最新内科护理学课件-英语-考试资料Coronary+Artery+Disease1

内科护理学课件英语考试资料Coronary+Artery+Disease(1)内科护理学课件英语考试资料Coronary+Artery1CoronaryArteryDiseaseAtherosclerosis动脉粥样硬化isoftenreferredtoas“hardeningofthearteries”.Althoughthisconditioncanoccurinanyarteryinthebody,theatheromas血管硬化(fattydeposits)haveapreferenceforthecoronaryarteries.AterioscleroticHeartDisease(ASHD)动脉粥样硬化性心脏病,CardiovascularHeartDisease(CHD)心血管心脏病,andCoronaryArteryDisease(CAD)冠状动脉疾病aresynonymoustermsusedtodescribethisdiseaseprocess.CoronaryArteryDiseaseAtheros2最新内科护理学课件-英语-考试资料Coronary+Artery+Disease13最新内科护理学课件-英语-考试资料Coronary+Artery+Disease14最新内科护理学课件-英语-考试资料Coronary+Artery+Disease15最新内科护理学课件-英语-考试资料Coronary+Artery+Disease16最新内科护理学课件-英语-考试资料Coronary+Artery+Disease17最新内科护理学课件-英语-考试资料Coronary+Artery+Disease18最新内科护理学课件-英语-考试资料Coronary+Artery+Disease19Riskfactors风险因素Threemostsignificantrisksare:elevatedserumlipids血脂,hypertensionandcigarettesmoking.RiskfactorscanbecategorizedasunmodifiableandmodifiableUnmodifiablefactors:Age,genderandraceFamilyhistoryandheredityModifiablemajorriskfactorsElevatedserumlipids血脂HypertensionSmokingPhysicalinactivityModifiableminorriskfactorsObesityDiabetesmellitus糖尿病StressandbehaviorpatternsRiskfactors风险因素Threemostsig10Healthpromotionandmaintenance健康促进和维护Identificationofhigh-riskManagementofhigh-riskPhysicalfitnessHealtheducationNutritionalmanagementPharmacologicmanagementDrugsthatincreaselipoproteinremovalDrugsthatrestrictlipoproteinproductionHealthpromotionandmaintenan11ClinicalmanifestationofCAD临床表现TherearethreemajorclinicalmanifestationofCAD:angina心绞痛acuteMI心肌梗死suddencardiacdeath猝死ClinicalmanifestationofCAD临12Anginapectoris心绞痛Myocardialischemia心肌缺血isexpressedsymptomaticallyasangina心绞痛.Morespecifically,anginapectorisistransient短暂的chestpaincausedbymyocardialischemia心肌缺血.Anginausuallylastsforonlyafewminutes(3to5minutes)andcommonlysubsides解除whentheprecipitatingfactor(usuallyexertion)isrelieved.Anginapectoris心绞痛Myocardiali13PathophysiologyofAnginapectoris病理生理Myocardialischemiadevelopswhenthedemandformyocardialoxygenexceedstheabilityofthecoronaryarteriestosupplyit.Theprimaryreasonforinsufficientflowisnarrowingofcoronaryarteriesbyatherosclerosis.Forischemiaasaresultofatherosclerosistooccur,thearteryisusually75%ormorestenosed狭窄.PathophysiologyofAnginapect14PathophysiologyofAnginapectoris病理生理Withthetotalocclusionofthecoronaryarteries,contractilityceasesafterseveralminutes,deprivingthemyocardialcellsofglucose葡萄糖foraerobicmetabolism有氧代谢.Anaerobicmetabolism无氧代谢beginsandlacticacid乳酸accumulates.Myocardialnervesfibersareirritatedbytheincreasedlacticacidandtransmitapainmessagetothecardiacnervesandupperthoracicposteriorroots上部胸椎神经后根(thereasonforreferredcardiacpaintotheleftshoulderandarm).PathophysiologyofAnginapect15Precipitatingfactors激发因素Extracardiacfactorsmyprecipitatemyocardialischemiaandanginalpainincluding:PhysicalexertionStrongemotionConsumptionofaheavymealTemperatureextremesCigarettesmokingSexualactivityStimulantsCircadianrhythmpatterns昼夜节律模式Precipitatingfactors激发因素Extr16TypesofanginaStableangina稳定型心绞痛Stableangina(classic)referstochestpainoccurringintermittently间歇性overalongperiodwiththesamepatternofonset,duration,andintensityofsymptoms.Stableanginaisusuallyexerciseinduced.Painatrestisunusual.AnECGusuallyrevealsSTsegmentdepressionST段压低，indicatingsubendocardialischemia.Stableanginacanbecontrolledwithmedicationsonanoutpatientbasis.Medicationcanbetimedtoprovidedpeakeffectsduringthetimeofdaywhenanginaislikingtooccur.TypesofanginaStableangina稳17Typesofangina2. Unstableangina不稳定型心绞痛Unstableangina(progressive进展的,cresendo渐强的,orpreinfarctionangina心肌梗死前心绞痛)maybethefirstmanifestationofCAD.Thepatientwithpreviouslydiagnosedstableanginawilldescribeasignificantchangeinthepatternofangina.Itwillbeoccurringwithincreasingfrequency,easilyprovokedbyminimalornoexercise,duringsleeporevenattotalrest.Typesofangina2. Unstablean18Typesofangina3. Prinzmetal’sangina

变异型的心绞痛Prinzmetal’sangina(variantangina),isarareformofangina,oftenoccursatrest,usuallyinresponsetospasmofamajorcoronaryartery.Factorsprecipitatecoronaryspasmincludesincreasedmyocardialoxygendemandandincreasedlevelsofavarietyofsubstances(e.g.,histamine组胺,angiotensin血管紧张素,epinephrine肾上腺素,norepinephrine去甲肾上腺素,prostaglandins前列腺素)Whenspasmoccurs,thepatientexperiencepainandmarked,transientSTsegmentelevation.Thepainmayoccurduringrapideyemovement(REM)sleep快速眼动睡眠whenmyocardialoxygenconsumptionincreases.Cyclical周期性的,shortburstsofpainatausualtimeeachdaymayalsooccurwiththistypeofangina.Typesofangina3. Prinzmetal’19Clinicalmanifestation临床表现

Themostcommoninitialsymptomischestpainordiscomfort.Patientmayhadavaguesensation,anunpleasantfeeling,oftendescribedasaconstrictive缩窄,squeezing压缩,heavy,choking,orsuffocatingsensation.Althoughmostofthepersonwithanginaexperiencediscomfortsubsternally,thesensationmayoccurintheneckorradiate放射tovariouslocationsincludingjaw下巴,shouldersanddownthearms.Oftenpeoplewillcomplaintofpainbetweentheshoulderblades肩胛骨之间anddismissitasnotbeingheartpain.Associatedsymptomsmayincludes:shortnessofbreath,coolsweat,weakness,orparesthesia感觉异常ofthearm(s).Reliefofclassicanginaisusuallyobtainedwithrestorcessationofactivity.Clinicalmanifestation临床表现The20Diagnosticstudies辅助检查ChestX-raySerumlipidCardiacenzymevaluesECGNuclearimagingAngiographyEchocardiographyDiagnosticstudies辅助检查ChestX-21EmergencymanagementchestpainEstablishandmaintainairwayAdministeroxygenbynasalcannulaifnotinrespiratorydistress;otherwiseusehighflow(100%)bynonbreathermask.AnticipateneedforintubationifrespiratorydistressevidentStart2IVlineswithlarge-gaugeneedlesRemoveclothing;comfortandreassurepatientMonitorcardiacrateandrhythm;monitorvitalsignsincludinglevelofconsciousnessBepreparedtoperformcardiopulmonaryresuscitation心肺复苏,defirbillation电除颤,externalpacingorcardioversion外部起搏或电复律Assessseverityandlocationofpain,medicateforpainasorderAssessforindicationsandcontraindicationsforthrombolytictherapyPreparetoinitiatethrombolytictherapy溶栓治疗ifindicatedEmergencymanagementchestpai22TherapeuticmanagementPharmacologicmanagement药理管理Antiplateletaggregationtherapy抗血小板聚集治疗:isthefirstlineofpharmacologicinterventioninthetreatmentofangina.Aspirin阿司匹林isthedrugofchoice.Nitrates硝酸盐:whicharecommonlyclassifiedasvasodilators,arethenextstepinthetreatmentofangina.Nitroglycerin硝酸甘油:itisgivensublinguallyforacuteanginaattacks,usuallyrelievepaininapproximately3minutesandhasadurationofapproximately20to45minutes.Nitratesproducetheirprincipleeffectsbythefollowing:DilatingperipheralbloodvesselsDilatingcoronaryarteriesandcollateral侧支vesselsTherapeuticmanagementPharmac23PharmacologicmanagementNitrates硝酸盐Theusualrecommendeddoseis1tablettakensublingually(SL)舌下,whichcanbefollowedat5-minuteintervalswithtwomoredoses.Ifrelieffromanginalpainhasnotbeenobtainedafter3tablesand15minutes,thepatientshouldbeinstructedtoseekmedicalattention.Thepredominantsideeffectofnitratedrugsisheadachefromthedilatationofcerebralbloodvessels.Othercomplicationsofthevasodilatordrugsareorthostatichypotension体位性低血压(nitratesyncope硝酸晕厥)andanaggravationofcerebralvascularinsufficiency.Thus,monitorBPandpulsepriortolong-actingnitratesadministration(ifBPis30mmHgbelowbaselineor<90mmHg,withholdmedicationandnotifythedoctors)。PharmacologicmanagementNitrat24Nitrates硝酸盐ThepatientneedstobeinstructedintheproperuseofsublingualnitroglycerinItshouldbeeasilyaccessibletothepatientatalltime.Forprotectionfromdegradation退化,itshouldbekeptinatightlycloseddarkglassbottlewithmetalcaps.Thepatientshouldbeinstructedtoplaceanitroglycerintablebeneaththetongueandallowittodissolve.Thisshouldcauseafizzingorslightlywarmfeelinglocally.ThepatientshouldbewarnedthatHRmayincreaseandapoundingheadache,dizziness头晕,orflushing脸红mayoccur.Thepatientshouldbecautionedagainstquicklyrisingtoastandingpositionbecauseposturalhypotensionmayoccurafternitroglyceriningestion.ifthepainhasnotbeenrelievedafter5minutes,thepatientshouldbetoldtotakeanothernitroglycerintablet.Thisproceduremayberepeatedforpainreliefevery5minutes,nottoexceedtheingestionof3tablets.Ifpainpersistafterthreedoses,thepatientshouldseekimmediatemedicaltreatment.Nitrates硝酸盐25TherapeuticmanagementPharmacologicmanagementβ-adrenergicblockingagents:propranolol普奈洛尔,metoprolol美托洛尔,nadolol钠多洛而,atenolol阿替洛尔.Thesedrugsproduceadirectdecreaseinmyocardialcontractility,HR,SVRandBP,allofwhichreducethemyocardialoxygendemand.Sideeffectofthesedrugsincludesbrachycardia心动过缓,hypotension,wheezingandGIcomplaints,weightgain,depressionandsexualdysfunction.Theβ-adrenergicblockersshouldnotbediscontinuedabruptlywithoutmedicalsupervision.TherapeuticmanagementPharmac26PharmacologicmanagementCalcium-channelblockingagents:nifedipine硝本地平,verapimil维拉帕米,diltiazem地尔硫卓

andnicardipine尼卡地平arethenextstepinthemanagementofangina.Thethreeprimaryeffectsofthesedrugsare:SystemicvascularvasodilatationwithdecreasedSVRDecreasedmyocardialcontractilityPharmacologicmanagementCalciu27Calcium-channelblockersCalcium-channelblockershaveadepressanteffectonthesinoatrial(SA)node窦房结rateofdischargeandtheconductionvelocity传导速度throughAVnode房室结isdecreased,thusslowingtheHR.Calcium-channelblockingagents地高辛potentiatetheactionofdigoxin地高辛byincreasingserumdigoxinlevelsduringtheearlypart(firstweek)oftherapy.Thereforeserumdigoxinlevelsshouldbecloselymonitoreduponinstitutionofthistherapy,andthepatientshouldbetaughtthesignsandsymptomsofdigoxintoxicity洋地黄中毒.Calcium-channelblockersCalciu28Nursingdiagnosis护理诊断

