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CoronaryHeartDiseaseBianBo,DongShaozhuangCardiovascularCenterTianjinMedicalUniversityGeneralHospital医学传媒car

diology英文教学1AS1No.1Killer•World•China•USA医学传媒cardiology英文教学1AS•Indifferentcountries,25-45%deatharecausedbycardiovasculardisease.•Mortalit

yofcardiovasculardisease(per100,000）：male,highestinRussia，1310，lowestinJapan,201；female,highestinRussia,5

81，lowestinFrance,84.医学传媒cardiology英文教学1ASChina•InChina,1year,10millionnewCHDpatients.•InChina,per15seconds

1peoplewilldiebecauseofCVD.•InChina,1year2.6millionpeoplewilldiebecauseofCVD.医学传媒cardiology英文教学1ASUSA•1995，USA,960,000diebecauseofC

VD,42%oftotalmortality，No.1causeinmale>45y,andinfemale>65y•TotalCVDpatientsinUSA,58million，20%oftotalpopulation医学传媒cardiology英文教学1ASCausesofCVD•

majorcauseatherosclerosis(AS)医学传媒cardiology英文教学1ASOtherCauses•Inflammation---Kawasakisyndrome•Emboli-----------youngmale,dehydration•Spasm-

----------Prinzmetal'sangina•Injury-------------trauma医学传媒cardiology英文教学1ASⅠAtherosclerosisAkindofclinicalvasculardisease医学传媒cardiolo

gy英文教学1AS8atherosclerosisCerebrovasculardiseaseCoronaryarterydiseasePeripheralarterydisease医学传媒cardiology英文教学1

ASAtherosclerosis•Atherosclerosisisanongoingprocessaffectingmainlylarge-andmedium-sizedarteries;itcanbegin

inchildhoodandprogressthroughoutaperson’slifetime.医学传媒cardiology英文教学1ASAtherosclerosis•Unstableatheroscleroticplaquesmayrupture

,leadingtotheformationofaplatelet-richthrombusthatpartiallyorcompletelyoccludesthearteryandcausesacuteischemicsympto

ms.医学传媒cardiology英文教学1AS医学传媒cardiology英文教学1ASprogressiveanginaPlaqueruptureUnstableanginaAcuteMIstableanginaPathophysiolo

gyofCAD医学传媒cardiology英文教学1ASWhatAretheResultsofAtherosclerosis?Results:•silence•ischemia---anginapectoris,TIA,

claudication...•necrosis---MI,stroke...•fibrosis---ischemiacardiomyopathy/nephropathy/dementia...医学传媒car

diology英文教学1ASⅡRisksFactors医学传媒cardiology英文教学1AS15ⅡRisksofAtherosclerosis•Age•Familyhistory•Gender•Cigarettesmoking•Low-densitylipoprot

eincholesterol(dyslipidemia)•Hypertension•Diabetesmellitus•Estrogendeficiency•Inactivity•Obesity•others:A-typecharacter,highTG,highh

omocysterine...医学传媒cardiology英文教学1AS•Unmodifiablerisks•Modifiablerisks医学传媒cardiology英文教学1AS2.1Unmodifiablerisks•Age•Familyhistor

y•Gender医学传媒cardiology英文教学1ASAge-unmodifiablerisks(1)•Chancesofapersonhavingatherosclerosisaredirectlyproportionaltoag

e.•peakincidenceofclinicalmanifestation,male,50-60y;female,60-70y医学传媒cardiology英文教学1AS19HeredityorFamilyHistoryunmodifiablerisks(2)•chancesofdevelop

ingatherosclerosisaremuchhigherifyouhaveadirectfamilymember(parentorsibling)whohasatherosclerosis,especiallybefore50y.医学传媒cardiology英文

教学1ASHeredityorFamilyHistory-immigrationresearch•Ni-Hon-Sanresearch：Japanese,livinginJapan,CVDmortalitylowest;livinginHawaii,middle;

livinginSanFrancisco,highestbutstilllowerthanAmerican,onlyhalfofAmerican's医学传媒cardiology英文教学1ASGender-unmodifiablerisks(3)•Untilmiddleage,itis

muchmorelikelytooccurinmenthaninwomen.Afteragefifty,however,thedifferencebetweenthesexesnearlydiminished.医学传媒cardiology英文教

学1ASGender(2)•menaremoreoftenaffectedthanwomanbyanoverallrationof4:1•<40y,theration8:1•>70y,theration1:1医学传媒cardiology英文教学1AS2.2Modifiabler

isks•Low-densitylipoproteincholesterol(dyslipidemia)•Cigarettesmoking•Hypertension•Diabetesmellitus•Estrogendeficiency•Inactivity•Obesity医学传媒cardi

ology英文教学1ASCholesterollevels——lipoprotein•LDL:low-densitylipoprotein•HDL:high-densitylipoprotein•CM

:chylomicron•VLDL:very-low-densitylipoprotein医学传媒cardiology英文教学1AS•LDL:carrycholesteroltoarteries•HDL:carrycholesterolbacktoliver•mostdangerous

