1、Coronary Heart DiseaseBian Bo,Dong ShaozhuangCardiovascular CenterTianjin Medical University General Hospital医学传媒cardiology英文教学1AS1No.1 Killer World China USA医学传媒cardiology英文教学1AS In different countries,25-45%death are caused by cardiovascular disease.Mortality of cardiovascular disease(per 100,000）
2、：）：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1ASChina In China,1 year,10 millIn China,1 year,10 milli ion new CHD on new CHD patients.patients.In China,per 15 seconds 1 people will die In China,per 15 seconds 1 people will die
3、because of CVD.because of CVD.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1ASUSA 19951995，USA,960,000 die because of CVD,42%USA,960,000 die because of CVD,42%of total mortalityof total mortality，No.1 cause i
4、n male45y,No.1 cause in male45y,and in female65yand in female65y 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1ASCauses of CVD major causemajor causeatherosclerosis(AS)atherosclerosis(AS)医学传媒cardiology英文教学1ASOt
5、her Causes Inflammation-Kawasaki syndrome Emboli-young male,dehydration Spasm-Prinzmetals angina Injury-trauma医学传媒cardiology英文教学1AS AtherosclerosisA kind of clinical vascular disease医学传媒cardiology英文教学1AS8atherosclerosisCerebrovascular diseaseCoronary artery diseasePeripheral artery disease 医学传媒cardi
6、ology英文教学1ASAtherosclerosis Atherosclerosis is an ongoing process Atherosclerosis is an ongoing process affecting mainly large-and medium-sized affecting mainly large-and medium-sized arteries;it can begin in childhood and arteries;it can begin in childhood and progress throughout a persons lifetime
7、.progress throughout a persons lifetime.医学传媒cardiology英文教学1ASAtherosclerosis Unstable atherosclerotic plaques may rupture,Unstable atherosclerotic plaques may rupture,leading to the formation of a platelet-rich leading to the formation of a platelet-rich thrombus that partially or completely thrombu
8、s 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cardiology英文教学1ASprogressiveanginaPlaque ruptureUnstableanginaAcuteMIstableanginaPathophysiology of CAD医学传媒cardiology英文教学1ASWhat Are t
9、he Results of Atherosclerosis?Results:Results:silencesilence ischemia-angina pectoris,ischemia-angina pectoris,TIA,TIA,claudicationclaudication .necrosis-MI,necrosis-MI,stroke.stroke.fibrosis-ischemia fibrosis-ischemia cardiomyopathy/nephropathycardiomyopathy/nephropathy/dementia.dementia.医学传媒cardio
10、logy英文教学1AS Risks Factors医学传媒cardiology英文教学1AS15 Risks of Atherosclerosis AgeAge Family historyFamily history GenderGender Cigarette smokingCigarette smoking Low-density lipoprotein cholesterol(dyslipidemia)Low-density lipoprotein cholesterol(dyslipidemia)HypertensionHypertension Diabetes mellitusDi
11、abetes mellitus Estrogen deficiencyEstrogen deficiency InactivityInactivity ObesityObesity others:A-type character,high TG,high others:A-type character,high TG,high homocysterine.homocysterine.医学传媒cardiology英文教学1AS Unmodifiable risks Modifiable risks 医学传媒cardiology英文教学1AS2.1 Unmodifiable risks Age F
12、amily history Gender医学传媒cardiology英文教学1ASAge-unmodifiable risks(1)Chances of a person having atherosclerosis are directly proportional to age.peak incidence of clinical manifestation,male,50-60y;female,60-70y医学传媒cardiology英文教学1AS19Heredity or Family History unmodifiable risks(2)chances of developing
13、 atherosclerosis are much higher if you have a direct family member(parent or sibling)who has atherosclerosis,especially before 50y.医学传媒cardiology英文教学1ASHeredity or Family History-immigration research Ni-Hon-San research：Japanese,living in Japan,CVD mortality lowest;living in Hawaii,middle;living in
14、 San Francisco,highest but still lower than American,only half of Americans 医学传媒cardiology英文教学1ASGender-unmodifiable risks(3)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1ASGender(2)
15、men are more often affected than woman by an overall ration of 4:1 70y,the ration 1:1医学传媒cardiology英文教学1AS2.2 Modifiable risks Low-density lipoprotein cholesterol Low-density lipoprotein cholesterol(dyslipidemia)(dyslipidemia)Cigarette smokingCigarette smoking HypertensionHypertension Diabetes melli
16、tusDiabetes mellitus Estrogen deficiencyEstrogen deficiency InactivityInactivity ObesityObesity医学传媒cardiology英文教学1ASCholesterol levels lipoprotein LDL:low-density lipoproteinLDL:low-density lipoprotein HDL:high-density lipoproteinHDL:high-density lipoprotein CM:chylomicronCM:chylomicron VLDL:very-lo
17、w-density lipoproteinVLDL:very-low-density lipoprotein医学传媒cardiology英文教学1AS LDL:carry cholesterol to arteriesLDL:carry cholesterol to arteries HDL:carry cholesterol back to liverHDL:carry cholesterol back to liver most dangerous:lipoprotein(a),samll and most dangerous:lipoprotein(a),samll and densit
18、y LDLdensity LDL 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1ASSmoking-Modifiable risks(2)Research demonstrates that smoking causes transient an