PainrelatedtoischemiamyocardiumAnxietyrelatedtodiagnosisandawarenessofbeingavitimofheartdisease,painandlimitedactivitytolerance,uncertaintiesaboutthefuture,diagnostictests,pendingsurgeryDecreasedCOrelatedtomyocardialischemiaaffectingcontractilityActivityintolerancerelatedtomyocardialischemiaNursingdiagnosis护理诊断Painrel29AcuteinterventionEstablishandmaintainairwayAdministeroxygenbynasalcannulaifnotinrespiratorydistress;otherwiseusehighflow(100%)bynonbreathermask.AnticipateneedforintubationifrespiratorydistressevidentStart2IVlineswithlarge-gaugeneedlesRemoveclothing;comfortandreassurepatientMonitorcardiacrateandrhythm;monitorvitalsignsincludinglevelofconsciousnessBepreparedtoperformcardiopulmonaryresuscitation心肺复苏,defirbillation电除颤,externalpacingorcardioversion外部起搏或电复律Assessseverityandlocationofpain,medicateforpainasorderAssessforindicationsandcontraindicationsforthrombolytictherapyPreparetoinitiatethrombolytictherapy溶栓治疗ifindicatedAcuteinterventionEstablishan30ChronicandhomemanagementThepatientneedstobereassuredthatalong,productivelifeispossible.ThepatientneedstobeeducatedregardingCADandangina,precipitatingfactors,riskfactors,andmedication.Educatingthepatientandthefamilyaboutdietsthatarelowinsodiumandreducedinsaturatedfatmaybeappropriated.It’simportanttoeducatethepatientandtheirfamilyintheuseofnitroglycerin.Nitroglycerin硝酸甘油片tabletsorointmentsmaybeusedprophylactically预防beforeanemotionallystressfulsituation,sexualintercourseorphysicalexertion.ChronicandhomemanagementThe31

结束语谢谢大家聆听！！！32

结束语谢谢大家聆听！！！32内科护理学课件英语考试资料Coronary+Artery+Disease(1)内科护理学课件英语考试资料Coronary+Artery33CoronaryArteryDiseaseAtherosclerosis动脉粥样硬化isoftenreferredtoas“hardeningofthearteries”.Althoughthisconditioncanoccurinanyarteryinthebody,theatheromas血管硬化(fattydeposits)haveapreferenceforthecoronaryarteries.AterioscleroticHeartDisease(ASHD)动脉粥样硬化性心脏病,CardiovascularHeartDisease(CHD)心血管心脏病,andCoronaryArteryDisease(CAD)冠状动脉疾病aresynonymoustermsusedtodescribethisdiseaseprocess.CoronaryArteryDiseaseAtheros34最新内科护理学课件-英语-考试资料Coronary+Artery+Disease135最新内科护理学课件-英语-考试资料Coronary+Artery+Disease136最新内科护理学课件-英语-考试资料Coronary+Artery+Disease137最新内科护理学课件-英语-考试资料Coronary+Artery+Disease138最新内科护理学课件-英语-考试资料Coronary+Artery+Disease139最新内科护理学课件-英语-考试资料Coronary+Artery+Disease140最新内科护理学课件-英语-考试资料Coronary+Artery+Disease141Riskfactors风险因素Threemostsignificantrisksare:elevatedserumlipids血脂,hypertensionandcigarettesmoking.RiskfactorscanbecategorizedasunmodifiableandmodifiableUnmodifiablefactors:Age,genderandraceFamilyhistoryandheredityModifiablemajorriskfactorsElevatedserumlipids血脂HypertensionSmokingPhysicalinactivityModifiableminorriskfactorsObesityDiabetesmellitus糖尿病StressandbehaviorpatternsRiskfactors风险因素Threemostsig42Healthpromotionandmaintenance健康促进和维护Identificationofhigh-riskManagementofhigh-riskPhysicalfitnessHealtheducationNutritionalmanagementPharmacologicmanagementDrugsthatincreaselipoproteinremovalDrugsthatrestrictlipoproteinproductionHealthpromotionandmaintenan43ClinicalmanifestationofCAD临床表现TherearethreemajorclinicalmanifestationofCAD:angina心绞痛acuteMI心肌梗死suddencardiacdeath猝死ClinicalmanifestationofCAD临44Anginapectoris心绞痛Myocardialischemia心肌缺血isexpressedsymptomaticallyasangina心绞痛.Morespecifically,anginapectorisistransient短暂的chestpaincausedbymyocardialischemia心肌缺血.Anginausuallylastsforonlyafewminutes(3to5minutes)andcommonlysubsides解除whentheprecipitatingfactor(usuallyexertion)isrelieved.Anginapectoris心绞痛Myocardiali45PathophysiologyofAnginapectoris病理生理Myocardialischemiadevelopswhenthedemandformyocardialoxygenexceedstheabilityofthecoronaryarteriestosupplyit.Theprimaryreasonforinsufficientflowisnarrowingofcoronaryarteriesbyatherosclerosis.Forischemiaasaresultofatherosclerosistooccur,thearteryisusually75%ormorestenosed狭窄.PathophysiologyofAnginapect46PathophysiologyofAnginapectoris病理生理Withthetotalocclusionofthecoronaryarteries,contractilityceasesafterseveralminutes,deprivingthemyocardialcellsofglucose葡萄糖foraerobicmetabolism有氧代谢.Anaerobicmetabolism无氧代谢beginsandlacticacid乳酸accumulates.Myocardialnervesfibersareirritatedbytheincreasedlacticacidandtransmitapainmessagetothecardiacnervesandupperthoracicposteriorroots上部胸椎神经后根(thereasonforreferredcardiacpaintotheleftshoulderandarm).PathophysiologyofAnginapect47Precipitatingfactors激发因素Extracardiacfactorsmyprecipitatemyocardialischemiaandanginalpainincluding:PhysicalexertionStrongemotionConsumptionofaheavymealTemperatureextremesCigarettesmokingSexualactivityStimulantsCircadianrhythmpatterns昼夜节律模式Precipitatingfactors激发因素Extr48TypesofanginaStableangina稳定型心绞痛Stableangina(classic)referstochestpainoccurringintermittently间歇性overalongperiodwiththesamepatternofonset,duration,andintensityofsymptoms.Stableanginaisusuallyexerciseinduced.Painatrestisunusual.AnECGusuallyrevealsSTsegmentdepressionST段压低，indicatingsubendocardialischemia.Stableanginacanbecontrolledwithmedicationsonanoutpatientbasis.Medicationcanbetimedtoprovidedpeakeffectsduringthetimeofdaywhenanginaislikingtooccur.TypesofanginaStableangina稳49Typesofangina2. Unstableangina不稳定型心绞痛Unstableangina(progressive进展的,cresendo渐强的,orpreinfarctionangina心肌梗死前心绞痛)maybethefirstmanifestationofCAD.Thepatientwithpreviouslydiagnosedstableanginawilldescribeasignificantchangeinthepatternofangina.Itwillbeoccurringwithincreasingfrequency,easilyprovokedbyminimalornoexercise,duringsleeporevenattotalrest.Typesofangina2. Unstablean50Typesofangina3. Prinzmetal’sangina

变异型的心绞痛Prinzmetal’sangina(variantangina),isarareformofangina,oftenoccursatrest,usuallyinresponsetospasmofamajorcoronaryartery.Factorsprecipitatecoronaryspasmincludesincreasedmyocardialoxygendemandandincreasedlevelsofavarietyofsubstances(e.g.,histamine组胺,angiotensin血管紧张素,epinephrine肾上腺素,norepinephrine去甲肾上腺素,prostaglandins前列腺素)Whenspasmoccurs,thepatientexperiencepainandmarked,transientSTsegmentelevation.Thepainmayoccurduringrapideyemovement(REM)sleep快速眼动睡眠whenmyocardialoxygenconsumptionincreases.Cyclical周期性的,shortburstsofpainatausualtimeeachdaymayalsooccurwiththistypeofangina.Typesofangina3. Prinzmetal’51Clinicalmanifestation临床表现

Themostcommoninitialsymptomischestpainordiscomfort.Patientmayhadavaguesensation,anunpleasantfeeling,oftendescribedasaconstrictive缩窄,squeezing压缩,heavy,choking,orsuffocatingsensation.Althoughmostofthepersonwithanginaexperiencediscomfortsubsternally,thesensationmayoccurintheneckorradiate放射tovariouslocationsincludingjaw下巴,shouldersanddownthearms.Oftenpeoplewillcomplaintofpainbetweentheshoulderblades肩胛骨之间anddismissitasnotbeingheartpain.Associatedsymptomsmayincludes:shortnessofbreath,coolsweat,weakness,orparesthesia感觉异常ofthearm(s).Reliefofclassicanginaisusuallyobtainedwithrestorcessationofactivity.Clinicalmanifestation临床表现The52Diagnosticstudies辅助检查ChestX-raySerumlipidCardiacenzymevaluesECGNuclearimagingAngiographyEchocardiographyDiagnosticstudies辅助检查ChestX-53EmergencymanagementchestpainEstablishandmaintainairwayAdministeroxygenbynasalcannulaifnotinrespiratorydistress;otherwiseusehighflow(100%)bynonbreathermask.AnticipateneedforintubationifrespiratorydistressevidentStart2IVlineswithlarge-gaugeneedlesRemoveclothing;comfortandreassurepatientMonitorcardiacrateandrhythm;monitorvitalsignsincludinglevelofconsciousnessBepreparedtoperformcardiopulmonaryresuscitation心肺复苏,defirbillation电除颤,externalpacingorcardioversion外部起搏或电复律Assessseverityandlocationofpain,medicateforpainasorderAssessforindicationsandcontraindicationsforthrombolytictherapyPreparetoinitiatethrombolytictherapy溶栓治疗ifindicatedEmergencymanagementchestpai54TherapeuticmanagementPharmacologicmanagement药理管理Antiplateletaggregationtherapy抗血小板聚集治疗:isthefirstlineofpharmacologicinterventioninthetreatmentofangina.Aspirin阿司匹林isthedrugofchoice.Nitrates硝酸盐:whicharecommonlyclassifiedasvasodilators,arethenextstepinthetreatmentofangina.Nitroglycerin硝酸甘油:itisgivensublinguallyforacuteanginaattacks,usuallyrelievepaininapproximately3minutesandhasadurationofapproximately20to45minutes.Nitratesproducetheirprincipleeffectsbythefollowing:DilatingperipheralbloodvesselsDilatingcoronaryarteriesandcollateral侧支vesselsTherapeuticmanagementPharmac55PharmacologicmanagementNitrates硝酸盐Theusualrecommendeddoseis1tablettakensublingually(SL)舌下,whichcanbefollowedat5-minuteintervalswithtwomoredoses.Ifrelieffromanginalpainhasnotbeenobtainedafter3tablesand15minutes,thepatientshouldbeinstructedtoseekmedicalattention.Thepredominantsideeffectofnitratedrugsisheadachefromthedilatationofcerebralbloodvessels.Othercomplicationsofthevasodilatordrugsareorthostatichypotension体位性低血压(nitratesyncope硝酸晕厥)andanaggravationofcerebralvascularinsufficiency.Thus,monitorBPandpulsepriortolong-actingnitratesadministration(ifBPis30mmHgbelowbaselineor<90mmHg,withholdmedicationandnotifythedoctors)。PharmacologicmanagementNitrat56Nitrates硝酸盐ThepatientneedstobeinstructedintheproperuseofsublingualnitroglycerinItshouldbeeasilyaccessibletothepatientatalltime.Forprotectionfromdegradation退化,itshouldbekeptinatightlycloseddarkglassbottlewithmetalcaps.Thepatientshouldbeinstructedtoplaceanitroglycerintablebeneaththetongueandallowittodissolve.Thisshouldcauseafizzingorslightlywarmfeelinglocally.ThepatientshouldbewarnedthatHRmayincreaseandapoundingheadache,dizziness头晕,orflushing脸红mayoccur.Thepatientshouldbecautionedagainstquicklyrisingtoastandingpositionbecauseposturalhypotensionmayoccurafternitroglyceriningestion.ifthepainhasnotbeenrelievedafter5minutes,thepatientshouldbetoldtotakeanothernitroglycerintablet.Thisproceduremayberepeatedforpainreliefevery5minutes,nottoexceedtheingestionof3tablets.Ifpainpersistafterthreedoses,thepatientshouldseekimmediatemedicaltreatment.Nitrates硝酸盐57TherapeuticmanagementPharmacologicmanagementβ-adrenergicblockingagents:propranolol普奈洛尔,metoprolol美托洛尔,nadolol钠多洛而,atenolol阿替洛尔.Thesedrugsproduceadirectdecreaseinmyocardialcontractility,HR,SVRandBP,allofwhichreducethemyocardialoxygendemand.Sideeffectofthesedrugsincludesbrachycardia心动过缓,hypotension,wheezingandGIcomplaints,weightgain,depressionandsexualdysfunction.Theβ-adrenergicblockersshouldnotbediscontinuedabruptlywithoutmedicalsupervision.TherapeuticmanagementPharmac58PharmacologicmanagementCalcium-channelblockingagents:nifedipine硝本地平,verapimil维拉帕米,diltiazem地尔硫卓

andnicardipine尼卡地平arethenextstepinthemanagementofangina.Thethreeprima