最新血管痉挛和冠脉微血管疾病PPT课件教学讲义PPT课件.ppt

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1、血管痉挛和冠脉微血管疾病PPT课件CoronaryVasoconstrictionCoronaryperfusioncanbetransientlyorpersistentlyimpairedbycoronaryvasoconstrictionresultinginmyocardialischemia.Vasoconstrictionmayoccurinlargecoronaryarteriesandinthemicrocirculation.VasoconstrictionofEpicardialCoronar

2、yArteriesCoronaryvasomotionmodulatesresidualcoronaryflowreserve,resultinginavariableefforttolerancewhenstenosingplaqueshaveapreservedmuscularmediawhichcanvarytheresiduallumenPrevalenceofVariantAnginaPisa,London,Rome=1.0%ofadmissionsDiagnosedonlyafterweeks,mon

3、thsoryearsRome(1991-96):64casesaged19-75years60%hadnormalangiograms40%majorevents40%hadstenosis6%majoreventsPathogeneticsMechanismsofSpasmAlocalcoronaryhyper-responseHackett1986Hence:asmoothmusclepost-receptorialalterationMaseri1990Provocationbystimuliactin

4、gondifferentreceptors:ErgonovineHiggins1976MetacholineEndo1976DopamineCrea1986HystamineGinsburg1981-Kaski1986AcetylcholineYasue1986SerotoninMcFadden1991TreatmentofVariantAnginaReduceaspecificallysmoothmuscleconstrictorresponsebynitratesandcalcium-antagonistsS

5、ometimesveryhighdosesrequiredFrenneauxetal.AmJCardiol1988;62:832Lefroyetal.Coronaryarterydisease1992;3:745Pace-maker,implantabledefibrillatorMicrovascularConstrictionThissyndromeincludes60-70%ofwomen(about60%post-menopausaland40%pre-menopausal)butalso30-40%of

6、men.Itischaracterizedbyanginapectorisand‘normal’coronaryangiography.Itsincidencemayvaryfrom10%to50%ofpatientssubmittedtocoronaryarteriography.Thediagnosisofmyocardialischemiaisdifficultforanumberofreasons.Inspiteoftheabsenceofincreasedriskofinfarctionandcardi

7、acdeath,thesepatientsmaybecrippledbypain.SyndromeX:PROBLEMTheinconsistentresponsetonitratesandanti-anginaldrugsandtononconventionalanti-ischemictherapy,indicatestheneedforresearchonmultiple,potentialcausesofcoronaryvasculardysfunction,inordertodeveloprational

8、formsoftherapy.SuspicionofMicrovascularAnginaLong-lasting(>10-30’),poorlyresponsivetoGTNTransientECGchangesorpositivemyocardialscintigraphyCardiacoriginofpainNoevidenceofleftventriculard