心血管系统疾病概述.ppt

More Thinking Less Testing McAllen Hospital Worse medicine; Fragmented care High-cost Low-quality ($15600/disease Rx) Profit (Quantity) driven Practitioner-orientated More testing less Thinking Mayo Clinic Best medicine Coordinated care Low cost high quality ($6688/disease Rx) Outcome (Quality) driven Patient-orientated More Thinking Less Testing New Yorker 2009 THANKS * * * Improvements in diagnosis, therapy, and prevention have contributed to a 70% or so decline in age-adjusted cardiovascular death rates in the United States since the 1960s. However, the absolute number of deaths from cardiovascular disease in the United States has not declined proportionately because of the increase in the population older than 40 years as well as the aging of the population in general. * CHF = congestive heart failure; DLCO = diffusing capacity of the lung for carbon monoxide; DVT = deep venous thrombosis. ? 左边2图，冠心病，白色心肌疤痕 右边上 致密化不全，海绵样结构，右下右心室发育不良心肌病（脂肪组织侵润右心室） * * * 左下支架内斑块破裂 其他可见支架内皮附着 * 右上图 获得性支架贴壁不良 * FFR-CTA 说到底一句话，道路漫长 很有前途，阴性预测高。 * 雅培的BVS其由多聚乳酸（Poly Lactide Acid）制成，可在植入体内2年间逐渐降解为水和二氧化碳。支架的花纹设计已经发展至第二代，为雅培的金属支架一直采用的、广受临床认可的MULTI-LINK设计。经测试，径向支撑力（对血管的支撑能力）与雅培的金属药物支架XIENCE V? 相似，但输送性和顺应性更佳，医生更容易将该支架送入患者弯曲的血管内。支架上带有的药物与XIENCE V?相同，即雷帕霉素的衍生物——依维莫司，药物释放曲线亦与XIENCE V?相似，药物在约120天内完全释放，可覆盖再狭窄的整个病理过程，防治再狭窄。而雅培的MULTI-LINK 和XIENCE V?支架是行业公认的金标准。 * ABSORB研究是一个前瞻性、开放标签、两个阶段的临床研究，在欧洲和澳洲的多个中心进行，主要研究者是Patrick W. Serruys和J Ormiston MD，该研究得出的结论是：ABSORB Cohort A随访3年仅有1例MACE（主要心血管不良事件），且无支架血栓事件，BVS继续保持着良好的疗效。 ABSORB Cohort B已经证实，植入BVS后不良事件发生率处于低水平，无支架血栓事件，6个月时的晚期管腔丢失与金属药物支架类似。该生物降解支架技术能使血管的完整性和功能得以恢复至自然状态，将为患者提供独特的生理收益。 TLR：POBA 21(38.9%) vs DEB 5(9.3%) MACE: POBA 32(59.3%) vs DEB 15(27.8%) * * * * * * PHYSICAL EXAMINATION Inspection and palpation the left ventricular apex systolic heaves or lifts thrills Percussion Heart border Ausculation heart sounds murmurs pericardial rubs General Appearance Ophthalmologic Examination Carotid Pulse Jugular Veins Cardiac examination Abdomen Skin