Hemorrhage Superimposed thrombosis Aneurysmal dilation Calcification Consequence of Atherosclerosis Thrombosis:blood clot forming in situ,leading to distal artery hypoperfusion Embolism:sudden obstruction of a blood vessel by an embolus coming from proximal vessels Ischemia:hypoperfusion of tissue Infarction:tissue damage due to ischemia Red Infarct:organ that has double blood supply Pale Infarct:organ that has single blood supply Clinical Features of Atherosclerosis Coronary heart dieases Intermittent claudication Abdominal aortic aneurysm Renal artey stenosis Transient ischemic attack involve:abdominal aortacoronary arterypopliteal arterycarotid artery circle of Willis Stable angina Clinical features:substernal chest pain when exertion,relieved by rest Pathogenesis: a.Narrowing of coronary artery(narrowing75% in CAD) b.When oxygen requirement exceeds supply,pain starts c.ECG:ST depression Principle of treatment:dilate coronary artery,decrease the oxygen consumption Unstable angina Clinical features:chest pain,change in frequency,duration,pain quality.Substernal