冠心病英文课件.ppt

Coronary Angiography Braunwald classification of unstable angina Severity： Class I： New-onset, or accelerated severe angina no rest pain within 2 months Class II： Angina at rest, subacute angina at rest (within the preceding month but not within 48 h) Class III： Angina at rest, acute ( within the preceding 48 h) UAP and non-STEMI Braunwald classification of unstable angina Clinical Circumstances Class A：Secondary UAP a clearly identified condition extrinsic to the coronary vascular bed that has intensified myocardial ischemia, e.g. anemia, hypotension, tachy-arrhythmia Class B：Primary unstable angina Class C：Post-infarction UAP (within 2 weeks of a documented MI) UAP and non-STEMI mechanism： 1.plaque rupture and erosion, with nonocclusive thrombus 2.dynamic obstruction: Vasoconstruction 3.progressive mechnial obstruction(rapidly advancing or ISR following stenting) 4.secondary UA Inflammation Thrombogenesis UAP and non-STEMI ECG: Non-STEMI: ST depression last 12 hr Cardiac biomarkers of myocardium damage: cTnT, cTnI CK-MB UAP and non-STEMI Coronary angiography Angioscopy and IVUS Other laboratory tests Risk stratification：TIMI Risk Score Age =65yrs More than 3 coronary risk factors Prior angiographic coronary obstruction ST-segment deviation ?0.5 mm More than 2 angina events within 24 hours Development of UA/NSTEMI while on aspirin Elevated cardiac markers Antaman, JAMA 2000; 284:835-42 TIMI IIB, ESSENCE, PRISM-PLUS,TACTICS-TIMI18 UAP and non-STEMI Treatment 1.Genearl management: rest, oxygen, CCU 2. Drug therapy A. Anti-ischemic drug: intravenously, orally nitrates ?-blocker calcium[k?lsi?m] antagnoist: first choice for variant angina Morphine sulfate UAP and non-STEMI Treatment 2. Drug therapy: B. antithrombotic therapy a. Anti-platelet Aspirin: early, 300mg loading dose ADP-receptor antagonist: clopidogrel 300mg-600mg loading dose, 75 mg/d GP IIb/IIIa receptor inhibitor: used in pts planned to PCI b. Anticoagulation