血管痉挛和冠脉微血管疾病.ppt

《血管痉挛和冠脉微血管疾病.ppt》由会员上传分享，免费在线阅读，更多相关内容在行业资料-天天文库。

1、VasospasticandMicrovascularCoronaryArteryDiseaseCoronaryVasoconstrictionCoronaryperfusioncanbetransientlyorpersistentlyimpairedbycoronaryvasoconstrictionresultinginmyocardialischemia.Vasoconstrictionmayoccurinlargecoronaryarteriesandinthemicrocirculation.Vasoconstr

2、ictionofEpicardialCoronaryArteriesCoronaryvasomotionmodulatesresidualcoronaryflowreserve,resultinginavariableefforttolerancewhenstenosingplaqueshaveapreservedmuscularmediawhichcanvarytheresiduallumenCoronaryArterySpasmCoronaryspasmcancausepersistentcoronaryocclusio

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

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

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

6、verperiodsofweeksandmonthsPredominantlyspontaneousattackswithpreservedefforttolerance,ofteninclustersof2-3Lasting1-10mins,relievedbyGTNOftenatnightorearlymorningwithwaxingandwaningoverperiodsofweeksandmonthsSometimesassociatedwithsyncopeNegativeexercisetestafterGTN

7、PrevalenceofVariantAnginaPisa,London,Rome=1.0%ofadmissionsDiagnosedonlyafterweeks,monthsoryearsRome(1991-96):64casesaged19-75years60%hadnormalangiograms40%majorevents40%hadstenosis6%majoreventsPathogeneticsMechanismsofSpasmAlocalcoronaryhyper-responseHackett1986H

8、ence:asmoothmusclepost-receptorialalterationMaseri1990Provocationbystimuliactingondifferentreceptors:ErgonovineHiggins1976MetacholineEndo1976Dopa