內科學-循環(huán)系統(tǒng)總論課件

葛均波復旦大學中山醫(yī)院，上海市心血管病研究所心血管系統(tǒng)疾病內科學循環(huán)系統(tǒng)總論2005年７月２日晚，成功扮演“毛澤東”的特型演員古月在廣東省三水區(qū)因突發(fā)大面積心肌梗死，搶救無效去世，享年66歲。2005年8月17日晚，著名表演藝術家高秀敏在長春的家中因心臟病突發(fā)辭世，享年46歲。名人的意外事件內科學循環(huán)系統(tǒng)總論名人的意外事件2006年12月20日上午，著名相聲表演藝術家馬季因心臟病逝世，享年72歲。2007年著名相聲表演藝術家侯耀文因突發(fā)心臟病被送往北醫(yī)三院，經搶救無效去世，享年59歲。內科學循環(huán)系統(tǒng)總論Yalta,Febr.1945內科學循環(huán)系統(tǒng)總論DiastolicandSystolicArterialPressureofFranklinD.Rooseveltfrom1935untilHisDeathonApril12,1945F.Messerli:NewEnglandJournalofMedicine332:1038-1039,April13,1995選舉內科學循環(huán)系統(tǒng)總論HeadlinesoftheSt.LouisPost-Dispatch,April13,1945F.Messerli:NewEnglandJournalofMedicine332:1038-1039,April13,1995內科學循環(huán)系統(tǒng)總論10TopCausesofDeathinUrbanChina2000CauseofDeath Mortality/100000Circulatory

235Cerebrovascular 128HeartDisease 107Cancer

146Respiratory 79InjuryandPoison 36Digestive 18Endocrine,MalnutritionMetabolic,Immunological 18Urogenital 9Psychosis 7Neurological 6內科學循環(huán)系統(tǒng)總論10TopCausesofDeathinRuralChina2000CauseofDeath

Mortality/100000Circulatory 189Cerebrovascular 115HeartDisease 73Cancer

113Respiratory

142InjuryandPoison

65Digestive

24Urogenital

9Tuberculosis 7Neonatal

697/numberofalivebirthEndocrine,Malnutrition Metabolic,Immunological

7Datasource:ChineseHealthStatisticalDigest,MOH,PRC內科學循環(huán)系統(tǒng)總論人心血管病流行狀況

——中國心血管病報告20052002年調查估計，我國每年心腦血管病新發(fā)及患病的病例數內科學循環(huán)系統(tǒng)總論心臟的工作各部，同時從肺部吸取新鮮血液，以便供左心室下一次收縮使用；右心室吸進從靜脈來的、帶有大量廢物和二氧化碳的血液，這種不新鮮的血通過右心房運送到肺部，在肺部吸收氧氣排出二氧化碳后，又變?yōu)轷r血流入左心房。心臟和與它相連的大血管組成一個密閉的管道網——血液循環(huán)系統(tǒng)。心臟工作起來就像一只泵，收縮時將左心室里富含氧氣和營養(yǎng)物質的鮮血“壓”到主動脈去，通過動脈輸送到身體MyocardiumCoronaryarteriesConductionsystemValvesPericardiumArteriesVeinsCapilaries內科學循環(huán)系統(tǒng)總論心臟疾病心臟病是人類健康的頭號殺手全世界約1/3的人口死亡是因心臟病引起的我國每年約有250-300萬人死于心臟病內科學循環(huán)系統(tǒng)總論PreloadAfterloadContractionHeartrateChamberstiffnessOxygenconsumptionCoronarybloodsupply

DeterminantsofNormalCirculation內科學循環(huán)系統(tǒng)總論

ClinicalHistoryLocationandradiationTimeanddurationFrequencyExertationoratrestBeforeoraftermealWeather(coldwinter)Relatedmedication......SymptomsChestpainSyncopeFatigueDyspneaPalpitationFeverCyanosisEdemaDizziness......

CharacteristicsRiskfactorsHypertensionDyslipidemiaSmokingPhysicalinactiveDiabetesmellitusInfectionStressFamilyhistory......

