冠心病课件(大医英)

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1、冠状动脉粥样硬化性心脏病(coronaryatheroscleroticheartdisease)大连医科大学附属二院心内科牛楠动脉粥样硬化atherosclerosisIntroductionArteriosclerosisThickeningandlossofelasticityofarterialwallsHardeningofthearteriesGreatestmorbidityandmortalityofallhumandiseasesviaNarrowingWeakeningPlaqueThatHasBeenSurgicallyRemov

2、edfromCoronaryArteryCourtesyRonaldD.GregoryandJohnRiley,MD.NonModifiableRiskFactorsAgeAdominantinfluenceAtherosclerosisbeginsintheyoung,butdoesnotprecipitateorganinjuryuntillaterinlifeGenderMenmorepronethanwomen,butbyage60-70aboutequalfrequencyFamilyHistoryFamilialclusterofriskf

3、actorsGeneticdifferencesModifiableRiskFactors(potentiallycontrollable)HyperlipidemiaHypertensionCigarettesmokingDiabetesMellitusElevatedHomocysteineFactorsthataffecthemostasisandthrombosisInfections:Herpesvirus;ChlamydiapneumoniaeObesity,sedentarylifestyle,stressPathogenesisofAt

4、herosclerosisResponsetoinjuryhypothesisInjurytotheendothelium(dysfunctionalendothelium)ChronicinflammatoryresponseMigrationofSMCfrommediatointimaProliferationofSMCinintimaExcessproductionofECMEnhancedlipidaccumulationResponsetoinjuryEndotheliadysfunctionInitiationofFattyStreakFa

5、ttyStreakFibro-fattyAtheromaAtherosclerosisTimelineFoamCellsFattyStreakIntermediateLesionAtheromaFibrousPlaqueComplicatedLesion/RuptureAdaptedfromPepineCJ.AmJCardiol.1998;82(suppl104).FromFirstDecadeFromThirdDecadeFromFourthDecadeEndothelialDysfunctionAHAClassificationofatherosc

6、lerosis动脉粥样硬化血栓形成:具共同病理基础的进展性过程正常脂肪条纹纤维斑块粥样硬化斑块斑块破溃/裂隙和血栓形成心肌梗死缺血性中风/TIA严重的下肢缺血临床无症状心血管死亡年龄增长稳定性心绞痛间歇性跛行不稳定性心绞痛}ACS*ACS,急性冠脉综合征;TIA,一过性脑缺血发作缺血性肾病缺血性肠病CoronaryArteryDisease冠心病Clinicalclassification(1979WHO)AsymptomaticCHD(隐匿型）AnginapectorisCHD（心绞痛型）MyocardialinfarctionCHD(心肌梗死型）

7、IschemiccardiomyopathyCHD（缺血性心肌病型）SuddendeathCHD（猝死型）ClassificationofIHDChronicischemicsyndrome:stableanginaasymptomaticCHDischemiccardiomyopathyCHDAcutecoronarysyndrome:unstableanginaSTEMI/NSTEMI急性冠脉综合症的病理生理学Fusteretal.NEnglJMed.1992;326:310-318.Daviesetal.Circulation.1990;82(S

8、upplII):II-38,II-46.不稳定血栓(UA/NSTEMI)脂肪池巨噬细胞内在的压