内科学--冠心病心绞痛课件.ppt

Atherosclerosis is a complex disease. Atherosclerotic plaques can be subdivided in accordance with their age and state of development. It is the newly formed lesions with a large lipid core, thin capped, which are fragile and therefore likely to rupture and lead to an acute ischemic event. * Slide 3 Atherothrombosis: a Generalized and Progressive Process Atherothrombosis is the common underlying disease process for MI, ischemia and vascular death. ACS are classic examples of atherothrombosis (plaque rupture and thrombus formation). ACS (in common with ischemic stroke and critical leg ischemia) are typically caused by rupture or erosion of an atherosclerotic plaque followed by formation of a platelet-rich thrombus. Atherosclerosis is an ongoing process affecting mainly large and medium-sized arteries, which can begin in childhood and progress throughout a person’s lifetime. Stable atherosclerotic plaques may encroach on the lumen of the artery and cause chronic ischemia, resulting in (stable) angina pectoris or intermittent claudication, depending on the vascular bed affected. Unstable atherosclerotic plaques may rupture, leading to the formation of a platelet-rich thrombus that partially or completely occludes the artery and causes acute ischemic symptoms. * Slide 19 Overview of Unstable Angina Guidelines The new US and European guidelines for the management of unstable angina and non-Q-wave MI have recently been published. The two sets of guidelines are very similar, with some minor differences. Once acute ST-elevation MI has been excluded, patients should receive appropriate medical therapy including ASA, beta-blockers, nitrates and heparin. High-risk patients, including those with recurrent ischemia, elevated cardiac markers, hemodynamic instability or major arrhythmias should undergo angiography. High-risk patients should also receive an intravenous GP IIb/IIIa inhibitor. Low-risk patients should be managed with aggressive medical therapy and then under