缺血性心脏病教学课件

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1、北京大学人民医院心脏中心孙艺红Coronary(Ischemic)HeartDisease冠心病缺血性心脏病CHDEpidemiologyPathophysiologyRiskfactorsandPreventionClinicalmanifestation,DiagnosisandmanagementMostcommonformofheartdiseaseSinglemostimportantcauseofprematuredeathEpidemiologyEpidemiology--USA1/2deaths(1/2milli

2、on)1.5millionMIeachyear45%MIunderage6550-100billion$peryearOnein4men/onein5womendiefromCHD300000peoplehaveMIeachyear1.7millionpeoplehaveanginaEpidemiology--UKTheincidenceofCHDEasternEuropeManydevelopingcountriesChinaIndiaEpidemiologyProportionateMortalityfortheTenLead

3、ingCausesofDeathinChina,1991-2001HeJ&GuD,etal,NEnglJMed2005;353;11:1124-34PathophysiologyAlmostalwaysduetoathromaanditscomplicationsparticularlythrombosisOccasionallyotherdisordersCongenitalanomaliesAnomalousoriginFistular/MalformationofamajorcoronaryarteryAortitisPol

4、yarteritisConnectivetissuedisordersPathophysiologyPathophysiologyAtheroma/AtherosclerosisDiffuseddiseaseofthearterialwallCoronaryarteryathighriskCerebral/peripheralvasculardiseaseoftencoexistRadial/InternalmammaryarterylargelysparedPlaquesbegintoappearin2ndand3rddecad

5、eoflifeThenature/compositionofplaqueschangesPathophysiologyPlaqueFormation1Soldiersdiedinthekoreanwar77.3%atherosclerosis39%occlusiveplaqueENOSJAMA1953300Casesautopsy(age,22.1y)TuzcuCirc19995.07mm2EEMArea13.2mm2AtheromaArea8.13mm2Female,32y17%37%60%85%71%020406080100

6、<2020-2930-3940-49≥50Incedenceofather(%)age(y)IncidenceofatherosclerosisindonorheartPathophysiologyPlaqueFormation2Fattystreaksdevelopemigrateintointimatake-upoxidisedLDLfromplasmabecomelipid-ladenfoamcellsCirculatingMonocytesPathophysiologyPlaqueFormation3LipidPoolFo

7、amcellsdieThecontentsreleasePathophysiologyPlaqueFormation4EarlyAtheromaSmoothmusclecellsmigrateintoproliferatewithinPlaquePathophysiologyPlaqueFormation5LesionGrowsEncroachesintolumenErodesmediaPathophysiologyPlaqueFormation6MatureFibrolipidPlaqueLipidcoreSurroundedb

8、ySMCFibrouscapPathophysiologyPlaqueFormation7PlagueRupture/FissureThrombosis+LocalspasmVesselOcclusionACSPathophysiologyPath