1、Generality of Cardiovascular DiseasesDao Wen Wang, M.D., Ph.D.Division of CardiologyDept. of Internal Medicine, Tongji HospitalThe recent decline in age-adjusted mortality-rate in USA since 1972 Fig 1. Age standardised (Dutch population of 1980-93 as direct standard) annual mortalities and hospital
2、discharge rates for cardiovascular diseases in the NetherlandsBonneux, L. et al. BMJ 1997;314:789Increased mortality-rate of CVD in ChinaCharacteristics of Structure and Functions of Cardiovascular System Cardiac Contraction 1）Preload 2）Afterload 3）contractility 4）heart rate and rhythm Cardiac Relax
3、ation Influenced by myocardial relaxation, ventricular filling, ventricles passive elastic properties, heart rate. Myocardial Oxygen Uptake Major determinants: heart rate, wall stress, and contractility Regulation of Coronary Blood Flow Major determinants: myocardial oxygen demand, perfusion pressur
4、e, neural control, endothelial function, autoregulation, pharmacologicCharacteristics of Structure and Functions of Cardiovascular System Schematic of coronary flow system. Coronary circulation consisted of interconnecting pathways with conduit arteries, distribution vessels (arterioles), exchanged
5、vessels (capillaries) and reception vessels (venules and veins).Schematic representation of anatomical and physical analogues of coronary circulation. Top panels: anatomic system composed of the epicardial coronary arteries and the myocardial microcirculation. Bottom panels: physical analogues that
6、simulate the flow and distribution volume behavior of the respective anatomic compartments- a rigid conduit and a well-stirred mixing chamber. Figure 4. Blood volume distribution in pigs coronary circulation. Figure 5. To match the oxygen supply to myocardial metabolic requirement, locally and highl
7、y organized vascular regulations are required. Figure 1. 10 to 20% of patients with ischemic syndromes undergoing cardiac catheterization are found to have normal coronary angiograms. Regulation of Systemic Circulation Regulation of Blood Volume Receptor and signaling mechanismsCharacteristics of St
8、ructure and Functions of Cardiovascular SystemDiagnosis of Cardiovascular Diseases Importance of the Medical History * The medical history remains the richest source of information concerning the patients illness. * The physicians attentive and thoughtful taking of a history establishes a bond with
9、the patient. Cardinal Symptoms of heart diseases * Dyspnea or short breath * Chest pain or discomfort * Syncope or presyncope * Edema * abdominal distensionPhysical Examination of the Heart and Circulation There are still many reasons to promote the teaching of bedside diagnostic skills such as card
10、iac ausculation. Among these are cost-effectiveness, the possibility of making inexpensive serial observations, the early detection of critical findings, the intelligent and well-guided selection of costly diagnostic technology, and the therapeutic value of the physical contact between physician and
11、 patient. - MangionePhysical Examination of the Heart and Circulation General appearance Chest and abdomen Jugular vein and venous pulse Sphygmomanometric measurement of arterial pressure The Cardiac ExaminationLab Test Electrocardiography, Exercise ECG, Ambulatory ECG X ray, CTA and MRI Echocardiog
12、raphy and other Images Ambulatory blood pressure monitoring Nuclear CardiologyLab Tests Cardiac Catheterization Biomarkers Translational Medicine Molecular and Genetic diagnosis and genotyping1- receptor Arg389 GlyArg389Arg389小鼠（左）及心衰病人（右）对小鼠（左）及心衰病人（右）对受体阻滞剂有更显著的反应性受体阻滞剂有更显著的反应性受体通路的基因多态性与心衰反应性Natu
13、re Med 2003;9:1300-1305GRK5 基因多态性 Gln41LeuNature Med 2008;14:510-517 GRK2与与GRK5主要在心脏中表达主要在心脏中表达 在心力衰竭中一个重要的下调在心力衰竭中一个重要的下调受体信号的机制是：心肌受体信号的机制是：心肌GRK表达增表达增 加，磷酸化加，磷酸化受体，招募受体，招募（视紫红质）抑制蛋白（视紫红质）抑制蛋白（-arrestin），使），使 G蛋白从受体上脱偶联，影响下游的效应分子蛋白从受体上脱偶联，影响下游的效应分子GRK5-Gln41心衰病人使用受体阻滞剂后，生存时间明显延长 Nature Med 2008;14
14、:510-517GRK5-Leu41携带者（纯合子或杂合子）用携带者（纯合子或杂合子）用或不用或不用阻断剂生存时间相当阻断剂生存时间相当Q41携带者用携带者用阻断剂和阻断剂和L41携带者不用携带者不用阻断剂的作用相当阻断剂的作用相当都不用都不用受体阻断剂时受体阻断剂时L41携带者比携带者比Q41携带者生存时间长携带者生存时间长Diagnosis of Cardiovascular DiseasesIt should be complete, accurate, logical and systimical. Diagnosis should include1. Cuases of diseas
15、es2. Pathology of diseases3. Function of heart4. PathophysiologyExample: 1. CHD, chronic myocardial infarction of anterile wall and unstable agina, 3 grade cardiac function, atrial fibrillation 2. acute respiratory infectionPrevention of Cardiovascular Diseases 一级预防(primary prevention)：预防疾病的发生 二级预防(
16、secondary prevention)：针对已确诊为心血管疾病的患者，通过适当的干预治疗措施，以减低心血管临床事件，达到改善病人远期预后和生活质量的目的。Therapy of Cardiovascular Diseases Therapeutic methods： 1）Psychological and behavior treatment 2）Drug therapy 3）Electronic therapy 4）Interventional and device therapy 5）Surgery The principles of therapy： Evidence-Based Me
17、dicine Individualization Translational Medicine (Transmedicine)Advancement Acute Coronary Syndrome Genomics of primary hypertension and cardiomyopathies Heart failure: biomarkers, Neuroendocrine abnormality, clinical phases, therapies of drug and pacemakerAdvancement Cardiac Arrhythmias: ablation th
18、erapy, pacemakers, ICD Interventional therapies for CHD, congenital heart disease, Aortic dissecting aneurysm, other arterial stenosis Application of molecular biological techniques做医生的三明白原则做医生的三明白原则 作明白医生的三明白三明白原则：符合“Shared Decision Making The Pinnacle of Patient-Centered Care” Enjoy your courses of cardiovascular diseases!Thank you
