医学传媒cardiology英文教学1AS课件

1、医学传媒cardiology英文教学1AS1 Coronary Heart Disease Bian Bo, Dong Shaozhuang Cardiovascular Center Tianjin Medical University General Hospital 医学传媒cardiology英文教学1AS No.1 Killer v World v China v USA 医学传媒cardiology英文教学1AS v In different countries, 25-45% death are caused by cardiovascular disease. v Mortal

2、ity of cardiovascular disease(per 100,000）：）：male, highest in Russia， 1310，lowest in Japan, 201；female, highest in Russia, 581，lowest in France, 84. 医学传媒cardiology英文教学1AS China v In China, 1 year, 10 millIn China, 1 year, 10 milli ion new CHD on new CHD patients.patients. v In China, per 15 seconds

3、1 people will die In China, per 15 seconds 1 people will die because of CVD.because of CVD. v In China, 1 year 2.6 millIn China, 1 year 2.6 milli ion people will die on people will die because of CVD. because of CVD. 医学传媒cardiology英文教学1AS USA v 19951995，USA, 960,000 die because of CVD, 42% USA, 960,

4、000 die because of CVD, 42% of total mortalityof total mortality，No.1 cause in male45y, No.1 cause in male45y, and in female65yand in female65y v Total CVD patients in USA ,58 millionTotal CVD patients in USA ,58 million，20% 20% of total populationof total population 医学传媒cardiology英文教学1AS Causes of

5、CVD v major causemajor cause atherosclerosis (AS)atherosclerosis (AS) 医学传媒cardiology英文教学1AS Other Causes v Inflammation-Kawasaki syndrome v Emboli-young male, dehydration v Spasm-Prinzmetals angina v Injury-trauma 医学传媒cardiology英文教学1AS8 Atherosclerosi s A kind of clinical vascular disease 医学传媒cardio

6、logy英文教学1AS atherosclerosis Cerebrovascular disease Coronary artery disease Peripheral artery disease 医学传媒cardiology英文教学1AS Atherosclerosis v Atherosclerosis is an ongoing process Atherosclerosis is an ongoing process affecting mainly large- and medium-sized affecting mainly large- and medium-sized

7、arteries; it can begin in childhood and arteries; it can begin in childhood and progress throughout a persons gress throughout a persons lifetime. 医学传媒cardiology英文教学1AS Atherosclerosis v Unstable atherosclerotic plaques may rupture, Unstable atherosclerotic plaques may rupture, leading t

8、o the formation of a platelet-rich leading to the formation of a platelet-rich thrombus that partially or completely thrombus that partially or completely occludes the artery and causes acute occludes the artery and causes acute ischemic symptoms.ischemic symptoms. 医学传媒cardiology英文教学1AS 医学传媒cardiolo

9、gy英文教学1AS progressive angina Plaque rupture Unstable angina Acute MI stable angina Pathophysiology of CAD 医学传媒cardiology英文教学1AS What Are the Results of Atherosclerosis? Results:Results: v silencesilence v ischemia-angina pectoris,ischemia-angina pectoris, TIA,TIA, claudicationclaudication . v necros

10、is-MI,necrosis-MI, stroke.stroke. v fibrosis-ischemia fibrosis-ischemia cardiomyopathy/nephropathycardiomyopathy/nephropathy/ /dementia.dementia. 医学传媒cardiology英文教学1AS15 Risks Factors 医学传媒cardiology英文教学1AS Risks of Atherosclerosis v AgeAge v Family historyFamily history v GenderGender v Cigarette sm

11、okingCigarette smoking v Low-density lipoprotein cholesterol (dyslipidemia)Low-density lipoprotein cholesterol (dyslipidemia) v HypertensionHypertension v Diabetes mellitusDiabetes mellitus v Estrogen deficiencyEstrogen deficiency v InactivityInactivity v ObesityObesity v others: A-type character, h

