课件：医学传媒cardiology--英文教学1AS.ppt

Coronary Heart Disease,Bian Bo, Dong Shaozhuang Cardiovascular Center Tianjin Medical University General Hospital,2,,Company Logo,No.1 Killer,World China USA,3,,Company Logo,In 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.,4,,Company Logo,China,In China, 1 year, 10 million new CHD patients. In China, per 15 seconds 1 people will die because of CVD. In China, 1 year 2.6 million people will die because of CVD.,5,,Company Logo,USA,1995，USA, 960,000 die because of CVD, 42% of total mortality，No.1 cause in male45y, and in female65y Total CVD patients in USA ,58 million，20% of total population,6,,Company Logo,Causes of CVD,major cause atherosclerosis (AS),7,,Company Logo,Other Causes,Inflammation-Kawasaki syndrome Emboli-young male, dehydration Spasm-Prinzmetals angina Injury-trauma, Atherosclerosis,A kind of clinical vascular disease,9,,Company Logo,10,,Company Logo,Atherosclerosis,Atherosclerosis is an ongoing process affecting mainly large- and medium-sized arteries; it can begin in childhood and progress throughout a persons lifetime.,11,,Company Logo,Atherosclerosis,Unstable atherosclerotic plaques may rupture, leading to the formation of a platelet-rich thrombus that partially or completely occludes the artery and causes acute ischemic symptoms.,12,,Company Logo,13,,Company Logo,progressive angina,Plaque rupture,Unstable angina,Acute MI,stable angina,Pathophysiology of CAD,14,,Company Logo,What Are the Results of Atherosclerosis?,Results: silence ischemia-angina pectoris, TIA, claudication . necrosis-MI, stroke. fibrosis-ischemia cardiomyopathy/nephropathy/dementia., Risks Factors,16,,Company Logo, Risks of Atherosclerosis,Age Family history Gender Cigarette smoking Low-density lipoprotein cholesterol (dyslipidemia) Hypertension Diabetes mellitus Estrogen deficiency Inactivity Obesity others: A-type character, high TG, high homocysterine.,17,,Company Logo,Unmodifiable risks Modifiable risks,18,,Company Logo,2.1 Unmodifiable risks,Age Family history Gender,19,Age - unmodifiable risks(1),Chances of a person having atherosclerosis are directly proportional to age. peak incidence of clinical manifestation, male ,50-60y; female, 60-70y,20,,Company Logo,Heredity 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.,21,,Company Logo,Heredity or Family History -immigration research,Ni-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,22,,Company Logo,Gender - 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.,23,,Company Logo,Gender (2),men are more often affected than woman by an overall ration of 4:1 70y, the ration 1:1,24,,Company Logo,2.2 Modifiable risks,Low-density lipoprotein cholesterol (dyslipidemia) Cigarette smoking Hypertension Diabetes mellitus Estrogen deficiency Inactivity Obesity,25,,Company Logo,Cholesterol levels lipoprotein,LDL: low-density lipoprotein HDL: high-density lipoprotein CM: chylomicron VLDL: very-low-density lipoprotein,26,,Company Logo,LDL: carry cholesterol to arteries HDL: carry cholesterol back to liver most dangerous: lipoprotein(a), samll and density LDL in CAD patients, alwalys high LDL-c, low HDL-c,27,,Company Logo,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,28,,Company Logo,Smoking- Modifiable risks(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.,29,,Company Logo,Smoking,smokers are twice as likely to develop atherosclerosis and coronary artery disease as are non-smokers.,收缩压和脉压对冠心病危险性的联合影响 The Framingham Hear Study；入选者年龄50岁,Stanley S, et al. Circulation 1999;100:354,30,40,50,60,70,80,90,100,110,0.5,1.0,1.5,2.0,2.5,3.0,血压(mm Hg),冠 心 病 危 险 率,SBP 170 mm Hg (P=.0487),SBP 150 mm Hg (P=.0194),SBP 130 mm Hg (P=.0086),SBP 110 mm Hg (P=.2076),Hypertension-Modifiable risks(3),31,,Company Logo,29%,22%,31%,3%,15%,34%,22%,30%,4%,10%,NGT,IFG（6.1mmol/L）,IGT,Known DM,New DM,The Euro Heart Survey on diabetes and the heart，European Heart Journal (2004) 25, 18801890,Diabetes mellitus -Modifiable risks(4), Treatment of AS,33,,Company Logo, Treatment of AS,education life style change drugs intervention or surgery,34,,Company Logo,3.1 Education,make patients know: what is AS, what are risks, what is results of AS, How to control AS, What they can do for themselves,35,,Company Logo,3.2 Life Style Change,body weight control: less food, more exercise; more vegetable, less fat 管住嘴，迈开腿 BMI=24 moderately intense physical activity , at least 30 minutes every time, at least 3 times a week.,36,,Company Logo,3.2 Life Style Change,no smoking good emotion regular life style,37,,Company Logo,3.3 Drugs,anti-platelet-prevent thrombosis statins-decrease LDL, stabilize plaque, anti-inflammation, improve endothelia function, anti-oxygen stress. dilate artery-nitrate, CCB,ACEI control risks-hypertension, DM,38,,Company Logo,3.4 Intervention or Surgery,to treat severe stenosis (70%) PTCA （percutaneous transluminal coronary angioplasty ） Stent CABG（coronary artery bypass grafting）,CAD or CHD,anatomy of heart and coronary arteries,40,,Company Logo,41,,Company Logo,42,,Company Logo,43,,Company Logo,Definition,Coronary Artery Disease means coronary artery narrowing or obstruction that leads to myocardial ischemia or necrosis, often caused by atherosclerosis.,44,,Company Logo,Definition,Coronary Heart Disease means myocardial ischemia, necrosis,arrhythmia, function abnormality, structural and electrical remodeling caused by coronary artery narrowing or obstruction.,45,,Company Logo,CAD: coronary artery disease cause CHD: coronary heart disease result,46,,Company Logo,Classification,CHD: 5 types latent or silence angina pectoris myocardial infarction heart failure and arrhythmia cardiac sudden death key point: clinical presentation,47,,Company Logo,Classification,new trend of classification stable: stable angina pectoris unstable: ACS unstable angina pectoris ST-elevated AMI non ST-elevated AMI cardiac sudden death key point: pathophysiology,48,,Company Logo,Definition,ACS: acute coronary syndrome ACS include UAP,NSTEAMI,STEAMI,and sudden death. ACS has the same pathophysiology,that is caused by suddenly r