缺血性心肌病ppt课件

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1、Coronary（Ischaemic）HeartDisease冠心病缺血性心脏病北京大学人民医院心研所胡大一MostCommonformofheartdiseaseSinglemostimportantcauseofprematuredeathUSA1/2deaths(1/2million)1.5millionMIeachyeas45%MIunderage6550-100billion$peryearUKOnein4men/onein5womendiefromCHD300000peoplehav

2、eMIeachyear1.7millionpeoplehaveanginaTheincidenceEasternEuropeManydevelopingcountriesChinaIndiaPathophysiologyRiskFactorsPreventionAlmostalwaysduetoAthromaanditscomplicationsparticularlythrombosisOccasionallyotherdisordersCongenitalanomaliesAnomalous

3、originFistular/MalformationofamajorcoronaryarteryAortitisPolyarteritisConnectivetissuedisordersAtheroma/AtherosclerosisPatchyfocaldiseaseofthearterialwallRadial/InternalmamaryarterylargelysparedCoronaryarteryathighriskCerebral/peripheralvasculardisea

4、seoftencoexist斑块形成（一）Plaguesbegintoappearin2ndand3rddecadeoflifeThenature/compositionofPlagueschanges斑块形成（二）斑块形成（三）FattystreaksdevelopmigrateintointimaCirculatingtake-upoxidisedLDLMonocytesfromplasmabecomelipid-ladenfoamcells斑块形成（四）LipidPoolFoamcells

5、dieThecontentsrelease斑块形成（五）EarlyAtheromaSmoothmusclecellsmigrateintoPlagueproliferatewithin斑块形成（六）LesionGrowsEncroachesintolumenErodesmedia斑块形成（七）MatureFibrolipidPlagueLipidcoreSurroundedbySMCFibrouscapPlagueRupture/FissureThrombosis+LocalspasmVesse

6、lOcclusionACSSOMEIMPORTANTRISKFACTORSFORCORONARYARTERYDISEASEFixedModifiableAge•SomkingMalesex•HypertensionFamilyhistory•Lipiddisorders•Diabetesmellitus•Haemostaticvariables•Sedentarylifestyle•Obesity•Dietarydeficienciesofantioxidantvitaminsandpolyun

7、saturatedfattyacidsCHD:RiskFactorsCHD:PreventionPrimarySecondaryCHD:PreventionPrimaryModifyRiskFactorsPopulationAdviceDonotsmokeTakeregularexerciseMaintian“ideal”bodyweightEatamixeddietrichinfreshfruitandvegetablesAimtogetnomorethan30%ofenergyintakef

8、romfatExamplesofthebenefitsoflong-termsecondarypreventionfollowingmyocardialinfarctionPreventiveEventspreventdeper1000patientmeasureyearsoftreatmentSmokingcessation15deaths46non-fatalmyocardialinfarctions(Mls)Aspirin7deaths9non-fatalMls9non-fatalstro