12、igh TG, high others: A-type character, high TG, high homocysterine.homocysterine. 医学传媒cardiology英文教学1AS v Unmodifiable risks v Modifiable risks 医学传媒cardiology英文教学1AS 2.1 Unmodifiable risks v Age v Family history v Gender 医学传媒cardiology英文教学1AS19 Age - unmodifiable risks(1) v Chances of a person havin

13、g atherosclerosis are directly proportional to age. v peak incidence of clinical manifestation, male ,50-60y; female, 60-70y 医学传媒cardiology英文教学1AS Heredity or Family History unmodifiable risks(2) v chances of developing atherosclerosis are much higher if you have a direct family member (parent or si

14、bling) who has atherosclerosis, especially before 50y. 医学传媒cardiology英文教学1AS Heredity or Family History -immigration research v 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

15、 Americans 医学传媒cardiology英文教学1AS Gender - unmodifiable risks(3) v 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. 医学传媒cardiology英文教学1AS Gender (2) v men are more often affected than woman by an over

16、all ration of 4:1 v 70y, the ration 1:1 医学传媒cardiology英文教学1AS 2.2 Modifiable risks v Low-density lipoprotein cholesterol Low-density lipoprotein cholesterol (dyslipidemia)(dyslipidemia) v Cigarette smokingCigarette smoking v HypertensionHypertension v Diabetes mellitusDiabetes mellitus v Estrogen de

17、ficiencyEstrogen deficiency v InactivityInactivity v ObesityObesity 医学传媒cardiology英文教学1AS Cholesterol levels lipoprotein v LDL: low-density lipoproteinLDL: low-density lipoprotein v HDL: high-density lipoproteinHDL: high-density lipoprotein v CM: chylomicronCM: chylomicron v VLDL: very-low-density l

18、ipoproteinVLDL: very-low-density lipoprotein 医学传媒cardiology英文教学1AS v LDL: carry cholesterol to arteriesLDL: carry cholesterol to arteries v HDL: carry cholesterol back to liverHDL: carry cholesterol back to liver v most dangerous: lipoprotein(a), samll and most dangerous: lipoprotein(a), samll and d

19、ensity LDLdensity LDL v in CAD patients, alwalys high LDL-c, low in CAD patients, alwalys high LDL-c, low HDL-c HDL-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：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；上条和中条：高胆固醇组； 下条：对照组下条：对照组 医学传媒cardiology英文教学1AS Smoking- Modifiable risks(2) v Research demonstrates that smoking

20、 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. 医学传媒cardiology英文教学1AS Smoking v smokers are twice as likely to deve

21、lop atherosclerosis and coronary artery disease as are non-smokers. 医学传媒cardiology英文教学1AS30 收缩压和脉压对冠心病危险性的联合影响收缩压和脉压对冠心病危险性的联合影响 The Framingham Hear StudyThe Framingham Hear Study；入选者年龄入选者年龄5050岁岁 Stanley S, et al. Circulation 1999;100:354 3030404050506060707080809090100100110110 0.50.5 1.01.0 1.51.

22、5 2.02.0 2.52.5 3.03.0 血压(mm Hg)(mm Hg) 冠 心 病 危 险 率 SBP 170 mm HgSBP 170 mm Hg ( (P P=.0487)=.0487) SBP 150 mm HgSBP 150 mm Hg ( (P P=.0194)=.0194) SBP 130 mm HgSBP 130 mm Hg ( (P P=.0086)=.0086) SBP 110 mm HgSBP 110 mm Hg ( (P P=.2076)=.2076) HypertensionHypertension- -Modifiable risksModifiable ri

23、sks(3)(3) 医学传媒cardiology英文教学1AS 急诊入院急诊入院 择期患者择期患者 29%29% 22%22% 31%31% 3%3% 15%15% 34%34% 22%22% 30%30% 4%4% 10%10% NGTNGT IFGIFG（6.1mmol/L6.1mmol/L） IGTIGT Known Known DMDM New New DMDM The Euro Heart Survey on diabetes and the heartThe Euro Heart Survey on diabetes and the heart，European Heart Jou

