最新血管痉挛和冠脉微血管疾病PPT课件教学讲义PPT.ppt

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1、血管痉挛和冠脉微血管疾病PPT课件CoronaryVasoconstrictionCoronaryperfusioncanbetransientlyorpersistentlyimpairedbycoronaryvasoconstrictionresultinginmyocardialischemia.Vasoconstrictionmayoccurinlargecoronaryarteriesandinthemicrocirculation.VasoconstrictionofEpicardialCo

2、ronaryArteriesCoronaryvasomotionmodulatesresidualcoronaryflowreserve,resultinginavariableefforttolerancewhenstenosingplaqueshaveapreservedmuscularmediawhichcanvarytheresiduallumenPrevalenceofVariantAnginaPisa,London,Rome=1.0%ofadmissionsDiagnosedonlyafte

3、rweeks,monthsoryearsRome(1991-96):64casesaged19-75years60%hadnormalangiograms40%majorevents40%hadstenosis6%majoreventsPathogeneticsMechanismsofSpasmAlocalcoronaryhyper-responseHackett1986Hence:asmoothmusclepost-receptorialalterationMaseri1990Provocatio

4、nbystimuliactingondifferentreceptors:ErgonovineHiggins1976MetacholineEndo1976DopamineCrea1986HystamineGinsburg1981-Kaski1986AcetylcholineYasue1986SerotoninMcFadden1991TreatmentofVariantAnginaReduceaspecificallysmoothmuscleconstrictorresponsebynitratesand

5、calcium-antagonistsSometimesveryhighdosesrequiredFrenneauxetal.AmJCardiol1988;62:832Lefroyetal.Coronaryarterydisease1992;3:745Pace-maker,implantabledefibrillatorMicrovascularConstrictionThissyndromeincludes60-70%ofwomen(about60%post-menopausaland40%pre-m

6、enopausal)butalso30-40%ofmen.Itischaracterizedbyanginapectorisand‘normal’coronaryangiography.Itsincidencemayvaryfrom10%to50%ofpatientssubmittedtocoronaryarteriography.Thediagnosisofmyocardialischemiaisdifficultforanumberofreasons.Inspiteoftheabsenceofinc

7、reasedriskofinfarctionandcardiacdeath,thesepatientsmaybecrippledbypain.SyndromeX:PROBLEMTheinconsistentresponsetonitratesandanti-anginaldrugsandtononconventionalanti-ischemictherapy,indicatestheneedforresearchonmultiple,potentialcausesofcoronaryvasculard

8、ysfunction,inordertodeveloprationalformsoftherapy.SuspicionofMicrovascularAnginaLong-lasting(>10-30’),poorlyresponsivetoGTNTransientECGchangesorpositivemyocardialscintigraphyCardiacoriginofpainNoevidenceofleftventriculard