哈里森内科学---心血管内科疾病

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1、42704Harrison/Braunwald:HPIM16/eMcGraw-HillRIGHTBATCHtopofrhbaseofrhPARTVIIIDISORDERSOFTHECARDIOVASCULARSYSTEMcapheightbaseoftextSection1DiagnosisofCardiovascularDisorders208APPROACHTOTHEPATIENTWITHCARDIOVASCULARDISEASEEugeneBraunwaldTHEMAGNITUDEOFTHEPROBLEMbeinadequateduringexertion.Thuschestd

2、iscomfortand/ordyspneathatappearonlyduringactivityarecharacteristicofheartdisease,Cardiovasculardiseasescomprisethemostprevalentseriousdisorderswhiletheoppositepattern,i.e.,theappearanceofthesesymptomsatinthedevelopednations.TheAmericanHeartAssociationhasre-restandtheirremissionduringexertion,i

3、srarelyobservedinpatientsportedthatin2002,62millionAmericans—32millionfemalesandwithorganicheartdisease.30millionmales(i.e.,morethanoneinfivepersons)—hadacardio-Manypatientswithcardiocirculatorydiseasemayalsobeasymp-vasculardisease(includinghypertension).Theprevalencerisespro-tomatic,bothatresta

4、ndduringexertion,butmaypresentanabnormalgressivelywithagefrom5%atage20to75%atage
75years.physicalfinding,suchasaheartmurmur,elevatedarterialpressure,orDischargesfromU.S.hospitalsforcardiovasculardisordershaveanabnormalityoftheelectrocardiogram(ECG)orofthecardiacsil-beenrisingsteadilyandnowexceed

5、6millionperyear.Despitesub-houetteonthechestroentgenogram.Patientsmayexhibitasympto-stantialprogressintheprimaryandsecondarypreventionofcoronarymaticischemiaonanexercisestresstest.Insomeasymptomaticheartdisease,approximately6.5millionAmericanssufferfromanginapatientsthefirstclinicaleventmaybecat

6、astrophic—suddencardiacpectorisandmorethan1millionexperienceamyocardialinfarctiondeath,acutemyocardialinfarction,orstroke.eachyear.About4.8millionAmericanshavecongestiveheartfailureandmorethanhalfamillionnewcasesoccureachyear.Hospitaliza-FEAROFHEARTDISEASEtionsforheartfailurehaverisenfrom400,00

7、0to950,000peryearinDiseasesoftheheartandcirculationaresocommonandthelaityisthepast20years.Morethan1.4millionpatientsundergocardiaccath-sowellacquaintedwiththemajorsymptomsresultingfromthesedis-eterizationeachyear,andapproximately1