內科學循環(huán)系統(tǒng)總論

PhysicalExaminationInspection:Generalstatus,cyanosis,dyspnea......Palpation:Pulse,frequency,extrasystoli,edema,apical impulse,thrill......Percussion:MarginoftheheartAuscultation:

HeartrateCardiacrhythmCardiacsoundExtracardiacsound(Galloprhythm,openingsnap,pericardialknock)Cardiacmurmur(systolic,diastolic,continuous)內科學循環(huán)系統(tǒng)總論

LaboratoryExaminationBloodWBC,RBC,thrombocytesESR,CRP, INR,TPT,CK-MB,Troponin-I,AST,LDHLipidGlucoseElectrolytesBloodgasUrine:Protein,RBC,......內科學循環(huán)系統(tǒng)總論

Electrogram(Holter)andElectrophysiology

SurfaceECG

IntracardiacECG內科學循環(huán)系統(tǒng)總論

CardiovascularImagingX-Ray,CT,MRIEcho-andDopplercardiographyRadioactiveNuclearimaging,PETCatheterization,angiography內科學循環(huán)系統(tǒng)總論

CardiovascularImagingRadioactiveNuclearimaging內科學循環(huán)系統(tǒng)總論

IntravascularUltrasoundImagine內科學循環(huán)系統(tǒng)總論PreventiveCardiovascularMedicineA:AspirinACEIB:B-blockerBPC:CholesterolCigarettequittingD:DiabetesControlDietE:ExerciseEducation內科學循環(huán)系統(tǒng)總論

ConventionalTherapyBehaviorandpsychotherapy(TypeAandTypeBbehavior)MedicationDosagei.v,oral,i.m.TimeFrequencyDruginteractions......AntihypertensiveLipid-loweringAntidiabeticagentsVasodilatorsDiureticsDigitalisAntiarrhythmics......UsageSideeffectsDrugsHypotensionLong-QTProarrhythmiaDisturbanceofelectrolytesDemagingofrenalandliverfunctionTachy-andBradycardia........內科學循環(huán)系統(tǒng)總論

InterventionalTherapyAndreasGrüntzig,performedhisfirstcoronaryangioplastyprocedureinZurich,Switzerlandin1977;movedtotheUnitedStatestojointhefacultyofEmoryUniversityin1980,diedinaplanecrashinMonroeCounty,GeorgiaonOctober27,19851984內科學循環(huán)系統(tǒng)總論內科學循環(huán)系統(tǒng)總論內科學循環(huán)系統(tǒng)總論

InterventionalTherapyAMIPTCAStenting內科學循環(huán)系統(tǒng)總論術前球囊擴張

InterventionalTherapy內科學循環(huán)系統(tǒng)總論植入支架術后

InterventionalTherapy內科學循環(huán)系統(tǒng)總論CoronaryinterventionsinEurope02505007501000125015009092949698捷克西班牙土耳其希臘意大利波蘭立陶宛羅馬尼亞德國比利時法國荷蘭瑞典丹麥英國芬蘭YearBoersmaetal(eds).CardiovascularDiseasesinEurope.EuropeanRegistriesofCardiovascularDiseasesandPatientManagement.SophiaAntipolis,France:EuropeanSocietyofCardiology,1999手術病人數(/百)內科學循環(huán)系統(tǒng)總論內科學循環(huán)系統(tǒng)總論

CatheterAblationAblationofVTRFduringVT 3seconds 內科學循環(huán)系統(tǒng)總論

PacemakertherapyX-ray.MedtronicAttainLVleadinmid-lateralveinwithInSyncdevice.CardiacResynchronization內科學循環(huán)系統(tǒng)總論

ICDTherapyICD-Secondaryprevention:Meta-Analysis(AVID,CIDS,CASH)NumberatriskICD:934715467273159104934715467273159104Amio:9326644272481288293266442724812882YearsYearsAmioICDAmioICD5040302010050403020100012345012345ConnollySJ.EurHeartJ2000;21:2071DeathRhythmogenicdeath內科學循環(huán)系統(tǒng)總論

ProgressandPerspectivesAngiogenesisImplantationofself(autologous)bonemarrowstemcellsisarelativelysimplemethodforangiogenesiswithoutcausingtoxicityorimmunologicalrejectionIsnerJM,etal.JClinInvest1999;103:1231-6內科學循環(huán)系統(tǒng)總論

ProgressandPerspectivesBoneMarrowCellsRegenerateInfarctedMyocardium

Orlicetal.Nature2001;410:701

Lin-c-kitPOSBMCfromtransgenicmiceinjectedintheperi-infarctedleftventricleoffemalemiceaftercoronaryligation

Newlyformedmyocardiumoccupied68%oftheinfarctedportionoftheventricle9daysaftertransplantingthebonemarrowcells.DevelopingtissuecomprisedproliferatingmyocytesandvascularstructuresA.BonemarrowcellsandmyocardialregenerationB.Myocardialrepairandconnexin內科學循環(huán)系統(tǒng)總論

ProgressandPe