醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS課件

1、Coronary Heart DiseaseBian Bo, Dong ShaozhuangCardiovascular CenterTianjin Medical University General Hospital醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS1Coronary Heart DiseaseBian Bo,No.1 KillerWorldChinaUSA醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASNo.1 KillerWorld醫(yī)學(xué)傳媒cardiologyIn different countries, 25-45% death are caused by cardiovascul

2、ar 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.醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASIn different countries, 25-45%ChinaIn China, 1 year, 10 million new CHD patients.In China, per 15 seconds 1 people w

3、ill die because of CVD.In China, 1 year 2.6 million people will die because of CVD. 醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASChinaIn China, 1 year, 10 millUSA1995，USA, 960,000 die because of CVD, 42% of total mortality，No.1 cause in male45y, and in female65yTotal CVD patients in USA ,58 million，20% of total population醫(yī)

4、學(xué)傳媒cardiology英文教學(xué)1ASUSA1995，USA, 960,000 die becauCauses of CVDmajor causeatherosclerosis (AS)醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASCauses of CVDmajor cause醫(yī)學(xué)傳媒cOther CausesInflammation-Kawasaki syndromeEmboli-young male, dehydration Spasm-Prinzmetals anginaInjury-trauma醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASOther CausesInflammation-

5、Kaw AtherosclerosisA kind of clinical vascular disease醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS8 AtherosclerosisA kind of cliatherosclerosisCerebrovascular diseaseCoronary artery diseasePeripheral artery disease 醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASatherosclerosisCerebrovascularAtherosclerosisAtherosclerosis is an ongoing process affe

6、cting mainly large- and medium-sized arteries; it can begin in childhood and progress throughout a persons lifetime.醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASAtherosclerosisAtherosclerosisAtherosclerosisUnstable atherosclerotic plaques may rupture, leading to the formation of a platelet-rich thrombus that partially or c

7、ompletely occludes the artery and causes acute ischemic symptoms.醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASAtherosclerosisUnstable athero醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASprogressiveanginaPlaque ruptureUnstableanginaAcuteMIstableanginaPathophysiology of CAD醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASprogressivePlaque UnstableAcutWhat

8、Are the Results of Atherosclerosis? Results:silenceischemia-angina pectoris, TIA, claudication .necrosis-MI, stroke.fibrosis-ischemia cardiomyopathy/nephropathy/dementia.醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASWhat Are the Results of Athero Risks Factors醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS15 Risks Factors醫(yī)學(xué)傳媒cardiology英 Risks of Ath

9、erosclerosisAgeFamily historyGenderCigarette smokingLow-density lipoprotein cholesterol (dyslipidemia)HypertensionDiabetes mellitusEstrogen deficiencyInactivityObesityothers: A-type character, high TG, high homocysterine.醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS Risks of AtherosclerosisAge醫(yī)Unmodifiable risksModifiable

10、risks 醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASUnmodifiable risks醫(yī)學(xué)傳媒cardiolo2.1 Unmodifiable risksAgeFamily historyGender醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS2.1 Unmodifiable risksAge醫(yī)學(xué)傳媒cAge - unmodifiable risks(1)Chances of a person having atherosclerosis are directly proportional to age. peak incidence of clinical manifestation, m

11、ale ,50-60y; female, 60-70y醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS19Age - unmodifiable risks(1)ChaHeredity or Family History unmodifiable risks(2)chances of developing atherosclerosis are much higher if you have a direct family member (parent or sibling) who has atherosclerosis, especially before 50y. 醫(yī)學(xué)傳媒cardiology英

12、文教學(xué)1ASHeredity or Family History unmHeredity or Family History -immigration researchNi-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 醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASHeredity or

13、Family History -imGender - unmodifiable risks(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. 醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASGender - unmodifiable risks(3)Gender (2)men are more often affected than woman by

14、 an overall ration of 4:170y, the ration 1:1醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASGender (2)men are more often a2.2 Modifiable risks Low-density lipoprotein cholesterol (dyslipidemia)Cigarette smokingHypertensionDiabetes mellitusEstrogen deficiencyInactivityObesity醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS2.2 Modifiable risks Low-densiC

15、holesterol levels lipoproteinLDL: low-density lipoproteinHDL: high-density lipoproteinCM: chylomicronVLDL: very-low-density lipoprotein醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASCholesterol levels lipoproteLDL: carry cholesterol to arteriesHDL: carry cholesterol back to livermost dangerous: lipoprotein(a), samll and dens

