冠心病英文版VIP免费

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:compensatoryenlargementVascularremodeling:compensatoryenlargementAtheromaevolution:Involvementofarterialsmooth-musclecellsBloodcoagulationmicrovesselsAtheromaevolutionandcomplications炎症炎症细胞细胞少量平滑肌少量平滑肌细胞细胞激活的巨噬细胞激活的巨噬细胞血栓血栓Complicatedlesion:thrombosisAtheromaevolutionandcomplicationsAtheromaevolutionandcomplicationsVulnerableplaque:Vulnerableplaque:ThinfibrouscapThinfibrouscapRelativelylargelipidcoreRelativelylargelipidcoreHighcontentofmacrophagesHighcontentofmacrophagesInflammatorymediatorsInflammatorymediatorsIntravascularultrasoundClassicificationofatheroscleroticlesionusingIVUSCliniclstagesandclassification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):cholesterolscreeninginall>20yrsElevated: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=1059P<0.001P<...