不穩(wěn)定性心絞痛心肌梗死課件

不穩(wěn)定性心絞痛21.03.2020不穩(wěn)定性心絞痛1不穩(wěn)定性心絞痛定義不穩(wěn)定性心絞痛(unstableanginaUA)是介于慢性穩(wěn)定性心絞痛與急性心肌梗死之間的一種狀態(tài),發(fā)病率高,病情變化快,可逆轉(zhuǎn)為穩(wěn)定性心絞痛,也可能迅速發(fā)展為急性心肌梗死,甚至發(fā)生猝死。近年來(lái),已成為國(guó)內(nèi)、外學(xué)者廣泛深入研究的熱點(diǎn)。21.03.2020不穩(wěn)定性心絞痛定義2不穩(wěn)定性心絞痛心肌梗死課件3不穩(wěn)定斑塊有活躍的炎癥細(xì)胞、纖維帽薄,伴大的脂質(zhì)核心,斑塊有裂口,有內(nèi)皮細(xì)胞脫落、內(nèi)皮的損傷,使黏附的血小板變形、伸出偽足與周圍血小板聚集,形成白血栓。使血管腔嚴(yán)重狹窄并影響血流發(fā)生心絞痛。21.03.2020不穩(wěn)定斑塊4不穩(wěn)定斑塊不穩(wěn)定斑塊的破裂,使纖維蛋白原轉(zhuǎn)變?yōu)槔w維蛋白,并網(wǎng)絡(luò)大量紅細(xì)胞形成紅色血栓。因此,動(dòng)脈內(nèi)血栓迅速發(fā)展成阻塞性血栓,發(fā)生急性心肌梗死。21.03.2020不穩(wěn)定斑塊5血小板粘附和激活血流中的正常血小板血小板粘附于受損內(nèi)膜并激活血小板聚集內(nèi)皮細(xì)胞內(nèi)皮下間陳血小板血栓21.03.2020粘附在內(nèi)皮下間隙的血小板血小板粘附和激活6不穩(wěn)定性心絞痛心肌梗死課件7不穩(wěn)定性心絞痛心肌梗死課件8惡化勞力型心絞痛指穩(wěn)定勞力型心絞痛患者短期心絞痛發(fā)作頻率突然增加,疼痛程度加重,持續(xù)時(shí)間延長(zhǎng),一般發(fā)作時(shí)伴有所T段顯著壓低,經(jīng)內(nèi)科治療90%患者趨于穩(wěn)定,但少部分患者可發(fā)展為心肌梗死。21.03.2020惡化勞力型心絞痛9胸痛時(shí)描記EcG例1.邢XX男55胸痛發(fā)作時(shí)ST段明顯壓低豐胸痛時(shí)描記EcG10不穩(wěn)定性心絞痛心肌梗死課件11不穩(wěn)定性心絞痛心肌梗死課件12不穩(wěn)定性心絞痛心肌梗死課件13不穩(wěn)定性心絞痛心肌梗死課件14不穩(wěn)定性心絞痛心肌梗死課件15不穩(wěn)定性心絞痛心肌梗死課件16不穩(wěn)定性心絞痛心肌梗死課件17不穩(wěn)定性心絞痛心肌梗死課件18不穩(wěn)定性心絞痛心肌梗死課件19不穩(wěn)定性心絞痛心肌梗死課件20不穩(wěn)定性心絞痛心肌梗死課件21不穩(wěn)定性心絞痛心肌梗死課件22不穩(wěn)定性心絞痛心肌梗死課件23不穩(wěn)定性心絞痛心肌梗死課件24不穩(wěn)定性心絞痛心肌梗死課件25不穩(wěn)定性心絞痛心肌梗死課件26不穩(wěn)定性心絞痛心肌梗死課件27不穩(wěn)定性心絞痛心肌梗死課件28不穩(wěn)定性心絞痛心肌梗死課件29不穩(wěn)定性心絞痛心肌梗死課件30不穩(wěn)定性心絞痛心肌梗死課件31不穩(wěn)定性心絞痛心肌梗死課件32不穩(wěn)定性心絞痛心肌梗死課件33不穩(wěn)定性心絞痛心肌梗死課件34不穩(wěn)定性心絞痛心肌梗死課件35不穩(wěn)定性心絞痛心肌梗死課件36不穩(wěn)定性心絞痛心肌梗死課件37不穩(wěn)定性心絞痛心肌梗死課件38不穩(wěn)定性心絞痛心肌梗死課件39不穩(wěn)定性心絞痛心肌梗死課件40不穩(wěn)定性心絞痛心肌梗死課件41不穩(wěn)定性心絞痛心肌梗死課件42不穩(wěn)定性心絞痛心肌梗死課件43不穩(wěn)定性心絞痛心肌梗死課件44不穩(wěn)定性心絞痛心肌梗死課件45不穩(wěn)定性心絞痛心肌梗死課件46不穩(wěn)定性心絞痛心肌梗死課件47不穩(wěn)定性心絞痛心肌梗死課件48不穩(wěn)定性心絞痛心肌梗死課件49不穩(wěn)定性心絞痛心肌梗死課件50不穩(wěn)定性心絞痛心肌梗死課件51不穩(wěn)定性心絞痛心肌梗死課件52不穩(wěn)定性心絞痛心肌梗死課件53不穩(wěn)定性心絞痛心肌梗死課件54不穩(wěn)定性心絞痛心肌梗死課件55不穩(wěn)定性心絞痛心肌梗死課件56不穩(wěn)定性心絞痛心肌梗死課件57不穩(wěn)定性心絞痛心肌梗死課件58不穩(wěn)定性心絞痛心肌梗死課件59不穩(wěn)定性心絞痛心肌梗死課件60不穩(wěn)定性心絞痛心肌梗死課件61不穩(wěn)定性心絞痛心肌梗死課件62不穩(wěn)定性心絞痛心肌梗死課件63不穩(wěn)定性心絞痛心肌梗死課件64不穩(wěn)定性心絞痛心肌梗死課件65不穩(wěn)定性心絞痛心肌梗死課件66不穩(wěn)定性心絞痛心肌梗死課件67不穩(wěn)定性心絞痛心肌梗死課件68不穩(wěn)定性心絞痛心肌梗死課件69不穩(wěn)定性心絞痛心肌梗死課件70不穩(wěn)定性心絞痛心肌梗死課件71不穩(wěn)定性心絞痛心肌梗死課件72不穩(wěn)定性心絞痛心肌梗死課件73不穩(wěn)定性心絞痛心