16、ity LDLin CAD patients, alwalys high LDL-c, low HDL-c 醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASLDL: carry cholesterol to arte各組兔主動脈動脈粥樣硬化病變情況：上條和中條：高膽固醇組； 下條：對照組醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS各組兔主動脈動脈粥樣硬化病變情況：醫(yī)學(xué)傳媒cardiologSmoking- Modifiable risks(2)Research demonstrates that smoking causes transient and reversible prothrombotic

17、 increases in fibrinogen levels and platelet adhesion, increased blood carboxyhemoglobin levels, reduced high-density lipoprotein (HDL) cholesterol, and coronary artery vasoconstriction. 醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASSmoking- Modifiable risks(2)ReSmokingsmokers are twice as likely to develop atherosclerosis

18、and coronary artery disease as are non-smokers. 醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASSmokingsmokers are twice as li 收縮壓和脈壓對冠心病危險性的聯(lián)合影響 The Framingham Hear Study；入選者年齡50歲 Stanley S, et al. Circulation 1999;100:354304050607080901001100.51.01.52.02.53.0血壓(mm Hg)冠心病危險率SBP 170 mm Hg(P=.0487)SBP 150 mm Hg(P=.0194)SBP 130

19、 mm Hg(P=.0086)SBP 110 mm Hg(P=.2076)Hypertension-Modifiable risks(3)醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS30 收縮壓和脈壓對冠 急診入院 擇期患者29%22%31%3%15%34%22%30%4%10%NGTIFG（6.1mmol/L）IGTKnown DMNew DMThe Euro Heart Survey on diabetes and the heart，European Heart Journal (2004) 25, 18801890Diabetes mellitus -Modifiable risks(4

20、) 醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS 急診入院 擇期患者29%22%31%3%15 Treatment of AS醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS32 Treatment of AS醫(yī)學(xué)傳媒cardiolog Treatment of ASeducationlife style changedrugsintervention or surgery醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS Treatment of ASeducation醫(yī)學(xué)傳3.1 Educationmake patients know:what is AS, what are risks, what is

21、 results of AS, How to control AS, What they can do for themselves醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS3.1 Educationmake patients kno3.2 Life Style Changebody weight control:less food, more exercise; more vegetable, less fat 管住嘴，邁開腿BMI=24 moderately intense physical activity , at least 30 minutes every time, at lea

22、st 3 times a week.醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS3.2 Life Style Changebody weig3.2 Life Style Changeno smokinggood emotionregular life style醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS3.2 Life Style Changeno smokin3.3 Drugsanti-platelet-prevent thrombosisstatins-decrease LDL, stabilize plaque,anti-inflammation, improve endothelia f

23、unction, anti-oxygen stress.dilate artery-nitrate, CCB,ACEIcontrol risks-hypertension, DM醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS3.3 Drugsanti-platelet-preve3.4 Intervention or Surgeryto treat severe stenosis (70%)PTCA （percutaneous transluminal coronary angioplasty ）StentCABG（coronary artery bypass grafting）醫(yī)學(xué)傳媒cardi

24、ology英文教學(xué)1AS3.4 Intervention or Surgeryto CAD or CHDanatomy of heart and coronary arteries醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS39CAD or CHDanatomy of heart an醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS醫(yī)學(xué)傳媒cardiology英文教學(xué)1AS醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASDefinition Coronary Artery Disea

25、se means coronary artery narrowing or obstruction that leads to myocardial ischemia or necrosis, often caused by atherosclerosis. 醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASDefinition Coronary Artery DiDefinition Coronary Heart Disease means myocardial ischemia, necrosis,arrhythmia, function abnormality, structural and e

26、lectrical remodeling caused by coronary artery narrowing or obstruction.醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASDefinition Coronary Heart DiseCAD: coronary artery disease causeCHD: coronary heart disease result醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASCAD: coronary artery disease醫(yī)ClassificationCHD: 5 types latent or silence angina pectorismyocardial infarctionheart failure and arrhythmiacardiac sudden death key point: clinical presentation醫(yī)學(xué)傳媒cardiology英文教學(xué)1ASClassificationCHD: 5 types 醫(yī)Classificationnew trend of classificationstable: stable angina pectorisunstable: ACSunstable ang