1. 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

2. 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

3. 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

4. Epidemiology

5. Risk Factors CHDStrokePAD 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+++

6. 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)

7. 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

8. 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

9. PHYSICAL EXAMINATION

10. Chest X-ray 胸片 心影大小

11. Pulmonary edema 肺水肿

12. ELECTROCARDIOGRAPHY （ ECG ）心电图

13. 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

14. 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. ……

15. 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

16. ECHOCARDIOGRAPHY （ ECHO) 超声心动图 Transthoracic echocardiography (TTE) Transesophageal echocardiography (TEE) Handheld echocardiography Contrast echocardiography Three-dimensional echocardiography Stress echocardiography

18. NUCLEAR CARDIOLOGY 核素检查

19. COMPUTED TOMOGRAPHY ANGIOGRAPHY (CTA)

20. CARDIOVASCULAR MAGNETIC RESONANCE IMAGING 心血管磁共振

21. Coronary Angiography (CAG) 冠状动脉造影

22. THANKS