缺血性心脏病和动脉瘤课件

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1、IschemicheartdiseaseandaorticaneurysmsCardiovascularlab#1IschemicheartdiseasegeneralconceptsIschemicheartdisease--DesignationofagroupofdisordersthatallcauseischemiatothemyocardiumIschemiaresultsfromanimbalanceofsupplyanddemandDecreasedcoronarybloodflow(~90%ofmyoc

2、ardialischemicdz)Mostcommonlyduetoatherosclerosiswithsuperimposedthrombus,vasospasmorbothUncommoncausesofdecreasedsupplyarearteritis,emboli,cocaine-vasospasmandsystemichypotensionNormalflowbutnotenoughoxygen(increaseddemandorhypoxia)Tachycardia,andhypertrophyCyan

3、osisduetocongenitalheartdisese(rt-ltshunts),smoking,carbonmonoxidepoisoning,lungdisease...MyocardialischemicsyndromesFourbasicischemicsyndromes--Anginapectoris--chestpainresultingfromischemiawithoutfrankinfarction(reversibleischemia)ThreeclinicalpatternsofanginaS

4、table--underlyingpathisusuallystenosisofmajorcoronaryvessel(<75%stenosis)Prinzemetal--VasospasmUnstabe--plaquedisruptionwithvariablemuralthrombiMyocardialinfarction(MI)--DeathofcardiacmusclecellsTransmuralinfarcts--infarctionsoffullthicknessofventricularwall.Sube

5、ndocardialinfarcts--infarctionlimitedtotheinner1/3-1/2ofmyocardiumChronicischemicheartdisease--ElderlywithmultivesseldiseaseinsidiouslydevelopCHFduetopost-infarctdecompensation,orslowmyocytedegenerationSuddencardiacdeath--definedasunexpectedcardiacdeathwithin1hou

6、rofsx’sonsetManyunderlyingdiseasethatalltriggeracommonfinalmechanismofdeath--fatalarrhthymiaMyocardialinfarctionTransmuralinfarcts--Pathogenesis--Underlyingdisease--90%duetocoronaryatherosclerosisandsubsequentdisruptionofplaquesInitialevent--acuteplaquechangeordi

7、sruption(thisincludeserosion,ulceration,fissuring,ruptureorhemorrhagicexpansion)--plaquechangeprecipitatedbyvasospasmorhemodynamicstressThrombosisfollowsacuteplaquechangeandleadstoischemiaFateofthethrombus--maylysespontaneously,orbytherapy(fibrinolytics),orvasosp

8、asmmightletupandreleasethrombusMyocytefate--Myocytesmaydieduetoischemia,ormaygetre-flowquicklyenoughtojustsustaininjuryandbe“stunned”(stunnedmyocytespoorlycont