缺血性心脏病教学 ppt课件
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become lipid-laden foam cells
Pathophysiology Plaque Formation 4
Lipid Pool
Foam cells die The contents release
Pathophysiology Plaque Formation 5
Early Atheroma
coexist Radial / Internal mammary artery largely
spared
Pathophysiology Plaque Formation 1
Plaques begin to appear in 2nd and 3rd decade of life The nature/composition of plaques changes
management
Epidemiology
Most common form of heart disease
Single most important cause of premature death
Epidemiology -- USA
1/2 deaths (1/2million) 1.5 million MI each year 45% MI under age 65 50-100 billion $ per year
Mature Fibrolipid Plaque
Lipid core Surrounded by SMC Fibrous cap
Pathophysiology
Plague Rupture / Fissure Thrombosis + Local spasm Vessel Occlusion
Pathophysiology
Occasionally other disorders
• Congenital anomalies • Anomalous origin • Fistular/Malformation of a major coronary artery • Aortitis • Polyarteritis • Connective tissue disorders
Ischaemia due to fixed atheromatous stenosis of one or more coronary arteries Ischaemia caused by dynamic obstruction of a coronary artery due to plaque rupture with superimposed thrombosis and spasm Acute occlusion of a coronary artery due to plaque rupture and thrombosis and resulting in myocardial necrosis Myocardial dysfunction due to infarction or ischaemia
Heart diseases Cancer Stroke Pneumonia & influenza Infectious diseases Accidents COPD Chronic liver disease Diabetes mellitus Others
Pathophysiology
Almost always due to athroma and its complications particularly thrombosis
ACS
Pathophysiology Plaque Rupture
CHD
clinical manifestation and pathology
Clinical problem
Pathology
Stable angina Unstable angina
Myocardial infarction Heart failure
Soldiers died in the korean war
300 Cases autopsy (age, 22.1y)
77.3% atherosclerosis
39%
occlusive plaque
ENOS JAMA 1953
Incidence of atherosclerosis in donor heart
Pathophysiology Plaque Formation 2
Pathophysiology Plaque Formation 3
Fatty streaks develope
Circulating Monocytes
migrate into intima take-up oxidised LDL from plasma
Pathophysiology
Atheroma/Atherosclerosis
Diffused disease of the arterial wall Coronary artery at high risk Cerebral / peripheral vascular disease often
Incedence of ather (%)
EEM Area 13.2 mm2
5.07 mm2
Atheroma Area 8.13 mm2
Female,32y
100 85%
80
71%
60% 60
40
37%
20 17%
0 <20 20-2930-3940-49 ≥50
age (y)
Tuzcu Circ 1999
Smooth muscle cells migrate into proliferate within Plaque
Pathophysiology Plaque Formation 6
Lesion Grows Encroaches into lumen Erodes media
Pathophysiology Plaque Formation 7
Coronary (Ischemic) Heart Disease
冠心病 缺血性心脏病
北京大学人民医院 心脏中心 孙艺红
CHD
Epidemiology Pathophysiology Risk factors and Prevention Clinical manifestation,Diagnosis and
Proportionate Mortality for the Ten Leading Causes of Death in China,
1991-2001
20.1
1.5 1.5 1.8 2.8 3.1
3Hale Waihona Puke Baidu2
21.3
22.5 22.3
He J & Gu D, et al, N Engl J Med 2005;353;11:1124-34
Pathophysiology Plaque Formation 4
Lipid Pool
Foam cells die The contents release
Pathophysiology Plaque Formation 5
Early Atheroma
coexist Radial / Internal mammary artery largely
spared
Pathophysiology Plaque Formation 1
Plaques begin to appear in 2nd and 3rd decade of life The nature/composition of plaques changes
management
Epidemiology
Most common form of heart disease
Single most important cause of premature death
Epidemiology -- USA
1/2 deaths (1/2million) 1.5 million MI each year 45% MI under age 65 50-100 billion $ per year
Mature Fibrolipid Plaque
Lipid core Surrounded by SMC Fibrous cap
Pathophysiology
Plague Rupture / Fissure Thrombosis + Local spasm Vessel Occlusion
Pathophysiology
Occasionally other disorders
• Congenital anomalies • Anomalous origin • Fistular/Malformation of a major coronary artery • Aortitis • Polyarteritis • Connective tissue disorders
Ischaemia due to fixed atheromatous stenosis of one or more coronary arteries Ischaemia caused by dynamic obstruction of a coronary artery due to plaque rupture with superimposed thrombosis and spasm Acute occlusion of a coronary artery due to plaque rupture and thrombosis and resulting in myocardial necrosis Myocardial dysfunction due to infarction or ischaemia
Heart diseases Cancer Stroke Pneumonia & influenza Infectious diseases Accidents COPD Chronic liver disease Diabetes mellitus Others
Pathophysiology
Almost always due to athroma and its complications particularly thrombosis
ACS
Pathophysiology Plaque Rupture
CHD
clinical manifestation and pathology
Clinical problem
Pathology
Stable angina Unstable angina
Myocardial infarction Heart failure
Soldiers died in the korean war
300 Cases autopsy (age, 22.1y)
77.3% atherosclerosis
39%
occlusive plaque
ENOS JAMA 1953
Incidence of atherosclerosis in donor heart
Pathophysiology Plaque Formation 2
Pathophysiology Plaque Formation 3
Fatty streaks develope
Circulating Monocytes
migrate into intima take-up oxidised LDL from plasma
Pathophysiology
Atheroma/Atherosclerosis
Diffused disease of the arterial wall Coronary artery at high risk Cerebral / peripheral vascular disease often
Incedence of ather (%)
EEM Area 13.2 mm2
5.07 mm2
Atheroma Area 8.13 mm2
Female,32y
100 85%
80
71%
60% 60
40
37%
20 17%
0 <20 20-2930-3940-49 ≥50
age (y)
Tuzcu Circ 1999
Smooth muscle cells migrate into proliferate within Plaque
Pathophysiology Plaque Formation 6
Lesion Grows Encroaches into lumen Erodes media
Pathophysiology Plaque Formation 7
Coronary (Ischemic) Heart Disease
冠心病 缺血性心脏病
北京大学人民医院 心脏中心 孙艺红
CHD
Epidemiology Pathophysiology Risk factors and Prevention Clinical manifestation,Diagnosis and
Proportionate Mortality for the Ten Leading Causes of Death in China,
1991-2001
20.1
1.5 1.5 1.8 2.8 3.1
3Hale Waihona Puke Baidu2
21.3
22.5 22.3
He J & Gu D, et al, N Engl J Med 2005;353;11:1124-34