内科学-循环系统总论课件

葛均波复旦大学中山医院，上海市心血管病研究所心血管系统疾病内科学循环系统总论2005年７月２日晚，成功扮演“毛泽东”的特型演员古月在广东省三水区因突发大面积心肌梗死，抢救无效去世，享年66岁。2005年8月17日晚，著名表演艺术家高秀敏在长春的家中因心脏病突发辞世，享年46岁。名人的意外事件内科学循环系统总论名人的意外事件2006年12月20日上午，著名相声表演艺术家马季因心脏病逝世，享年72岁。2007年著名相声表演艺术家侯耀文因突发心脏病被送往北医三院，经抢救无效去世，享年59岁。内科学循环系统总论Yalta,Febr.1945内科学循环系统总论DiastolicandSystolicArterialPressureofFranklinD.Rooseveltfrom1935untilHisDeathonApril12,1945F.Messerli:NewEnglandJournalofMedicine332:1038-1039,April13,1995选举内科学循环系统总论HeadlinesoftheSt.LouisPost-Dispatch,April13,1945F.Messerli:NewEnglandJournalofMedicine332:1038-1039,April13,1995内科学循环系统总论10TopCausesofDeathinUrbanChina2000CauseofDeath Mortality/100000Circulatory

235Cerebrovascular 128HeartDisease 107Cancer

146Respiratory 79InjuryandPoison 36Digestive 18Endocrine,MalnutritionMetabolic,Immunological 18Urogenital 9Psychosis 7Neurological 6内科学循环系统总论10TopCausesofDeathinRuralChina2000CauseofDeath

Mortality/100000Circulatory 189Cerebrovascular 115HeartDisease 73Cancer

113Respiratory

142InjuryandPoison

65Digestive

24Urogenital

9Tuberculosis 7Neonatal

697/numberofalivebirthEndocrine,Malnutrition Metabolic,Immunological

7Datasource:ChineseHealthStatisticalDigest,MOH,PRC内科学循环系统总论人心血管病流行状况

——中国心血管病报告20052002年调查估计，我国每年心脑血管病新发及患病的病例数内科学循环系统总论心脏的工作各部，同时从肺部吸取新鲜血液，以便供左心室下一次收缩使用；右心室吸进从静脉来的、带有大量废物和二氧化碳的血液，这种不新鲜的血通过右心房运送到肺部，在肺部吸收氧气排出二氧化碳后，又变为鲜血流入左心房。心脏和与它相连的大血管组成一个密闭的管道网——血液循环系统。心脏工作起来就像一只泵，收缩时将左心室里富含氧气和营养物质的鲜血“压”到主动脉去，通过动脉输送到身体MyocardiumCoronaryarteriesConductionsystemValvesPericardiumArteriesVeinsCapilaries内科学循环系统总论心脏疾病心脏病是人类健康的头号杀手全世界约1/3的人口死亡是因心脏病引起的我国每年约有250-300万人死于心脏病内科学循环系统总论PreloadAfterloadContractionHeartrateChamberstiffnessOxygenconsumptionCoronarybloodsupply

DeterminantsofNormalCirculation内科学循环系统总论

ClinicalHistoryLocationandradiationTimeanddurationFrequencyExertationoratrestBeforeoraftermealWeather(coldwinter)Relatedmedication......SymptomsChestpainSyncopeFatigueDyspneaPalpitationFeverCyanosisEdemaDizziness......

CharacteristicsRiskfactorsHypertensionDyslipidemiaSmokingPhysicalinactiveDiabetesmellitusInfectionStressFamilyhistory......

