心血管系统课件：心肌缺血治疗.pptVIP

Treatment of Myocardial Ischemia心肌缺血的治疗 冠状动脉粥样硬化性心脏病 Coronary Heart Disease 冠心病表现与类型 心绞痛 Angina Pectoris 劳力型 stable 变异型 variant 不稳定性心绞痛 unstable 心肌梗塞 Myocardial Infarction 冠脉综合征 Coronary Syndrome 猝死 Sudden Death 无症状性心肌缺血 Silent Ischemia 冠脉粥样硬化 斑块出血与心肌梗死 coronary atherosclerosis, plaque bleeding, myocardial infarction Pathophysiology of ischemic heart disease Angina pectoris, the primary symptom of ischemic heart disease, is caused by transient episodes of myocardial ischemia that are due to an imbalance in the myocardial oxygen supply-demand relationship.心绞痛是心肌缺血的主要症状，发生基于一过性氧的供需矛盾 This imbalance may be caused by an increase in myocardial oxygen demand (determined by heart rate, ventricular contractility, and ventricular wall tension) or by a decrease in myocardial oxygen supply (primarily determined by coronary blood flow but occasionally modified by the oxygen-carrying capacity of the blood) or sometimes by both. 心率、心肌收缩力、容量负荷与压力负荷（决定室壁张力）增加均可增加氧耗，而氧供减少主要是由于冠脉流量降低 Pathophysiology of ischemic heart disease Angina pectoris may occur in a stable pattern over many years or may become unstable, increasing in frequency or severity and even occurring at rest. In typical stable angina, the pathological substrate is usually fixed atherosclerotic narrowing of an epicardial coronary artery, on which exertion or emotional stress superimposes an increase in myocardial oxygen consumption.稳定型心绞痛与不稳定型心绞痛 In variant angina, focal or diffuse coronary vasospasm episodically reduces coronary flow. 变异型心绞痛 Patients also may display a mixed pattern of angina with the addition of altered vessel tone on a background of atherosclerotic narrowing. In most patients with unstable angina, rupture of an atherosclerotic plaque, with consequent platelet adhesion and aggregation, decreases coronary blood flow. Plaques with thinner fibrous caps are more “vulnerable” to rupture.. Pharmacologica