重庆大学内科学课件-第4章冠心病.pptVIP

第四章Coronary Heart Disease  (Ischemic Heart Disease)重庆大学《内科学》 Content: 1. Atherosclerosis 2. Angina pectoris 3. Myocardial infarction ? CHD is defined as myocardial impairment due to an imbalance between coronary blood flow and myocardial requirements caused by changes in the coronary circulation ????? a.Coronary atherosclerosis ????? b.Coronary spasm Definition Manifestation of Ischemia Heart Disease 1.Angina Pectoris 2.Myocardial Infarction 3.Heart Failure and Arrhythmias 4.No obvious clinical manifestation ? Acute coronary syndrome Account for more than 50% Manifested with unstable angina pectoris,acute myocardial infarction(ST-segment elevate or non-ST-segment elevate), cardiac shock . 第一大死亡原因1998年460,000人死于该病每5个成年人中就有一个发病率每年约1,100,000人新发或复发冠心病，其中40％死于该病每年约有400,000新发稳定型心绞痛病例和150,000新发不稳定型心绞痛病例目前，12,000,000人具有心梗和/或心绞痛史美国心血管病流行病学 中国心血管病流行病学20世纪后叶，在我国以心血管疾病为代表的慢性疾病的 发病率和死亡率日益增加目前估计我国仅高血压病患者就近1亿人，心肌梗死患者200－300万人，死于冠心病的人数约30万 Atherosclerosis Understand the definition and classification of CHDB.Understand the pathophysiology of atherosclerosisC.Grasping risk factors for coronary atherosclerosis and clinical featuresD.Mastering diagnosis and preventionObjective Risk factors Irreversible risk factors1. Age2. Male sex3. Family History? Modifiable risk factors 1.lipid disorder1).classification of lipid protein CM　 VLDL　 LDL　 HDL 2).Relative large clinical trial 4S,WOSCOPS,CARE,AFCAPS,LIPID enroll 30817 patients, follow up 4.5 years. TC decrease 20%,TG decrease 13% LDL-C decrease 28%,HDL increase 5% Morbidity of major coronary events decrease 31% 2.Smoking 3.Hypertension 4.Diabetes mellitus 5.Physical activity 6.Alcohol 7.others: obesity,low levels of antioxidants , gene of ACE overly express, high levels of fibrinogen and factor VII, homocysteine , fibrinogen