西安交通大学医学院循环系统疾病课件 Coronary Atherosclerotic Heart Disease (CHD).pptVIP

Coronary Atherosclerotic Heart Disease (CHD) Definition Coronary atherosclerotic heart disease: Coronary heart disease: Ischemic heart disease: Clinical Type Silent myocardial ischemia Angina pectoris Myocardial infarction Ischemic cardiomyopathy Sudden cardiac death Silent Myocardial Ischemia Defined as documented episodes of ischemia not associated with any typical or atypical symptoms that among patients with obstructive coronary artery disease. Type I: myocardial ischemia is detected on routine ECG, 24h ambulatory ECG monitoring (Holter), etc. but not experience angina at any time; Type II: patients are most frequently encountered in clinical practice. Some episodes of ischemia are associated with chest discomfort and other episodes are asymptomatic. Ischemic Cardiomyopathy Symptoms of heart failure, caused by ischemic myocardial dysfunction (hibernation), diffuse fibrosis, and multiple infarction, alone or in combination. Manifestations: ventricles enlargement (dominant left ventricle), heart failure and arrhythmias. Sudden Cardiac Death SCD is natural death due to cardiac causes, heralded by abrupt loss of consciousness within 1 hours of the onset of acute symptoms. The time and mode of death are unexpected. WHO definition: unexpected death within 6 hours. This definition incorporates the key elements of natural, rapid and unexpected. One half of SCD due to coronary heart disease，caused by severe arrhythmias, such as ventricular fibrillation and cardiac arrest. Acute Coronary Syndromes（ACS） ACS represents a spectrum of conditions: including: acute MI, unstable angina and sudden cardiac death. Acute plaque change characterized by plaque rupture and exposure of substances that promote platelet activation and thrombin generation. Risk Factor Age, gender and family history Hypertension Dislipidmia Diabetes mellitus Tobacco use Obesity Candidate Risk Factor Homocystein ? Fibrinogen ? LP(a) ? Fibrinolytic activity（tP