冠心病英文版.pptx

Atherosclerosis&Coronary heart diseases,Zhengzhou University,First affiliated HospitalDept.of CardiologyHaiyu Li,M.D.,第一页，共一百一十五页。,Cardiovascular Diseases,第二页，共一百一十五页。,Atherosclerosis,第三页，共一百一十五页。,leading cause of death and disabilityCommon location:Coronary circulation:Proximal left anterior descending coronary artery(LAD)Proximal portion of renal arteriesExtracranial circulation to the brainCarotid bifurcation,Atherosclerosis,第四页，共一百一十五页。,Coronary heart disease,atherosclerosis,Coronary stenosis,coronary spasm,Myocardial ischemia,anoxaemia,Coronary heart disease,CHDIschemic heart disease,第五页，共一百一十五页。,AtherosclerosisStable angina pectoris(SAP)Acute coronary syndromeUnstable angina(UAP)and non-STEMI(UA/NSTEMI)ST elevation myocardial infarction(STEMI),第六页，共一百一十五页。,Three fundamental biological processes of atherosclerosis,Accumulation of intimal cells:smooth muscle cells MacrophagesT-lymphocytesProliferated connective tissue matrix:collagenelastic fibersproteoglycans3.Accumulation of lipid:cholesterol estersfree cholesterol,第七页，共一百一十五页。,Hypothesis of lipoprotein infiltrationAggregation of platelets and thrombosisClonal theory the response-to-injury hypothesis,Atherosclerosis-Hypothesis,第八页，共一百一十五页。,Response-to-injury,Atherosclerosis:hypothesis,High blood pressure,bacterium,virus,toxin,ox-LDL,immune factor,vasoactive substanceendothelium damage and dysfunction(vasoactive substance,adhesion and aggregation of monocytes-foam cell,platelets)Lipidosis,growth factor,proliferation of smooth mucle cells,collagen,lipolytic enzyme,atherosclerosis,第九页，共一百一十五页。,Pathology and pathophysiologyFatty steakFibrous plaqueComplicated lesion,Atherosclerosis,第十页，共一百一十五页。,Initiation of Atherosclerosis,Fatty steak formation,第十一页，共一百一十五页。,Initiation of Atherosclerosis,Fatty steak formation Lipoprotein oxidation Nonenzymatic glycationLeukocyte recruitmentFoam cell formation,第十二页，共一百一十五页。,Atheroma evolution:fibrous plaque,Atheroma evolution and complications,Vascular remodeling:compensatory enlargement,第十三页，共一百一十五页。,Atheroma evolution:Involvement of arterial smooth-muscle cellsBlood coagulationmicrovessels,Atheroma evolution and complications,第十四页，共一百一十五页。,Complicated lesion:thrombosis,Atheroma evolution and complications,第十五页，共一百一十五页。,Atheroma evolution and complications,Vulnerable plaque:Thin fibrous capRelatively large lipid coreHigh content of macrophages,Inflammatory mediators,第十六页，共一百一十五页。,Intravascular ultrasound,第十七页，共一百一十五页。,Classicification of atherosclerotic lesion using IVUS,第十八页，共一百一十五页。,Clinicl stages and classificationAbsence of symptom or stage of delitescenceischemianecrosis(target organ)fibrosis,Atherosclerosis,第十九页，共一百一十五页。,General manifestationAortic atherosclerosisCoronary artery atherosclerosisCerebral atherosclerosisMesenteric atherosclerosisPeripheral artery atherosclerosis,Atherosclerosis,clinical manifestation,第二十页，共一百一十五页。,laboratory examinationLack of sensitive and specific methods for early diagnosisDyslipidemia：X-ray：DSA show severity of stenosisDoppler ultrasound:blood flowradionuclide：detection of ischemiaEchocardiogram：CHDECG and stress test:CHDNew techniques:intravascular ultrasound,angioscopeCT,MRI,Atherosclerosis,第二十一页，共一百一十五页。,Risk factors and prevention,1.Lifestyle modification2.Lipid disorders(Dyslipidemia):cholesterol screening in all 20yrsElevated:cholesterol(Tc and LDL-c),TG,ApoB/ApoA,Lp(a),Low:HDL-c LDL lowering by HMG-CoA reductase(statins):cardiovascular events 30%，risk of MI 62%3.Hypertension：4.DM,Metabolic syndrome or insulin resistance syndrome:BP,BMI,TG,serum insulin HDL-c,第二十二页，共一百一十五页。,Diabetes mellitus(DM):RR 1.9 for male,3.3 for female more diffuse lesion.CAD equivalent 75-80%cause of death in adult DM are vascular diseases:CAD,cerebrovascular disease,or peripheral vascular disease,Risk factors and prevention,第二十三页，共一百一十五页。,7 years incidence of death/non-fatal MI(East West Study),*These patients had no history of myocardial infarction Haffner SM,et al.N Engl J Med.1998;339:229234.,0,5,10,15,20,25,30,35,40,45,50,Events of MI in 7 years,No history of MI OMI No history of MI*OMI,non-diabetics diabetics n=1373n=1059,P 0.001,P 0.001,4%,19%,20%,45%,DM:CAD equivalent,第二十四页，共一百一十五页。,5.Cigarette smoking：more thrombogenic6.Family history：genetic factor7.Aging：40yrs adults，4/5 fatal myocardial infarction occured in patiens 65 yrs8.Male gender/postmenopausal state：male:female=2：1,man develop CHD 10-15 yrs earlier than woman9.alcohol10.Others:diet,homocysteine,hemostatic factors inflammation/infection,Risk factors and prevention,第二十五页，共一百一十五页。,Drug therapy：anti-platelet：aspirin,clopidogrel,GPIIb/IIIa inhitibor,Dipyridamole,cilostazolLipid-lowering,Risk factors and prevention,第二十六页，共一百一十五页。,HMG-CoA reductase inhibitorsstatins Atorvastatin,Fluvastatin,Lovastatin,Pravastatin,Simvastatin,Cerivastatin,Rosuvastatin：*elevation of aminopherase,rhabdomyolysis2.Bile acid-binding Resins cholestyramine，colestipol3.Nicotinic Acid：4.Fibric acid derivativesfibrates Gemifibrozil,clofibrate,Fenofibrate5.Cholestero