血管痉挛和冠脉微血管疾病PPT课件.ppt

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1、VasospasticandMicrovascularCoronaryArteryDiseaseAttilioMaseri,MDUniversityVita-SaluteSanRaffaele–Milan,Italy15thGWICCBeijing,October2004CoronaryVasoconstrictionCoronaryperfusioncanbetransientlyorpersistentlyimpairedbycoronaryvasoconstrictionresultinginmyocardialischemia.Vasoconstriction

2、mayoccurinlargecoronaryarteriesandinthemicrocirculation.VasoconstrictionofEpicardialCoronaryArteriesCoronaryvasomotionmodulatesresidualcoronaryflowreserve,resultinginavariableefforttolerancewhenstenosingplaqueshaveapreservedmuscularmediawhichcanvarytheresiduallumenCoronaryArterySpasmCor

3、onaryspasmcancausepersistentcoronaryocclusionwhenassociatedwithlocalthrombosis,resultinginacuteinfarctionSoonafteracuteMI,intracoronaryacetilcolinecausecoronaryspasminabout60%ofJapanesepatients,butonlyin20%ofItaliansPristipinoetal,Circulation2000;101:1102-1108VasoconstrictionofEpicardia

4、lCoronaryArteriesVariantanginaistypicallycharacterizedbyanginaatrest,particularlyatnightorinthemorning,inthepresenceofanormaleffecttolerance,butoftencausesinfarctionandfatalarrhythmiasSuspicionofVariantAnginaPredominantlyspontaneousattackswithpreservedefforttolerance,ofteninclustersof2-

5、3Predominantlyspontaneousattackswithpreservedefforttolerance,ofteninclustersof2-3Lasting1-10mins,relievedbyGTNPredominantlyspontaneousattackswithpreservedefforttolerance,ofteninclustersof2-3Lasting1-10mins,relievedbyGTNOftenatnightorearlymorningwithwaxingandwaningoverperiodsofweeksandmo

6、nthsPredominantlyspontaneousattackswithpreservedefforttolerance,ofteninclustersof2-3Lasting1-10mins,relievedbyGTNOftenatnightorearlymorningwithwaxingandwaningoverperiodsofweeksandmonthsSometimesassociatedwithsyncopeNegativeexercisetestafterGTNPrevalenceofVariantAnginaPisa,London,Rome=1.

7、0%ofadmissionsDiagnosedonlyafterweeks,monthsoryearsRome(1991-96):64casesaged19-75years60%hadnormalangiograms40%majorevents40%hadstenosis6%majoreventsPathogeneticsMechanismsofSpasmAlocalcoronaryhyper-responseHackett1986Hence:asmoothmusclepost-receptorialalterationMaseri1990Pro