ACS Microsoft PowerPoint 演示文稿ppt课件.ppt

诊断:冠状动脉粥样硬化性心病 急性下壁心肌梗死 原发性心脏骤停 心肺复苏术后 I度房室传导阻滞 Killip’s Ⅳ级 * * 小 结 胸痛乃常见症状，心血管急诊占较大比例 危及生命的胸痛：ACS、肺栓塞、急性主动脉夹层、气胸 鉴别诊断：临床特点＋重要辅助检查检验 四种危重症胸痛的诊断要点 胸痛“快速通道” 5个关键部分 * * * * * * * * * * * * * * LDL-C是动脉粥样硬化的病因，是冠心病的首要危险因素。因此，坚持他汀治疗至关重要，如果停药3个月，LDL-C水平即可恢复到治疗前水平，斑块的发生、发展、不稳定斑块破裂、引发事件这一系列变化又会重新开始。 * 动脉粥样硬化性疾病是系统性、进展性疾病。我们刚才提到，LDL-C进入内皮是整个链条的开始，LDL-C是动脉粥样硬化的启动因子。 LDL进入内皮下，吸引单核细胞进入血管壁，并引发一系列炎症反应，单核巨噬细胞吞噬氧化的LDL，形成泡沫细胞，泡沫细胞死亡后释放游离的LDL，形成脂质核心。 平滑肌细胞的移行和增殖以及纤维组织的沉积使斑块体积不断增大，并引起结构的变化使斑块被纤维帽覆盖。当斑块破裂时，脂质核心里的致血栓物质就被暴露在血液中，引起急性血栓栓塞，造成心肌梗死甚至猝死。1,3 References: 1. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105:1135-1143. 2. Al Suwaidi J, Hamasaki S, Higano ST, et al. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation. 2000;101:948-954. 3. Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med. 1999;340:115-126. 4. Libby P. Current concepts of the pathogenesis of the acute coronary syndromes. Circulation. 2001;104:365-372. * This graphic illustrates the history of plaque formation. Early lesions in the form of isolated macrophage foam cells may occur in infancy. Lipid accumulation can then lead to a fatty streak. Next, lipids accumulate in the extracellular space within the vessel wall. After age 30, an atheroma or visible lipid core may develop. Note that at this point, plaque growth is marked primarily by lipid accumulation. From age 40 on, we can see more fibrous plaques, which depend on the growth of a matrix of smooth muscle cells and collagen over the atheromatous core. Finally, if unstable, plaques may erode or rupture. Once the contents of the plaque are exposed to blood, platelet activation and thrombosis may occur. Stary, et al. Circulation. 1995;92:1355-1374. * * Slide 16 Yeghiazarians Y, Braunstein JB, Askari A, Stone PH. Unstable angina pectoris. N Engl J Med. 2000;342:101-114. *