内科学循环系统总论

PhysicalExaminationInspection:Generalstatus,cyanosis,dyspnea......Palpation:Pulse,frequency,extrasystoli,edema,apical impulse,thrill......Percussion:MarginoftheheartAuscultation:

HeartrateCardiacrhythmCardiacsoundExtracardiacsound(Galloprhythm,openingsnap,pericardialknock)Cardiacmurmur(systolic,diastolic,continuous)内科学循环系统总论

LaboratoryExaminationBloodWBC,RBC,thrombocytesESR,CRP, INR,TPT,CK-MB,Troponin-I,AST,LDHLipidGlucoseElectrolytesBloodgasUrine:Protein,RBC,......内科学循环系统总论

Electrogram(Holter)andElectrophysiology

SurfaceECG

IntracardiacECG内科学循环系统总论

CardiovascularImagingX-Ray,CT,MRIEcho-andDopplercardiographyRadioactiveNuclearimaging,PETCatheterization,angiography内科学循环系统总论

CardiovascularImagingRadioactiveNuclearimaging内科学循环系统总论

IntravascularUltrasoundImagine内科学循环系统总论PreventiveCardiovascularMedicineA:AspirinACEIB:B-blockerBPC:CholesterolCigarettequittingD:DiabetesControlDietE:ExerciseEducation内科学循环系统总论

ConventionalTherapyBehaviorandpsychotherapy(TypeAandTypeBbehavior)MedicationDosagei.v,oral,i.m.TimeFrequencyDruginteractions......AntihypertensiveLipid-loweringAntidiabeticagentsVasodilatorsDiureticsDigitalisAntiarrhythmics......UsageSideeffectsDrugsHypotensionLong-QTProarrhythmiaDisturbanceofelectrolytesDemagingofrenalandliverfunctionTachy-andBradycardia........内科学循环系统总论

InterventionalTherapyAndreasGrüntzig,performedhisfirstcoronaryangioplastyprocedureinZurich,Switzerlandin1977;movedtotheUnitedStatestojointhefacultyofEmoryUniversityin1980,diedinaplanecrashinMonroeCounty,GeorgiaonOctober27,19851984内科学循环系统总论内科学循环系统总论内科学循环系统总论

InterventionalTherapyAMIPTCAStenting内科学循环系统总论术前球囊扩张

InterventionalTherapy内科学循环系统总论植入支架术后

InterventionalTherapy内科学循环系统总论CoronaryinterventionsinEurope02505007501000125015009092949698捷克西班牙土耳其希腊意大利波兰立陶宛罗马尼亚德国比利时法国荷兰瑞典丹麦英国芬兰YearBoersmaetal(eds).CardiovascularDiseasesinEurope.EuropeanRegistriesofCardiovascularDiseasesandPatientManagement.SophiaAntipolis,France:EuropeanSocietyofCardiology,1999手术病人数(/百)内科学循环系统总论内科学循环系统总论

CatheterAblationAblationofVTRFduringVT 3seconds 内科学循环系统总论

PacemakertherapyX-ray.MedtronicAttainLVleadinmid-lateralveinwithInSyncdevice.CardiacResynchronization内科学循环系统总论

ICDTherapyICD-Secondaryprevention:Meta-Analysis(AVID,CIDS,CASH)NumberatriskICD:934715467273159104934715467273159104Amio:9326644272481288293266442724812882YearsYearsAmioICDAmioICD5040302010050403020100012345012345ConnollySJ.EurHeartJ2000;21:2071DeathRhythmogenicdeath内科学循环系统总论

ProgressandPerspectivesAngiogenesisImplantationofself(autologous)bonemarrowstemcellsisarelativelysimplemethodforangiogenesiswithoutcausingtoxicityorimmunologicalrejectionIsnerJM,etal.JClinInvest1999;103:1231-6内科学循环系统总论

ProgressandPerspectivesBoneMarrowCellsRegenerateInfarctedMyocardium

Orlicetal.Nature2001;410:701

Lin-c-kitPOSBMCfromtransgenicmiceinjectedintheperi-infarctedleftventricleoffemalemiceaftercoronaryligation

Newlyformedmyocardiumoccupied68%oftheinfarctedportionoftheventricle9daysaftertransplantingthebonemarrowcells.DevelopingtissuecomprisedproliferatingmyocytesandvascularstructuresA.BonemarrowcellsandmyocardialregenerationB.Myocardialrepairandconnexin内科学循环系统总论

ProgressandPe