第19章治疗冠心病药物课件.pptVIP

第19章 治疗冠心病药物Agents to treat CHD;coronary heart disease Background: IHD is the leading single cause of death in the US and is responsible for 1 of every 4.8 deaths. About half of the patients with IHD initially present with chronic stable angina. IHD manifests as an imbalance in myocardial oxygen supply and demand that results in myocardial hypoxemia. IHD is usually due to atherosclerotic disease of the coronary arteries (coronary heart disease [CHD] and coronary artery disease [CAD])。;病因学Etiology ;Risk Factors ;Cigarette smoking Alcohol abuse Diets high in animal fat and calories and low in fruits, vegetables, and fiber Diets low in polyunsaturated fatty acids Diets high in trans fats (Willett et al, 1993) Poor stress management High blood levels of insulin Decreased oxidative radical antioxidant capacity (ORAC) (Fazendas et al, 2000) Diabetes mellitus Hypertension Hypothyroidism Marital stress (Orth-Gomer, 2002) ;1．动脉粥样硬化与冠心病 动脉粥样硬化是冠心病的病理基础。 胆固醇等脂质沉着在大中动脉血管壁，形成粥样斑块，尤其在动脉分叉处。在心外膜下中等动脉分支的内膜下胆固醇沉着，管腔内新月形隆起，表面为纤维帽，含增殖平滑肌、胶原、脂质及泡沫细胞，内膜下形成坏死区，含胆固醇结晶、胆固醇酯，钙盐等。 冠脉狭窄为偏狭窄，开始为新月形，狭窄50%为轻度，对供血影响不大，无明显症状；狭窄50%-70%为重度，供血大减，可出现心绞痛。若管腔被血栓迅速阻塞，可产生急性心肌梗死。 冠脉痉挛亦导致缺血性心脏病，可造成心绞痛（如变异型心绞痛），甚至心肌梗死。;Pathophysiology ;影响心肌耗氧量的影响;Factors that Affect Myocardial Oxygen Demand;Treatment;抗血栓形成;Start all patients with suspected coronary artery disease (CAD) or ischemic heart disease (IHD) on aspirin (75 to 150 milligrams [mg] one time a day), unless contraindicated Aspirin reduces the risk of adverse cardiovascular events by 25% to 33% in patients with stable angina. Clopidogrel (75 mg a day) appears to be as effective as aspirin, but it is much more expensive; it is recommended for patients with contraindication(s) to aspirin ;缓解心绞痛Three categories of agents are used in the treatment of angina;3. Beta-adrenergic antagonists (decrease heart rate, decrease contractility, decrease afterload due to decrease in cardiac output, may inhibit platelet aggregation) ;硝酸酯及亚硝酸酯;Beta-