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Pandect of Cardiovascular Disease Second affiliated Hospital of Zhejiang University school of medicine Wang Jian ’ an
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Generality Cardiovascular system : Heart, vessels, nervous- fluid system, et al. Cardiovascular system : Heart, vessels, nervous- fluid system, et al. Function : transportation, neuroendocrine Function : transportation, neuroendocrine Cardiovascular disease : heart disease and vascular disease Cardiovascular disease : heart disease and vascular disease
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Classification 一、 Pathogenic Classitication (一) congenital heart&vascular disease A congenital heart defect (CHD) is a defect in the structure of the heart and great vessels of a newborn. A congenital heart defect (CHD) is a defect in the structure of the heart and great vessels of a newborn.
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Classification (二) Acquired heart&vascular disease AHD includs: AHD includs: 1 、 Atherosclerosis ; 2 、 Rheumatic Heart disease ; 3 、 Primary Hypertension ; 4 、 Pulmonary heart disease ; 5 、 Septic heart disease ; 6 、 Endocritic heart disease ; 7 、 Hemopathological heart disease ; 8 、 Nutritional and metabolic heart disease ; 9 、 Cardiovascular neurosis ; 10 、 Others
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Classification 二、 pathoanatomic classification 1 、 endocardic disease 1 、 endocardic disease 2 、 myocardial disease 2 、 myocardial disease 3 、 pericardial disease 3 、 pericardial disease 4 、 vascular disease 4 、 vascular disease 5 、 congenital malformation disease 5 、 congenital malformation disease
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Classification 三、 Pathophysiological Calssification 1 、 heart failure 1 、 heart failure 2 、 shock 2 、 shock 3 、 cononary dysfunction disease 3 、 cononary dysfunction disease 4 、 muscuil papillares dysfunction 4 、 muscuil papillares dysfunction 5 、 arrhythmia 5 、 arrhythmia 6 、 hyperdynamic circulation 6 、 hyperdynamic circulation 7 、 temaponade 7 、 temaponade 8 、 others 8 、 others
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Standard Diagnosis style Including: pathogenic, pathoanatomic and pathophysiological diagnosis. Including: pathogenic, pathoanatomic and pathophysiological diagnosis. example : example : Rheumatic Heart Disease Rheumatic Heart Disease Severe mitral stenosis with moderate insufficiency; Enlarged left atrium and ventricle Severe mitral stenosis with moderate insufficiency; Enlarged left atrium and ventricle Heart function III degree(NYHA) atrial Fibrillation Heart function III degree(NYHA) atrial Fibrillation
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051015202530 28.7 Atherosclerosis with thrombosis* 17.8 epidemics 12.6 Cancer 9.1 trauma 6 Pulmonary Disease 5.1 AIDS Atherosclerosis with thrombosis * the biggest case of death 1 † 1. The World Health Report, 2002, WHO Geneva mortality (%) (% all death)
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Time trend : Epidemological four periods (低发期)(上升期)(高峰期)(下降期) 死亡构成死亡构成 Developed Countries Such as : U.S.A Developing Countries Such as : China
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我国心血管疾病流行概况
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“No.1 Human Killer” Almost every 1 of 3 death in the real world is due to the Cardiovescular Disease.
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Diagnosis As other disease, the diagnosis of cardiovascular diseases need history, symptoms, signs, Lab examinations, device-based examinations, et al. As other disease, the diagnosis of cardiovascular diseases need history, symptoms, signs, Lab examinations, device-based examinations, et al.
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Examinations for Diagnosis 一、 invasive examinations Percutanious Coronary Intervention 、 Swan- Ganz catheter 、 eletrophysiological study 、 myocardical biopsy 、 inter-luminal\vascular echocardiography 、 cardiovascular endoscopy …… Percutanious Coronary Intervention 、 Swan- Ganz catheter 、 eletrophysiological study 、 myocardical biopsy 、 inter-luminal\vascular echocardiography 、 cardiovascular endoscopy ……
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Examination for Diagnosis 二、 non-invasive examinations 二、 non-invasive examinations ECG 、 ABPM 、 ECHO\Doppler 、 CT 、 CTA 、 MRI 、 MRA 、 ECT 、 DSA 、 PET 、 SPECT 。 ECG 、 ABPM 、 ECHO\Doppler 、 CT 、 CTA 、 MRI 、 MRA 、 ECT 、 DSA 、 PET 、 SPECT 。 Stress examinations Stress examinations
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J. Am. Coll. Cardiol. 2005;46;552-557
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功能学评价-活动平板
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功能学评价-应激超声
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应激超声 评价运动前后各心室 壁的活动情况,以判 断有无相应心肌缺血 评价运动前后各心室 壁的活动情况,以判 断有无相应心肌缺血 可以用腺苷等药物替 代运动( 8 ~ 10 分钟 ) 可以用腺苷等药物替 代运动( 8 ~ 10 分钟 ) 可以加用超声造影剂 更好的显像 可以加用超声造影剂 更好的显像 操作过程可参考活动 平板的运动试验方案 操作过程可参考活动 平板的运动试验方案
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功能学检查- SPECT 与 PET
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可以同时进行运动试验
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Prognosis Quite different according to the disease and the stage
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What ancient Chinese doctors did about preventive medicine …… 是故圣人不治已病治未病,不治已乱治 未乱,此之谓也。夫病已成而后药之,乱 已成而后治之,譬犹渴而穿井,斗而铸锥, 不亦晚乎!(《素问 · 四气调神大论》)
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Risk factors hypertension hypertension Smoking Smoking Age ( Main Risk Factors ) Age ( Main Risk Factors ) gender gender familial history familial history Diabetes and insulin resistance ( Risk Equivalents ) Diabetes and insulin resistance ( Risk Equivalents ) mallipodemia mallipodemia Obesity and overweight Obesity and overweight Lack exercise Lack exercise Serum fibrinogen Serum fibrinogen Region and race Region and race Others, Others,
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Preventive medicine 一、 pathogenic therapy 二、 anatomic therapy 三、 pathophysiological therapy 四、 Rehabilitation
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Up to Date New Theories New Theories New Diagnosis New Diagnosis methods methods New therapy New therapy new medicine new medicine new device-based new device-based therapy therapy
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