心绞痛 1课件.ppt

Chapter 28 Antianginal drugs Section I Introduction Angina pectoris Definition Angina pectoris is a primary symptom of myocardial ischemia, which is the severe chest pain that occurs when coronary blood flow is inadequate to supply the oxygen required by the heart. Angina pectoris Typical Symptom Substernal pains described as pressure , heaviness, tightness burning, or numbness, often radiate to the left shoulder and the inner surface of the left arm. Classifications of angina (WHO) 1. Angina pectoris of effort (劳累性心绞痛, Classic angina) 2. Angina pectoris at rest (自发性心绞痛) 1.Angina pectoris of effort （劳累性心痛） ① Stable angina pectoris (稳定型心绞痛) ② Initial onset angina pectoris (初发型心绞痛) ③ Accelerated angina pectoris (恶化型心绞痛) 2. Angina pectoris at rest (自发性心绞痛) ①Angina decubitus (卧位型心绞痛) ②Prinzmetal’s variant angina pectoris (变异型心绞痛) ③Acute coronary insufficiency (急性冠状动脉功能不全) ④Postinfarction angina (梗死后心绞痛) 3. Mixed type angina pectoris (混合性 心绞痛) Clinical Classifications of angina Stable angina pectoris Unstable angina pectoris 1.Stable angina Occurs when the heart works harder Episodes of pain tend to be alike Usually lasts a short time Is relieved by a rest or angina medicine Is caused by narrowed arteries due to atherosclerosis 2.Unstable angina(不稳定型) Is caused by atherosclerotic plaque or platelet aggregation occurring in the vicinity of an atherosclerotic plaque. Is caused by episodes of vasospasm of coronary artery. Therapeutic: Decrease cardiac load and vasospasm of coronary arteries Inhibit platelet aggregation and thrombus formation Pathophysiology of angina Imbalance between myocardial oxygen supply (available) and oxygen consumption (requirement). Pathophysiology 心肌供氧和耗氧主要影响因素及药物作用 影响因素 药物作用 供氧 氧的摄取率 冠脉血流量 扩张冠脉，增加供血 耗氧 心室壁张力 扩张外周血管，↓心脏负荷 心率 抑制心脏，减慢心率 心肌收缩力 减弱心肌收缩力 T