医学传媒cardiology英文教学1ASppt课件

CoronaryHeartDiseaseBianBo,DongShaozhuangCardiovascularCenterTianjinMedicalUniversityGeneralHospital医学传媒cardiology英文教学1AS1Coronary Heart DiseaseBian Bo,No.1 KillerWorldChinaUSA医学传媒cardiology英文教学1ASNo.1 KillerWorld医学传媒cardiology2In different countries,25-45%death are caused by cardiovascular disease.Mortality of cardiovascular disease(per 100,000）：）：male,highest in Russia，1310，lowest in Japan,201；female,highest in Russia,581，lowest in France,84.医学传媒cardiology英文教学1ASIn different countries,25-45%3ChinaInChina,1year,10millionnewCHDpatients.InChina,per15seconds1peoplewilldiebecauseofCVD.InChina,1year2.6millionpeoplewilldiebecauseofCVD.医学传媒cardiology英文教学1ASChinaIn China,1 year,10 mill4USA1995，USA,960,000diebecauseofCVD,42%oftotalmortality，No.1causeinmale45y,andinfemale65yTotalCVDpatientsinUSA,58million，20%oftotalpopulation医学传媒cardiology英文教学1ASUSA1995，USA,960,000 die becau5CausesofCVDmajorcauseatherosclerosis(AS)医学传媒cardiology英文教学1ASCauses of CVDmajor cause医学传媒c6Other CausesInflammation-Kawasaki syndromeEmboli-young male,dehydration Spasm-Prinzmetals anginaInjury-trauma医学传媒cardiology英文教学1ASOther CausesInflammation-Kaw7AtherosclerosisAkindofclinicalvasculardisease医学传媒cardiology英文教学1AS8 AtherosclerosisA kind of cliatherosclerosisCerebrovasculardiseaseCoronaryarterydiseasePeripheralarterydisease医学传媒cardiology英文教学1ASatherosclerosisCerebrovascular9AtherosclerosisAtherosclerosisisanongoingprocessaffectingmainlylarge-andmedium-sizedarteries;itcanbegininchildhoodandprogressthroughoutapersonslifetime.医学传媒cardiology英文教学1ASAtherosclerosisAtherosclerosis10AtherosclerosisUnstableatheroscleroticplaquesmayrupture,leadingtotheformationofaplatelet-richthrombusthatpartiallyorcompletelyoccludesthearteryandcausesacuteischemicsymptoms.医学传媒cardiology英文教学1ASAtherosclerosisUnstable athero11医学传媒cardiology英文教学1AS医学传媒cardiology英文教学1AS12progressiveanginaPlaque ruptureUnstableanginaAcuteMIstableanginaPathophysiology of CAD医学传媒cardiology英文教学1ASprogressivePlaque UnstableAcut13WhatAretheResultsofAtherosclerosis?Results:silenceischemia-anginapectoris,TIA,claudication.necrosis-MI,stroke.fibrosis-ischemiacardiomyopathy/nephropathy/dementia.医学传媒cardiology英文教学1ASWhat Are the Results of Athero14RisksFactors医学传媒cardiology英文教学1AS15 Risks Factors医学传媒cardiology英RisksofAtherosclerosisAgeFamilyhistoryGenderCigarettesmokingLow-densitylipoproteincholesterol(dyslipidemia)HypertensionDiabetesmellitusEstrogendeficiencyInactivityObesityothers:A-typecharacter,highTG,highhomocysterine.医学传媒cardiology英文教学1AS Risks of AtherosclerosisAge医16Unmodifiable risksModifiable risks 医学传媒cardiology英文教学1ASUnmodifiable risks医学传媒cardiolo172.1 Unmodifiable risksAgeFamily historyGender医学传媒cardiology英文教学1AS2.1 Unmodifiable risksAge医学传媒c18Age-unmodifiablerisks(1)Chances of a person having atherosclerosis are directly proportional to age.peak incidence of clinical manifestation,male,50-60y;female,60-70y医学传媒cardiology英文教学1AS19Age-unmodifiable risks(1)ChaHeredityorFamilyHistoryunmodifiablerisks(2)chances of developing atherosclerosis are much higher if you have a direct family member(parent or sibling)who has atherosclerosis,especially before 50y.