内科学--循环系统总论 PPT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名人的意外事件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。大家一定还记得这些艺术家的音容笑貌名人的意外事件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。Yalta,Febr.1945DiastolicandSystolicArterialPressureofFranklinD.Rooseveltfrom1935untilHisDeathonApril12,1945F.Messerli:NewEnglandJournalofMedicine332:1038-1039,April13,1995选举HeadlinesoftheSt.LouisPost-Dispatch,April13,1945F.Messerli:NewEnglandJournalofMedicine332:1038-1039,April13,199510TopCausesofDeathinUrbanChina2000CauseofDeath Mortality/100000Circulatory 235Cerebrovascular 128HeartDisease 107Cancer 146Respiratory 79InjuryandPoison 36Digestive 18Endocrine,MalnutritionMetabolic,Immunological 18Urogenital 9Psychosis 7Neurological 610TopCausesofDeathinRuralChina2000CauseofDeath Mortality/100000Circulatory 189Cerebrovascular 115HeartDisease 73Cancer 113Respiratory 142InjuryandPoison 65Digestive 24Urogenital 9Tuberculosis 7Neonatal 697/numberofalivebirthEndocrine,Malnutrition Metabolic,Immunological 7Datasource:ChineseHealthStatisticalDigest,MOH,PRC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心脏就是这样“吸进”和“放出”血液，让血不停运转、循环的，由此，生命才能够得以生生不息的延续、发展。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DeterminantsofNormalCirculationPreloadAfterloadContractionHeartrateChamberstiffnessOxygenconsumptionCoronarybloodsupplyClinicalHistoryChestpainSyncopeFatigueDyspneaPalpitationFeverCyanosisEdemaDizziness...... Locationandradiation Timeandduration Frequency Exertationoratrest Beforeoraftermeal Weather(coldwinter) Relatedmedication ......SymptomsCharacteristicsRiskfactors Hypertension Dyslipidemia Smoking Physicalinactive Diabetesmellitus Infection Stress Familyhistory ......PhysicalExamination Inspection:Generalstatus,cyanosis,dyspnea...... Palpation:Pulse,frequency,extrasystoli,edema,apical impulse,thrill...... Percussion:Marginoftheheart Auscultation: Heartrate Cardiacrhythm Cardiacsound Extracardiacsound(Galloprhythm,openingsnap,pericardialknock) Cardiacmurmur(systolic,diastolic,continuous)LaboratoryExamination BloodWBC,RBC,thrombocytesESR,CRP, INR,TPT,CK-MB,Troponin-I,AST,LDHLipidGlucoseElectrolytesBloodgas Urine:Protein,RBC,......SurfaceECGElectrogram(Holter)andElectrophysiologyIntracardiacECGCardiovascularImaging X-Ray,CT,MRI Echo-andDopplercardiography RadioactiveNuclearimaging,PET Catheterization,angiographyCardiovascularImaging RadioactiveNuclearimagingIntravascularUltrasoundImaginePreventiveCardiovascularMedicineA:AspirinACEIB:B-blockerBPC:CholesterolCigarettequittingD:DiabetesControlDietE:ExerciseEducationConventionalTherapy Behaviorandpsychotherapy(TypeAandTypeBbehavior) Medication Dosage i.v,oral,i.m. Time Frequency Druginteractions ...... Antihypertensive Lipid-lowering Antidiabeticagents Vasodilators Diuretics Digitalis Antiarrhythmics ......UsageSideeffectsDrugs Hypotension Long-QT Proarrhythmia Disturbanceofelectrolytes Demagingofrenalandliverfunction Tachy-andBradycardia ........InterventionalTherapyAndreasGrüntzig,performedhisfirstcoronaryangioplastyprocedureinZurich,Switzerlandin1977;movedtotheUnitedStatestojointhefacultyofEmoryUniversityin1980,diedinaplanecrashinMonroeCounty,GeorgiaonOctober27,19851984选择性冠状动脉造影：诊断冠心病的金标准冠心病的介入治疗插入导引钢丝至冠脉病变处球囊扩张球囊扩张术后经皮冠状动脉腔内成型术(PTCA)冠心病的介入治疗InterventionalTherapyAMIPTCAStenting术前球囊扩张InterventionalTherapy植入支架术后InterventionalTherapyCoronaryinterventionsinEurope02505007501000125015009092949698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)NumberofInterventionalProceduresCatheterAblationAblationofVTRFduringVT 3seconds PacemakertherapyX-ray.MedtronicAttainLVleadinmid-lateralveinwithInSyncdevice.CardiacResynchronizationICDTherapyICD-Secondaryprevention:Meta-Analysis(AVID,CIDS,CASH)NumberatriskICD:934715467273159104934715467273159104Amio:9326644272481288293266442724812882YearsYearsAmioICDAmioICD5040302010050403020100012345012345ConnollySJ.EurHeartJ2000;21:2071DeathRhythmogenicdeathProgressandPerspectivesAngiogenesis Implantationofself(autologous)bonemarrowstemcellsisarelativelysimplemethodforangiogenesiswithoutcausingtoxicityorimmunologicalrejectionIsnerJM,etal.JClinInvest1999;103:1231-6ProgressandPerspectivesBoneMarrowCellsRegenerateInfarctedMyocardiumOrlicetal.Nature2001;410:701Lin-c-kitPOSBMCfromtransgenicmiceinjectedintheperi-infarctedleftventricleoffemalemiceaftercoronaryligationNewlyformedmyocardiumoccupied68%oftheinfarctedportionoftheventricle9daysaftertransplantingthebonemarrowcells.DevelopingtissuecomprisedproliferatingmyocytesandvascularstructuresA.BonemarrowcellsandmyocardialregenerationB.MyocardialrepairandconnexinProgressandPerspectivesSubstratemappingandlinearablationofVTProgressandPerspectivesMagnetguidingsystem 防止动脉粥样硬化控制危险因素:高血脂、高血压、糖尿病、吸烟、肥胖… 冠心病的药物和介入治疗药物支架:促进介入治疗后修复、消除内膜过度增生 射频消溶是根治快速性心律失常的里程碑 对终末期冠心病、心力衰竭Angiogenesis：促进血管新生Myogenesis：Stemcelltransplant，…小结MajorCausesofDeath:ChinaMUCAStudy1991-1995surveillancedatain1.5millionpopulation,usingMONICAprocedureWomenMenMajorCausesofCardiovascularDeath:ChinaMUCAStudy1991-1995surveillancedatain1.5millionpopulation,usingMONICAprocedureWomenMenIHDMortalityinUrbanandRuralChina,1988-96Rateper100,000forages35-74AdjustedtoWorldPopulationYearRateFromNationalHealthStatisties,MOPH,ChinaTheHeartandvesselsMyocardiumCoronaryarteriesConductionsystemValvesPericardiumArteriesVeinsCapilaries大家一定还记得这些艺术家的音容笑貌心脏就是这样“吸进”和“放出”血液，让血不停运转、循环的，由此，生命才能够得以生生不息的延续、发展。