慢性稳定性心绞痛的治疗ppt课件

1、Treatment of Chronic Stable AnginaMedicalRevascularizationPCIACBGWhite HD. Am J Cardiol 2019; 80:2B-10B.Schafer A. J Clin Invest 1986; 78:73-79.DeJong MJ, et al. Critical Care Nursing Clin of N Am 2019; 11:355-371. Moser M, et al. J Cardiovasc Pharmacol 2019;41:586-592.Phillips DR, Scarborough RM. A

2、m J Cardiol 2019;80(4A):11B-20B. GP IIb-IIIa inhibitors displace fibrinogen in existing thrombi to disaggregate thrombus and prevent further platelet cross-linking and thrombosis GP IIb-IIIa inhibitors prevent platelet activation by blocking GP IIb-IIa (outside-in signaling)High-dose heparin stimula

3、tes PAF which activates plateletsPHYSICIANS HEALTH STUDYA randomized, double-blind, placebo controlled trial designed to test the effects of low-dose aspirin and beta-carotene in the primary prevention of CVD and cancer among 22,071 US male physicians, aged 40 to 84 at baseline in 1982. Baseline blo

4、od specimens were collected and frozen for later analyses from 14,916 participants.Using a 2x2 factorial design:325 mg of aspirin (Bufferin, supplied by Bristol-Myers Products on alternate days)50 mg of beta-carotene (Lurotin, supplied by BASF AG on alternate days)PHYSICIANS HEALTH STUDY Total cance

5、r Prostate cancer Cardiovascular disease Eye disease Cataract Macular degenerationPrimary EndpointsDouble product = (Heart Rate) (systolic blood pressure)Printed from: Drugs for the Heart 2019 Elsevier Printed from: Drugs for the Heart 2019 Elsevier Printed from: Drugs for the Heart 2019 Elsevier AC

6、C/AHA 2019 Guideline Update for the Management of Patients With Chronic Stable Angina Printed from: Drugs for the Heart 2019 ElsevierPrinted from: Drugs for the Heart 2019 ElsevierPrinted from: Drugs for the Heart 2019 ElsevierPrinted from: Drugs for the Heart 2019 ElsevierPrinted from: Drugs for th

7、e Heart 2019 ElsevierPrinted from: Drugs for the Heart 2019 ElsevierPrinted from: Drugs for the Heart 2019 Elsevier Printed from: Drugs for the Heart 2019 Elsevier Printed from: Drugs for the Heart 2019 Elsevier Printed from: Drugs for the Heart 2019 ElsevierPrinted from: Drugs for the Heart 2019 El

8、sevierPrinted from: Drugs for the Heart 2019 ElsevierRanolazineConsequences of ischemia Electrical instability Myocardial dysfunction ( systolic function/ diastolic stiffness)Conventionalanti-ischemicmedications blockers Nitrates Ca+ blockersCompressionof nutritiveblood vesselsIschemia(Ca2+ overload

9、) O2 demand Heart rate Blood pressure Preload Contractility O2 supplyDevelopment of ischemia(Stone, 2019) Diseases(eg, ischemia, heart failure) Pathological milieu(reactive O2 species,ischemic metabolites) Toxins and drugs(eg, ATX-II, etc.)Na+ channel(Gating mechanism malfunction) Increase ATP consu

10、mption Decrease ATP formationOxygen supply and demand Abnormal contraction and relaxation diastolic tension(LV wall stiffness)Mechanicaldysfunction Early after potentials Beat-to-beat APD Arrhythmias (VT)ElectricalinstabilityIschemia Late INaNa+ overloadDiastolic relaxation failure(increased diastol

11、ic tension)Extravascular compressionCa2+ overloadRanolazineinhibits the late inwardNa currentn=175, *p 0.01 vs placebo; *p 0.001 vs. placeboPeakTrough*Placebo500 mg bid1000 mg bid1500 mg bidChaitman et al JACC 2019;43:5Change from baseline, secn=791*p 0.05; *p 0.01; *p 0.001 vs placebo.PeakTrough* *

12、Placebo750 mg bid1000 mg bid*Combination regimen of ranolazine with: Atenolol 50 mg qd, or Diltiazem 120 mg qd, or Amlodipine 5 mg qd(CARISA)Chaitman et al. JAMA 2019;291:3090123456Amlodipine+PlaceboAmlodipine+Ranolazinep=0.028BaselineOn placeboOn ranolazineAmlodipine+PlaceboAmlodipine+Ranolazinep=0.