acs急性冠脉综合症[].pptVIP

5/98 MedS  急性冠脉综合征（ACS）及其 治疗进展 国际现状 每年: 4 million patients are admitted with unstable angina and acute MI 900,000 patients undergo PTCA with or without stent Ischemic Heart Diseaseevaluation Based on the patient’s history / physical exam electrocardiogram Patients are categorized into 3 groups non-cardiac chest pain unstable angina myocardial infarction 急性冠脉综合征（ACS） Acute Coronary Syndrome The spectrum of clinical conditions ranging from: unstable angina non-Q wave MI Q-wave MI characterized by the common pathophysiology of a disrupted atheroslerotic plaque 不稳定心绞痛 – 定义 angina at rest ( 20 minutes) new-onset ( 2 months) exertional angina (at least CCSC III in severity) recent ( 2 months) acceleration of angina (increase in severity of at least one CCSC class to at least CCSC class III) Non-Q-Wave MIclues to diagnosis Prolonged chest pain Associated symptoms from the autonomic nervous system nausea, vomiting, diaphoresis Persistent ST-segment depression after resolution of chest pain NSTEACS诱发因素 Inappropriate tachycardia anemia, fever, hypoxia, tachyarrhythmias, thyrotoxicosis High afterload aortic valve stenosis, LVH High preload high cardiac output, chamber dilatation Inotropic state sympathomimetic drugs, cocaine intoxication NSTEACS预后预测因素 Presence of ST-T-wave changes with pain Hemodynamic deterioration pulmonary edema, new mitral regurgitation, 3rd heart sound, hypotension Other predictors left ventricular dysfunction, extensive CAD, age, comorbid conditions (diabetes mellitus, obstructive pulmonary disease, renal failure, malignancy) 非ST段抬高ACS（NSTEACS） Plaque disruption斑块破裂 Acute thrombosis急性血栓 Vasoconstriction血管收缩 NSTEACSpathogenesis 斑块破裂 Passive plaque disruptionsoft plaque with high concentration of cholesteryl esters and a thin fibrous cap Active plaque disruptionmacrophage-rich area with enzymes that may degrade and weaken the fibrous cap; predisposing it to rupture NSTEACS pathogenesis 急性血栓 Vulnerable plaque disrupted plaque wit