医学传媒cardiology英文教学1ASHeredity or Family History unm20HeredityorFamilyHistory-immigrationresearchNi-Hon-San research：Japanese,living in Japan,CVD mortality lowest;living in Hawaii,middle;living in San Francisco,highest but still lower than American,only half of Americans 医学传媒cardiology英文教学1ASHeredity or Family History-im21Gender-unmodifiablerisks(3)Until middle age,it is much more likely to occur in men than in women.After age fifty,however,the difference between the sexes nearly diminished.医学传媒cardiology英文教学1ASGender-unmodifiable risks(3)22Gender(2)men are more often affected than woman by an overall ration of 4:170y,the ration 1:1医学传媒cardiology英文教学1ASGender(2)men are more often a232.2 Modifiable risks Low-densitylipoproteincholesterol(dyslipidemia)CigarettesmokingHypertensionDiabetesmellitusEstrogendeficiencyInactivityObesity医学传媒cardiology英文教学1AS2.2 Modifiable risks Low-densi24Cholesterol levels lipoproteinLDL:low-densitylipoproteinHDL:high-densitylipoproteinCM:chylomicronVLDL:very-low-densitylipoprotein医学传媒cardiology英文教学1ASCholesterol levels lipoprote25LDL:carrycholesteroltoarteriesHDL:carrycholesterolbacktolivermostdangerous:lipoprotein(a),samllanddensityLDLinCADpatients,alwalyshighLDL-c,lowHDL-c医学传媒cardiology英文教学1ASLDL:carry cholesterol to arte26各组兔主动脉动脉粥样硬化病变情况：各组兔主动脉动脉粥样硬化病变情况：上条和中条：高胆固醇组；上条和中条：高胆固醇组；下条：对照组下条：对照组医学传媒cardiology英文教学1AS各组兔主动脉动脉粥样硬化病变情况：医学传媒cardiolog27Smoking-Modifiablerisks(2)Research demonstrates that smoking causes transient and reversible prothrombotic increases in fibrinogen levels and platelet adhesion,increased blood carboxyhemoglobin levels,reduced high-density lipoprotein(HDL)cholesterol,and coronary artery vasoconstriction.医学传媒cardiology英文教学1ASSmoking-Modifiable risks(2)Re28Smokingsmokers are twice as likely to develop atherosclerosis and coronary artery disease as are non-smokers.医学传媒cardiology英文教学1ASSmokingsmokers are twice as li29 收缩压和脉压对冠心病危险性的联合影响收缩压和脉压对冠心病危险性的联合影响 TheFraminghamHearStudy；入选者年龄入选者年龄50岁岁 StanleyS,etal.Circulation1999;100:35430304040505060607070808090901001001101100.50.51.01.01.51.52.02.02.52.53.03.0血压(mmHg)(mmHg)冠心病危险率SBP170mmHgSBP170mmHg(P P=.0487)=.0487)SBP150mmHgSBP150mmHg(P P=.0194)=.0194)SBP130mmHgSBP130mmHg(P P=.0086)=.0086)SBP110mmHgSBP110mmHg(P P=.2076)=.2076)HypertensionHypertension-ModifiablerisksModifiablerisks(3)(3)医学传媒cardiology英文教学1AS30 收缩压和脉压对冠 急诊入院急诊入院 择期患者择期患者29%29%22%22%31%31%3%3%15%15%34%34%22%22%30%30%4%4%10%10%NGTNGTIFGIFG（6.1mmol/L6.1mmol/L）IGTIGTKnownKnownDMDMNewNewDMDMTheEuroHeartSurveyondiabetesandtheheartTheEuroHeartSurveyondiabetesandtheheart，EuropeanHeartJournal(2004)25,18801890EuropeanHeartJournal(2004)25,18801890Diabetesmellitus-Modifiablerisks(4)医学传媒cardiology英文教学1AS 急诊入院 择期患者29%22%31%3%1531TreatmentofAS医学传媒cardiology英文教学1AS32 Treatment of AS医学传媒cardiologTreatmentofASeducationlife style changedrugsintervention or surgery医学传媒cardiology英文教学1AS Treatment of ASeducation医学传333.1 Educationmakepatientsknow:whatisAS,whatarerisks,whatisresultsofAS,HowtocontrolAS,Whattheycandoforthemselves医学传媒cardiology英文教学1AS3.1 Educationmake patients kno343.2 Life Style Changebody weight control:less food,more exercise;more vegetable,less fat 管住嘴，管住嘴，迈开腿开腿BMI=24 moderately intense physical activity,at least 30 minutes every time,at least 3 times a week.