cardiovascular disease 心血管疾病总论 王建安 浙江大学医学院附属第二医院
TRANSCRIPT
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CARDIOVASCULAR DISEASE心血管疾病总论
王建安浙江大学医学院附属第二医院
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IMPACT OF CARDIOVASCULAR DISEASE
• More than 70 million Americans are estimated to have one or more types of cardiovascular disease (CVD)
• 65 million have hypertension• 13 million have coronary heart disease (CHD)• 5.4 million have had a stroke• More than 8 million Americans have peripheral
artery disease (PAD)• Overall, about one in four Americans currently
have some forms of CVD
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IMPACT OF CARDIOVASCULAR DISEASE
• CVD contributes to about 1.4 million deaths annually in the United States, or 40% of all deaths
• Approximately 32% of CVD deaths occur prematurely (i.e., in persons <75 years old)
• Each year, about 1.2 million Americans have a new or recurrent myocardial infarction (MI), and more than 40% of these events are fatal
• The annual incidence of new or recurrent stroke is about 700,000 per year, and about 275,000 Americans die from a stroke each year
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Epidemiology
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Risk Factors CHD Stroke PAD
ESTABLISHED
Advanced age +++ ++++ ++++
Male gender ++ + +
Cigarette smoking +++ + ++++
Hypertension ++ ++++ ++
High LDL cholesterol ++ + +
Low HDL cholesterol +++ + +++
Triglycerides ++ + +++
Diabetes mellitus +++ + ++++
NEWER
Homocysteine ++ ++ +++
Fibrinogen ++++ ++ +++
C-reactive protein ++++ ++ ++
Lp(a) ++ ++ +++
Chlamydia pneumoniae ++ + ++
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SYMPTOMS OF CARDIOVASCULAR DISEASE
• Chest pain or discomfort
• Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, wheezing
• Palpitations, dizziness, syncope
• Cough, hemoptysis
• Fatigue, weakness
• Pain in extremities with exertion (claudication)
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History matters!
Chest pain• Provocative and Palliative factors: What
makes better or worse?• Quality: Visceral vs. somatic• Region and Radiation: Central, left, or right
To Back, neck, arm• Severity: Scale of 1-10• Timing: Gradual or sudden onset• Associated symptoms: SOB, sweating, nausea
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Complete medical history
• A thorough review of systems• Family history
– premature atherosclerosis– familial abnormalities, such as the long QT syndrome
or hypertrophic cardiomyopathy
• Social history– cigarette smoking– alcohol intake– use of illicit drugs
• Past medical history
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PHYSICAL EXAMINATION
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Chest X-ray 胸片• 心影大小
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Pulmonary edema 肺水肿
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ELECTROCARDIOGRAPHY ( ECG )心电图
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Ambulatory ECG (Holter) 动态心电图
Indications: to diagnose arrhythmia• Patients with unexplained syncope,near sy
ncope, or episodic dizziness in whom the cause is not obivious.
• Patients with unexplained recurrent palpitation
• To assess antiarrhythmic drug response.To diagnose silent myocardial ischemia• Transient ST segment depression
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Treadmill ECG stress testing活动平板检查
Mainly used to estimate the likelihood and extent of coronary artery disease.
主要用于诊断冠心病
Exercise protocol: 运动方案• Standard Bruce protocol• Modified Bruce protocol Designed for older patients whose exercise c
apacity is limited by cardiac disease. ……
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Treadmill ECG stress testing活动平板检查
Test result 检查结果• Positive 阳性 运动中出现典型心绞痛,心动图提示 ST 段
水平型或下斜型压低 >=0.1mv(J 点后 60-80ms) 持续 2 分钟为运动试验阳性标准
• False positive 假阳性• Negative 阴性• False negative 假阴性
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ECHOCARDIOGRAPHY ( ECHO)
超声心动图• Transthoracic echocardiography (TTE)
• Transesophageal echocardiography (TEE)
• Handheld echocardiography
• Contrast echocardiography
• Three-dimensional echocardiography
• Stress echocardiography
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NUCLEAR CARDIOLOGY 核素检查
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COMPUTED TOMOGRAPHY ANGIOGRAPHY (CTA)
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CARDIOVASCULAR MAGNETIC RESONANCE IMAGING 心血管磁共振
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Coronary Angiography (CAG)冠状动脉造影
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