冠心病英文版-文库吧

【正文】 omatousplaque•othercauses:spasmarterialthrombicoronaryemboliostialnarrowingduetolueticaortitiscongenitalabnormalitiessevereLVhypertrophy第三十一页，共一百一十五页。FactorseffectmyocardialoxygensupplyanddemandOxygensupplyOxygendemandHeartrateMyocardialcontractilitySystolicwallstressoxygencarryingcapacityofbloodCoronarybloodflowVascularresistanceExtravascularpressiveforcesautoregulationMetabolicregulationHumoralfactorNeuralregulationDurationofdiastolePressuregradientEndothelialcontrol第三十二页，共一百一十五页。CoronaryheartdiseaseType：•slientischemia:delitescence：(ECGchange)•Anginapectoris：angina,causedbymyocardialischemia•myocardialinfarction：acutemyocardialischemicnecrosiscausedbytheocclusionofcoronaryartery•Ischemiacardiomyopathy(Heartfailureandarrhythmia)：cardiacenlargement,heartfailure,arrhythmia,causedbythemyocardialfibrosisastheconsequenceofchronicmycardialischemia•Suddendeath：suddencardiacarrestcausedbyventricularfibrillation/flutter第三十三页，共一百一十五页。Coronaryheartdisease(CHD)Type：slientischemia:delitescenceAnginapectoris：myocardialinfarction：Ischemiccardiomyopathy(Heartfailureandarrhythmia)Suddendeath第三十四页，共一百一十五页。AcuteCoronarySyndrome(ACS)RestingischemiaNonSTelevationSTelevationUnstableanginaNonQwaveAMIQwaveAMI*positiveserumcardiacmarkers****occasionallyvariantangina第三十五页，共一百一十五页。Stableanginapectoris(SAP)第三十六页，共一百一十五页。definition:acuteandtransientmyocardialischemiaandanoxaemiausuallycausedbycoronaryinsufficiencyduringexertionoremotionalstressCharacteristics:paroxysmalprecordialsqueezinglikechestpain,behindthemidsternum，radiatedtoleftshoulderandupperarmprecipitatedbystressorexertionduration:25mintypicallyrelievedrapidlybyrestornitratesStableanginapectoris第三十七页，共一百一十五页。Coronarystenosis(others:aorticvalvedisease,HOCM,MB)+Myocardialoxygendemand〔HRXSBP〕increasedmyocardialhypoxiaacumulationofmetabolicproduct,stimulateC15nervetocausethesensationofchestpainStableanginapectorismechanism第三十八页，共一百一十五页。inangiographySignificantcoronarylesionwithdiameterstenosis>70%in75%ptsNosignificantstenosisinabout510%pts,Ischemiamayberelatedtocoronaryspasmormicrovasculardysfunction.PathologyStableanginapectoris第三十九页，共一百一十五页。pathophysiologyandelectrophysiology•ATPreduced,accumulationofacidsubstances•Dysfunctionofironpump(Na+K+,andNa+Ca++)•Earlydepolarization(STdeviation)functionandhemodynamicsituation•LVcontractilityandspeed,systolicBP,strokevolume,cardiacoutputdecreased•LVEDpressureandvolumeStunningofmyocardiumStableanginapectoris第四十页，共一百一十五页。symptom：chestpainoroppression•locationbehindorslightlytotheleftofthemidsternumnodefiniteborderlineradiatedtotheleftshoulderandupperarmAtypicallocation:lowerjaw,thebackofneckClinicalmanifestationStableanginapectoris第四十一页，共一百一十五页。chestpain•characteristics：tightness,squeezing,burning,pressing,choking,bursting,rarelysharp,notspasmodicforcethepatientstoptheactivitytillthesymptomrelieved•precipitationexertionoremotionalagitation。•duration：3－5mins•painrelief:withinseveralminsafterrestorusingnitroglycerinClinicalmanifestationStableanginapectoris第四十二页，共一百一十五页。PhysicalexaminationincreasedHR,elevatedBPanxietysweatingoccasionallygalloprhythm，transientsystolicmurmurClinicalmanifestationStableanginapectoris第四十三页，共一百一十五页。Laboratory：•atrest•Duringchestpain:STTchangefoundin95%pts•Holter:detectofslientischemia•Stresstest:indication：suspectionofCHD,preandpostCABGandPCI,ptswithOMIcontraindication：AMI,UAP,myocarditis,Hypertension,heartfailure,aorticstenosis,HOCM,severarrhythmia,aorticaneurysmEndofthetest：STor≥，APattacks，BP>220mmHg，BPdrop，ventriculararrhythmiaCriteriaforpositive:STsegmentdepression，last2minsStableanginapectoris第四十四页，共一百一十五页。StresstestrestExersciseStableanginapectoris第四十五页，共一百一十五页。:3.Radionuclideimagingassessment:TL201，Tc99msestamibimyocardialperfusionscintigraphyofheartangiography：finaldiagnose:IVUS、intracoronaryDopplerflow、intracoronarypressureLaboratoryStableanginapectoris第四十六页，共一百一十五页。CoronaryAngiography第四十七页，共一百一十五页。pain：aorticdissection,HOCM,aorticstenosis：PE,pneumothorax,pleuritis:gastroesophagealdiseases,Hiatalhernia,cholecystitis,pepticulceration,pancreatitis：TietzeSyndrome(Costochondritis),intercostalneuralgia,Herpeszoster:anxiety,depression,panicattacksStableanginapectorisDiagnosisChestpain,riskfactors,ECGevidenceofischemiaduringchestpain,angiographyDifferentiation第四十八页，共一百一十五页。FunctionalclassificationofSAP(CCS)CCSI：nochestpainatordinaryactivity.AnginaatstrenuousorrapidorprolongedexertionCCSII：Slightlimitationofordinaryactivity.Walkingorclimbingstairsrapidly,aftermeals,incold,inwind.Walkingmorethan2blocks,climbingmorethanstairsof3rdfloor.CCSIII：Markedlimitationofordinaryactivity.Walking1to2blocks,climbingstairsof3rdfloorCCSIV：Inabilitytocarryonanyactivitywithoutdisfort