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

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 ++ + ++

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 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

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. ……

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

ECHOCARDIOGRAPHY （ ECHO)

超声心动图• 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