Download IMPACT OF CARDIOVASCULAR DISEASE

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
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
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
Epidemiology
Risk Factors
CHD
Stroke
PAD
Advanced age
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Male gender
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Cigarette smoking
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Hypertension
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High LDL cholesterol
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Low HDL cholesterol
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Triglycerides
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Diabetes mellitus
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Homocysteine
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Fibrinogen
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C-reactive protein
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Lp(a)
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Chlamydia pneumoniae
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ESTABLISHED
NEWER
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)
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
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
PHYSICAL EXAMINATION
Chest X-ray 胸片
• 心影大小
Pulmonary edema 肺水肿
ELECTROCARDIOGRAPHY
（ECG）心电图
Ambulatory ECG (Holter)
动态心电图
Indications: to diagnose arrhythmia
• Patients with unexplained syncope,near
syncope, 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
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
capacity is limited by cardiac disease.
……
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6080ms)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
ECHOCARDIOGRAPHY （ECHO)
超声心动图
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Transthoracic echocardiography (TTE)
Transesophageal echocardiography (TEE)
Handheld echocardiography
Contrast echocardiography
Three-dimensional echocardiography
Stress echocardiography
NUCLEAR CARDIOLOGY 核素检查
COMPUTED TOMOGRAPHY
ANGIOGRAPHY (CTA)
CARDIOVASCULAR MAGNETIC
RESONANCE IMAGING 心血管磁共振
Coronary Angiography (CAG)
冠状动脉造影
THANKS