冠心病英文版

Atherosclerosis&CoronaryheartdiseasesZhengzhouUniversity,FirstaffiliatedHospitalDept.ofCardiologyHaiyuLi,M.D.CardiovascularDiseasesAtherosclerosis•leadingcauseofdeathanddisability•Commonlocation:Coronarycirculation:Proximalleftanteriordescendingcoronaryartery(LAD)ProximalportionofrenalarteriesExtracranialcirculationtothebrainCarotidbifurcationAtherosclerosisCoronaryheartdiseaseatherosclerosisCoronarystenosiscoronaryspasmMyocardialischemia,anoxaemiaCoronaryheartdisease,CHDIschemicheartdisease•Atherosclerosis•Stableanginapectoris(SAP)•AcutecoronarysyndromeUnstableangina(UAP)andnon-STEMI(UA/NSTEMI)STelevationmyocardialinfarction(STEMI)Threefundamentalbiologicalprocessesofatherosclerosis1.Accumulationofintimalcells:•smoothmusclecells•Macrophages•T-lymphocytes2.Proliferatedconnectivetissuematrix:•collagen•elasticfibers•proteoglycans3.Accumulationoflipid:•cholesterolesters•freecholesterolPathologyandpathophysiologyFattysteakFibrousplaqueComplicatedlesionAtherosclerosisInitiationofAtherosclerosisFattysteakformationInitiationofAtherosclerosisFattysteakformationLipoproteinoxidationNonenzymaticglycationLeukocyterecruitmentFoamcellformationAtheromaevolution:fibrousplaqueAtheromaevolutionandcomplicationsVascularremodeling:compensatoryenlargementAtheromaevolution:Involvementofarterialsmooth-musclecellsBloodcoagulationmicrovesselsAtheromaevolutionandcomplications炎症细胞少量平滑肌细胞激活的巨噬细胞血栓Complicatedlesion:thrombosisAtheromaevolutionandcomplicationsAtheromaevolutionandcomplicationsVulnerableplaque:ThinfibrouscapRelativelylargelipidcoreHighcontentofmacrophagesInflammatorymediatorsIntravascularultrasoundClassicificationofatheroscleroticlesionusingIVUSCliniclstagesandclassificationAbsenceofsymptomorstageofdelitescenceischemianecrosis(targetorgan)fibrosisAtherosclerosisGeneralmanifestationAorticatherosclerosisCoronaryarteryatherosclerosisCerebralatherosclerosisMesentericatherosclerosisPeripheralarteryatherosclerosisAtherosclerosisclinicalmanifestationlaboratoryexaminationLackofsensitiveandspecificmethodsforearlydiagnosisDyslipidemia：X-ray：DSAshowseverityofstenosisDopplerultrasound:bloodflowradionuclide：detectionofischemiaEchocardiogram：CHDECGandstresstest:CHDNewtechniques:intravascularultrasound,angioscopeCT,MRIAtherosclerosisRiskfactorsandprevention1.Lifestylemodification2.Lipiddisorders(Dyslipidemia):cholesterolscreeninginall20yrsElevated:cholesterol(TcandLDL-c),TG,ApoB/ApoA,Lp(a),Low:HDL-cLDLloweringbyHMG-CoAreductase(statins):cardiovascularevents30%，riskofMI62%3.Hypertension：4.DM,Metabolicsyndromeorinsulinresistancesyndrome:BP,BMI,TG,seruminsulinHDL-cDiabetesmellitus(DM):RR1.9formale,3.3forfemalemorediffuselesion.CADequivalent75-80%causeofdeathinadultDMarevasculardiseases:CAD,cerebrovasculardisease,orperipheralvasculardiseaseRiskfactorsandprevention7yearsincidenceofdeath/non-fatalMI(EastWestStudy)*ThesepatientshadnohistoryofmyocardialinfarctionHaffnerSM,etal.NEnglJMed.1998;339:229–234.05101520253035404550EventsofMIin7yearsNohistoryofMIOMINohistoryofMI*OMInon-diabeticsdiabeticsn=1373n=1059P0.001P0.0014%19%20%45%DM:CADequivalent5.Cigarettesmoking：morethrombogenic6.Familyhistory：geneticfactor7.Aging：40yrsadults，4/5fatalmyocardialinfarctionoccuredinpatiens65yrs8.Malegender/postmenopausalstate：male:female=2：1,mandevelopCHD10-15yrsearlierthanwoman9.alcohol10.Others:diet,homocysteine,hemostaticfactorsinflammation/infectionRiskfactorsandprevention•Drugtherapy：anti-platelet：aspirin,clopidogrel,GPIIb/IIIainhitibor,Dipyridamole,cilostazolLipid-loweringRiskfactorsandprevention1.HMG-CoAreductaseinhibitors（statins）Atorvastatin,Fluvastatin,Lovastatin,Pravastatin,Simvastatin,Cerivastatin,Rosuvastatin：*elevationofaminopherase,rhabdomyolysis2.Bileacid-bindingResinscholestyramine，colestipol3.NicotinicAcid：4.Fibricacidderivatives（fibrates）Gemifibrozil,clofibrate,Fenofibrate5.Cholesterolabsorptioninhibitors:ezetimibe6.ProbucolLipid-loweringdrugsPreventionofCAD•A:aspirin,ACEI•B:bloodpressure,β-blocker,•C:cigarettesmoking,Cholesterol•D:diet,diabetes•E:exercise,educationThirdReportoftheNationalCholesterolEducationProgram(NCEP)ExpertPanelonDetection,Evaluation,andTreatmentofHighBloodCholesterolinAdultsATPIII(adulttreatmentpanelIII)Circulation200217/24:3144-3373AtherosclerosisCoronaryheartdisease(CHD)Coronaryheartdisease(CHD)•mostcommoncause:obstructionofatheromatousplaque•othercauses:spasmarterialthrombicoronaryemboliostialnarrowingduetolueticaortitiscongenitalabnormalitiessevereLVhypertrophyFactorseffectmyocardialoxygensupplyanddemandOxygensupplyOxygendemandHeartrateMyocardialcontractilitySystolicwallstressoxygencarryingcapacityofbloodCoronarybloodflowVascularresistanceExtravascularcompressiveforcesautoregulationMetabolicregulationHumoralfactorNeuralregulationDurationofdiastolePressuregradientEndothelialcontrolCoronaryheartdiseaseType：•slientischemia:delitescence：(ECGchange)•Anginapectoris：angina,causedbymyocardialischemia•myocardialinfarction：acutemyocardialischemicnecrosiscausedbytheocclusionofcoron