第章抗心绞痛PPT课件.ppt

第二十一章抗心绞痛与抗动脉粥样硬化药;第 一节 抗心绞痛药;What is angina pectoris? Angina pectoris?is the medical term for chest pain or discomfort due to coronary heart disease.? Angina is a symptom of a condition called myocardial ischemia.? It occurs when the heart muscle (myocardium) doesnt get as much blood (hence as much oxygen) as it needs. This usually happens because one or more of the hearts arteries (blood vessels?that supply blood to the heart muscle) is narrowed or blocked.? Insufficient blood supply is called ischemia. Angina also can?occur in people with valvular heart disease, hypertrophic cardiomyopathy (this is an enlarged heart due to disease) or uncontrolled high blood pressure.??Typical angina is uncomfortable pressure, fullness, squeezing or pain in the center of the chest.? The discomfort also may?be felt in the neck, jaw, shoulder, back or arm.?;心绞痛的分类;冠脉循环特点： ?;;心室壁血供;心绞痛发生的主要机制：; 心肌的供氧及耗氧;⑴ 舒张冠脉，解除冠脉痉挛或促进侧支循环的形成。 ⑵ 舒张静脉，减少回心血量，降低前负荷；或舒张 外周小动脉，降低心后负荷，以降低心射血阻 抗，降低心室壁肌张力；或减慢心率；或抑制心 肌收缩力，降低心作功氧耗量。 ⑶ 抗血小板聚集，抑制血栓形成，加速血流速度。;抗心绞痛药物分类;硝酸甘油 (Nitroglycerin, NTG); 静脉 外周小动脉 较大冠状动脉;; [药理作用];缺血部位;;;[抗心绞痛机制];NO舒张血管作用过程;[临床应用];1、继发于血管舒张 ⑴ 眼、脑血管舒张?眼内压、颅内压?，头痛 青光眼、颅内压高者禁用 ⑵ 体位性低血压和晕厥 ⑶ 反射性心率加快 合用 ?-受体阻断药;（二）?-受体阻断药;[临床应用];心率 ? ? 心肌收缩力 ? ? 心室容积 ? ? 血压 ? ?;（三）钙拮抗药;[临床应用];钙拮抗剂的不良反应;