冠心病英文版.pptVIP

Atherosclerosis Coronary heart diseasesZhengzhou University, First affiliated HospitalDept. of CardiologyHaiyu Li, M.D. Cardiovascular Diseases Atherosclerosis leading cause of death and disability mon location:Coronary circulation: Proximal left anterior descending coronary artery〔LAD〕Proximal portion of renal arteriesExtracranial circulation to the brainCarotid bifurcationAtherosclerosis Coronary heart diseaseatherosclerosisCoronary stenosiscoronary spasmMyocardial ischemia, anoxaemiaCoronary heart disease, CHDIschemic heart disease AtherosclerosisStable angina pectoris〔SAP〕Acute coronary syndromeUnstable angina〔UAP〕 and non-STEMI 〔UA/NSTEMI〕ST elevation myocardial infarction〔STEMI〕 Three fundamental biological processes of atherosclerosisAccumulation of intimal cells:smooth muscle cells MacrophagesT-lymphocytesProliferated connective tissue matrix : collagenelastic fibersproteoglycans3. Accumulation of lipid:cholesterol estersfree cholesterol Hypothesis of lipoprotein infiltrationAggregation of platelets and thrombosisClonal theory the response-to-injury hypothesis Atherosclerosis-Hypothesis Response-to-injury Atherosclerosis: hypothesisHigh blood pressure,bacterium,virus,toxin,ox-LDL,immune factor,vasoactive substanceendothelium damage and dysfunction〔vasoactive substance, adhesion and aggregation of monocytes-foam cell, platelets〕Lipidosis, growth factor, proliferation of smooth mucle cells, collagen, lipolytic enzyme, atherosclerosis Pathology and pathophysiologyFatty steakFibrous plaque plicated lesionAtherosclerosis Initiation of AtherosclerosisFatty steak formation Initiation of AtherosclerosisFatty steak formation Lipoprotein oxidation Nonenzymatic glycationLeukocyte recruitmentFoam cell formation Atheroma evolution: fibrous plaqueAtheroma evolution and plicationsVascular remodeling: pensatory enlargement Atheroma evolution:Involvement of arterial smooth-muscle cellsBlood coagulationmicrovesselsAtheroma evolution and plications 炎