:lipoprotein(a),samllanddensityLDL•inCADpatients,alwalyshighLDL-c,lowHDL-c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：上条和中条：高胆固醇组；下条：对照组

医学传媒cardiology英文教学1ASSmoking-Modifiablerisks(2)•Researchdemonstratesthatsmokingcausestransientandreversibleprothrombot

icincreasesinfibrinogenlevelsandplateletadhesion,increasedbloodcarboxyhemoglobinlevels,reducedhigh-densityl

ipoprotein(HDL)cholesterol,andcoronaryarteryvasoconstriction.医学传媒cardiology英文教学1ASSmoking•smokersaretwiceas

likelytodevelopatherosclerosisandcoronaryarterydiseaseasarenon-smokers.医学传媒cardiology英文教学1AS收缩压和脉压对冠心病危险性的联合影响TheFraminghamHear

Study；入选者年龄>50岁StanleyS,etal.Circulation1999;100:354304050607080901001100.51.01.52.02.53.0血压(mmHg)冠心病危险率SBP170mmHg(P

=.0487)SBP150mmHg(P=.0194)SBP130mmHg(P=.0086)SBP110mmHg(P=.2076)Hypertension-Modifiablerisks(3)医学传媒cardiology英文教学1AS

30急诊入院择期患者29%22%31%3%15%34%22%30%4%10%NGTIFG（6.1mmol/L）IGTKnownDMNewDMTheEuroHeartSurveyondiabetesandtheheart，EuropeanHeartJournal(20

04)25,1880–1890Diabetesmellitus-Modifiablerisks(4)医学传媒cardiology英文教学1ASⅢTreatmentofAS医学传媒cardiology英文教学1AS32ⅢT

reatmentofAS•education•lifestylechange•drugs•interventionorsurgery医学传媒cardiology英文教学1AS3.1Education•makepatientsknow:whatisAS,

whatarerisks,whatisresultsofAS,HowtocontrolAS,Whattheycandoforthemselves医学传媒cardiology英文教学1AS3.2LifeStyleChange•bo

dyweightcontrol:•lessfood,moreexercise;•morevegetable,lessfat•管住嘴，迈开腿•BMI=24•moderatelyintensephysicala

ctivity,atleast30minuteseverytime,atleast3timesaweek.医学传媒cardiology英文教学1AS3.2LifeStyleChange•nosmoking•goodemotion•regularlifestyle医学传媒car

diology英文教学1AS3.3Drugs•anti-platelet---preventthrombosis•statins---decreaseLDL,stabilizeplaque,anti-inflamm

ation,improveendotheliafunction,anti-oxygenstress...•dilateartery---nitrate,CCB,ACEI•controlrisks---hypertension,DM医学传媒cardiology英文教学1AS3.4Interven

tionorSurgery•totreatseverestenosis(>70%)•PTCA（percutaneoustransluminalcoronaryangioplasty）•Stent•CABG（corona

ryarterybypassgrafting）医学传媒cardiology英文教学1ASCADorCHDanatomyofheartandcoronaryarteries医学传媒cardiology英文教学1AS39医学传媒cardiology英文教学1AS医学传媒cardiology英文

教学1AS医学传媒cardiology英文教学1ASDefinition•CoronaryArteryDiseasemeanscoronaryarterynarrowingorobstructionthat

leadstomyocardialischemiaornecrosis,oftencausedbyatherosclerosis.医学传媒cardiology英文教学1ASDefinition•CoronaryHea

rtDiseasemeansmyocardialischemia,necrosis,arrhythmia,functionabnormality,structuralandelectricalremodelingcausedbycoronaryarterynarrowingorobstruc

tion.医学传媒cardiology英文教学1AS•CAD:coronaryarterydiseasecause•CHD:coronaryheartdiseaseresult医学传媒cardiology英文教学1ASClassificationCHD:5types•

latentorsilence•anginapectoris•myocardialinfarction•heartfailureandarrhythmia•cardiacsuddendeathkeypoint:clinicalpresent

ation医学传媒cardiology英文教学1ASClassificationnewtrendofclassification1.stable:stableanginapectoris2.unstable:ACS•unstableanginapectoris•ST-elevatedAM

I•nonST-elevatedAMI•cardiacsuddendeathkeypoint:pathophysiology医学传媒cardiology英文教学1ASDefinitionACS:acutecoronarysyndrome•ACSincludeUAP,NSTEAMI,STEAM

I,andsuddendeath.•ACShasthesamepathophysiology,thatiscausedbysuddenlyruptureorerosionofatherosclerosisplaqueandleadi

ngtoformationofthrombosis.Theresultsarefromcompleteorpartialocclusionofcoronaryarteries.医学传媒cardiology英文教学1ASPlaqueruptureandthrombosis完全闭塞纤

溶并残存血栓疾病进展富含脂质斑块斑块破裂AMIUAPNQMI再闭塞部分闭塞稳定心绞痛AdaptedfromFusterV.NEnglJMed.1992;326:242-250,withpermission.医学传媒cardiology英文教学1AShowtotreatCHD?waita

ndseedetailinlessonofAPandAMI医学传媒cardiology英文教学1AS•attention:keypointsareinredcolor医学传媒cardiology英文教学1AS