医学传媒cardiology英文教学1AS3.2 Life Style Changebody weig353.2 Life Style Changenosmokinggoodemotionregularlifestyle医学传媒cardiology英文教学1AS3.2 Life Style Changeno smokin363.3 Drugsanti-platelet-preventthrombosisstatins-decreaseLDL,stabilizeplaque,anti-inflammation,improveendotheliafunction,anti-oxygenstress.dilateartery-nitrate,CCB,ACEIcontrolrisks-hypertension,DM医学传媒cardiology英文教学1AS3.3 Drugsanti-platelet-preve373.4 Intervention or Surgeryto treat severe stenosis(70%)PTCA（percutaneous transluminal coronary angioplasty）StentCABG（coronary artery bypass grafting）医学传媒cardiology英文教学1AS3.4 Intervention or Surgeryto 38CADorCHDanatomyofheartandcoronaryarteries医学传媒cardiology英文教学1AS39CAD or CHDanatomy of heart an医学传媒cardiology英文教学1AS医学传媒cardiology英文教学1AS40医学传媒cardiology英文教学1AS医学传媒cardiology英文教学1AS41医学传媒cardiology英文教学1AS医学传媒cardiology英文教学1AS42Definition CoronaryArteryDiseasemeanscoronaryarterynarrowingorobstructionthatleadstomyocardialischemiaornecrosis,oftencausedbyatherosclerosis.医学传媒cardiology英文教学1ASDefinition Coronary Artery Di43Definition CoronaryHeartDiseasemeansmyocardialischemia,necrosis,arrhythmia,functionabnormality,structuralandelectricalremodelingcausedbycoronaryarterynarrowingorobstruction.医学传媒cardiology英文教学1ASDefinition Coronary Heart Dise44CAD:coronaryarterydiseasecauseCHD:coronaryheartdiseaseresult医学传媒cardiology英文教学1ASCAD:coronary artery disease医45ClassificationCHD:5typeslatentorsilenceanginapectorismyocardialinfarctionheartfailureandarrhythmiacardiacsuddendeathkeypoint:clinicalpresentation医学传媒cardiology英文教学1ASClassificationCHD:5 types 医46Classificationnewtrendofclassification1.stable:stableanginapectoris2.unstable:ACSunstableanginapectorisST-elevatedAMInonST-elevatedAMIcardiacsuddendeathkeypoint:pathophysiology医学传媒cardiology英文教学1ASClassificationnew trend of cla47DefinitionACS:acutecoronarysyndromeACSincludeUAP,NSTEAMI,STEAMI,andsuddendeath.ACShasthesamepathophysiology,thatiscausedbysuddenlyruptureorerosionofatherosclerosisplaqueandleadingtoformationofthrombosis.Theresultsarefromcompleteorpartialocclusionofcoronaryarteries.医学传媒cardiology英文教学1ASDefinitionACS:acute coronary48PlaqueruptureandthrombosisPlaqueruptureandthrombosis完全闭塞完全闭塞纤溶并残存血栓纤溶并残存血栓疾病进展疾病进展富含脂富含脂质斑块质斑块斑块破裂斑块破裂AMIAMIUAPUAPNQMINQMI再闭塞再闭塞部分闭塞部分闭塞稳定心绞痛稳定心绞痛AdaptedfromFusterV.AdaptedfromFusterV.NEnglJMedNEnglJMed.1992;326:242-250,withpermission.1992;326:242-250,withpermission.医学传媒cardiology英文教学1ASPlaque rupture and thrombosis完49 howtotreatCHD?waitandseedetailinlessonofAPandAMI医学传媒cardiology英文教学1AS how to treat CHD?医学传媒cardio50attention:keypointsareinredcolor医学传媒cardiology英文教学1ASattention:key points are in r51