山东大学《内科学》2015本科讲课.pptVIP

苏 国 海 山东大学博士生导师 二级教授 享受国务院特殊津贴 全国五一劳动奖章获得者 山东省有突出贡献的中青年专家 山东大学附属济南市中心医院副院长兼心内科主任 邮箱：guohaisu@ Atherosclerosis and Coronary Heart Disease  Jinan Central hospital Su guohai guohaisu@ 冠心病-人类灾难 “The Lower, the Better” 冠 心 病 CORONARY HEART DISEASE 济南市中心医院 苏国海 Location Quality Precipitating factors Duration Frequency Location (1) The discomfort of angina pectoris is most commonly felt beneath the sternum. Pain may radiate to the left shoulder and down the inside of the left arm, even to the fingers. It may radiate to the front or back of the neck, into the throat, the mandible , the jaws, the teeth and the neck. Location (2) Anginal discomfort may also be felt in the upper abdomen. Since it is seldom felt in the region of the cardiac apex, the patient who points to that precise area usually does not have angina. Quality Chest pain likes such as strangling, constriction, tightness, squeezing, pressing, heaviness expanding sensation, choking in the throat or indigestion. The patient who describes fleeting, sharp sensations usually does not have angina. Precipitating factors The attacks are typically triggered by physical activity or emotional distress. It tends to occur during, rather than after, the exertion. Overeating, coldness, smoking, tachycardia, and shock can also evoke the attacks. Stable angina pectoris typically occurs in the similar circumstances. Duration Stable angina pectoris lasts only a short time, usually 3 to 5 minutes . It can be also relived by sublingual nitroglycerin during several minutes. Attacks may vary in frequency from several/day to occasional episodes separated by symptom-free intervals of weeks, or months. The physical examination is usually normal in patients with angina pectoris . Some transient findings that may be detected during the attack include atrial or ventricular gallop sounds, apical systolic murmur due to papillary muscle dysfuncti