24、rnal (2004) 25, European Heart Journal (2004) 25, 1880189018801890 Diabetes mellitus -Modifiable risks(4) 医学传媒cardiology英文教学1AS32 Treatment of AS 医学传媒cardiology英文教学1AS Treatment of AS v education v life style change v drugs v intervention or surgery 医学传媒cardiology英文教学1AS 3.1 Education v make patient

25、s know:make patients know: what is AS, what are risks, what is results of what is AS, what are risks, what is results of AS, How to control AS, What they can do for AS, How to control AS, What they can do for themselvesthemselves 医学传媒cardiology英文教学1AS 3.2 Life Style Change v body weight control: v l

26、ess food, more exercise; v more vegetable, less fat v 管住嘴，迈开腿管住嘴，迈开腿 v BMI=24 v moderately intense physical activity , at least 30 minutes every time, at least 3 times a week. 医学传媒cardiology英文教学1AS 3.2 Life Style Change v no smokingno smoking v good emotiongood emotion v regular life styleregular li

27、fe style 医学传媒cardiology英文教学1AS 3.3 Drugs v anti-platelet-prevent thrombosisanti-platelet-prevent thrombosis v statins-decrease LDL, statins-decrease LDL, stabilizestabilize plaque, plaque, anti-inflammation, improve endothelia function, anti-inflammation, improve endothelia function, anti-oxygen str

28、ess.anti-oxygen stress. v dilate artery-nitrate, CCB,ACEIdilate artery-nitrate, CCB,ACEI v control risks-hypertension,control risks-hypertension, DMDM 医学传媒cardiology英文教学1AS 3.4 Intervention or Surgery v to treat severe stenosis (70%) v PTCA （percutaneous transluminal coronary angioplasty ） v Stent v

29、 CABG（coronary artery bypass grafting） 医学传媒cardiology英文教学1AS39 CAD or CHD anatomy of heart and coronary arteriesanatomy of heart and coronary arteries 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1AS 医学传媒cardiology英文教学1AS Definition v Coronary Artery DiseaseCoronary Artery Disease m

30、eans coronary means coronary artery narrowing or obstruction that leads artery narrowing or obstruction that leads to myocardial ischemia or necrosis, often to myocardial ischemia or necrosis, often caused by atherosclerosis. caused by atherosclerosis. 医学传媒cardiology英文教学1AS Definition v Coronary Hea

31、rt DiseaseCoronary Heart Disease means myocardial means myocardial ischemia, necrosis,arrhythmia, function ischemia, necrosis,arrhythmia, function abnormality, structural and electrical abnormality, structural and electrical remodeling caused by coronary artery remodeling caused by coronary artery n

32、arrowing or obstruction.narrowing or obstruction. 医学传媒cardiology英文教学1AS v CAD: coronary CAD: coronary arteryartery disease disease cause cause v CHD: coronary CHD: coronary heartheart disease disease result result 医学传媒cardiology英文教学1AS Classification CHD: CHD: 5 types 5 types v latent or silence lat

33、ent or silence v angina pectorisangina pectoris v myocardial infarctionmyocardial infarction v heart failure and arrhythmiaheart failure and arrhythmia v cardiac sudden death cardiac sudden death key point: clinical presentation key point: clinical presentation 医学传媒cardiology英文教学1AS Classification n

34、ew trend of classificationnew trend of classification v stable: stable angina pectorisstable: stable angina pectoris v unstable: ACSunstable: ACS v unstable angina pectorisunstable angina pectoris v ST-elevated AMIST-elevated AMI v non ST-elevated AMInon ST-elevated AMI v cardiac sudden deathcardiac sudden death key point: pathophysiology key point: pathophysiology 医学传媒cardiology英文教学1AS Definition ACSACS: acute coronar