19、d 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1ASSmoking smokers are twice as likely to develop atherosclerosis and coron
20、ary artery disease as are non-smokers.医学传媒cardiology英文教学1AS 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;100:35430304040505060607070808090901001001101100.50.51.01.01.51.52.02.02.52.53.03.0血压(mm Hg)(mm Hg)冠心病
21、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 risks(3)(3)医学传媒cardiology英文教学1AS30 急诊入院急诊入院 择期患者择期患者29%29%22%22%31%31
22、%3%3%15%15%34%34%22%22%30%30%4%4%10%10%NGTNGTIFGIFG（6.1mmol/L6.1mmol/L）IGTIGTKnown Known DMDMNew New DMDMThe Euro Heart Survey on diabetes and the heartThe Euro Heart Survey on diabetes and the heart，European Heart Journal(2004)25,European Heart Journal(2004)25,1880189018801890Diabetes mellitus-Modi
23、fiable risks(4)医学传媒cardiology英文教学1AS Treatment of AS医学传媒cardiology英文教学1AS32 Treatment of AS education life style change drugs intervention or surgery医学传媒cardiology英文教学1AS3.1 Education make patients know:make patients know:what is AS,what are risks,what is results of what is AS,what are risks,what is
24、 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1AS3.2 Life Style Change body weight control:less food,more exercise;more vegetable,less fat 管住嘴，迈开腿管住嘴，迈开腿 BMI=24 moderately intense physical activity,at least 30 mi
25、nutes every time,at least 3 times a week.医学传媒cardiology英文教学1AS3.2 Life Style Change no smokingno smoking good emotiongood emotion regular life styleregular life style医学传媒cardiology英文教学1AS3.3 Drugs anti-platelet-prevent thrombosisanti-platelet-prevent thrombosis statins-decrease LDL,statins-decrease
26、LDL,stabilizestabilize plaque,plaque,anti-inflammation,improve endothelia function,anti-inflammation,improve endothelia function,anti-oxygen stress.anti-oxygen stress.dilate artery-nitrate,CCB,ACEIdilate artery-nitrate,CCB,ACEI control risks-hypertension,control risks-hypertension,DMDM医学传媒cardiology
27、英文教学1AS3.4 Intervention or Surgery to treat severe stenosis(70%)PTCA（percutaneous transluminal coronary angioplasty）Stent CABG（coronary artery bypass grafting）医学传媒cardiology英文教学1ASCAD or CHDanatomy of heart and coronary arteriesanatomy of heart and coronary arteries医学传媒cardiology英文教学1AS39医学传媒cardiol
28、ogy英文教学1AS医学传媒cardiology英文教学1AS医学传媒cardiology英文教学1ASDefinition Coronary Artery DiseaseCoronary Artery Disease means 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 necrosi
29、s,often caused by atherosclerosis.caused by atherosclerosis.医学传媒cardiology英文教学1ASDefinition Coronary Heart DiseaseCoronary Heart Disease means myocardial means myocardial ischemia,necrosis,arrhythmia,function ischemia,necrosis,arrhythmia,function abnormality,structural and electrical abnormality,str
30、uctural and electrical remodeling caused by coronary artery remodeling caused by coronary artery narrowing or obstruction.narrowing or obstruction.医学传媒cardiology英文教学1AS CAD:coronary CAD:coronary arteryartery disease disease cause cause CHD:coronary CHD:coronary heartheart disease disease result resu
31、lt医学传媒cardiology英文教学1ASClassificationCHD:CHD:5 types 5 types latent or silence latent or silence angina pectorisangina pectoris myocardial infarctionmyocardial infarction heart failure and arrhythmiaheart failure and arrhythmia cardiac sudden death cardiac sudden death key point:clinical presentatio
32、n key point:clinical presentation医学传媒cardiology英文教学1ASClassificationnew trend of classificationnew trend of classification1.1.stable:stable angina pectorisstable:stable angina pectoris2.2.unstable:ACSunstable:ACS unstable angina pectorisunstable angina pectoris ST-elevated AMIST-elevated AMI non ST-
33、elevated AMInon ST-elevated AMI cardiac sudden deathcardiac sudden death key point:pathophysiology key point:pathophysiology医学传媒cardiology英文教学1ASDefinitionACSACS:acute coronary syndrome:acute coronary syndrome ACS include UAP,NSTEAMI,STEAMI,and sudden ACS include UAP,NSTEAMI,STEAMI,and sudden death.
34、death.ACS has the same pathophysiology,that is ACS has the same pathophysiology,that is caused by suddenly rupture or erosion of caused by suddenly rupture or erosion of atherosclerosis platherosclerosis pla aque and leading to que and leading to formation of thrombosis.The results are formation of
35、thrombosis.The results are from from complete or partial occlusion of complete or partial occlusion of coronary arteries.coronary arteries.医学传媒cardiology英文教学1ASPlaque rupture and thrombosisPlaque rupture and thrombosis完全闭塞完全闭塞纤溶并残存血纤溶并残存血栓栓疾病进展疾病进展富含脂富含脂质斑块质斑块斑块破裂斑块破裂AMIAMIUAPUAPNQMINQMI再闭塞再闭塞部分闭塞部分
36、闭塞稳定心绞痛稳定心绞痛Adapted from Fuster V.Adapted from Fuster V.N Engl J MedN Engl J Med.1992;326:242-250,with permission.1992;326:242-250,with permission.医学传媒cardiology英文教学1AS how to treat CHD?how to treat CHD?wait and see detail in lesson of AP and AMIwait and see detail in lesson of AP and AMI医学传媒cardiology英文教学1AS attention:key points are in attention:key points are in red colorred color医学传媒cardiology英文教学1AS
