循环系统疾病总论 Overview of circulatory system diseases (cardiovascular diseases) 南方医科大学第二临床学院心内科 副主任 吴宏超 博士 主任医师 副教授 手机　13922708396 E-Mail wuhc@163.com I am glad to have the chance to study circulatory system diseases with my students. Now, let’s have an Overview of circulatory system diseases. It is also called cardiovascular diseases. Before giving the lecture, let me introduce myself briefly. My name is . I will not say my age. It is not important. My telephone number is . It is important. If you have any questions, please send short message or email to me after class.

循环系统 循环系统组成：心脏、血管和调节血液循环的神经体液装置 循环系统主要功能：① 为全身组织器官运输血液，通过血液将氧、营养物质和激素等供给组织；② 将组织代谢废物运走，以保证人体正常代谢的进行；③ 内分泌功能：心肌细胞和血管内皮细胞可分泌心钠素、内皮素、EDRF等。

年代 心血管病死亡率 （死亡人数/10万） 占总死亡的百分数 （%） 排位 50 47.2 6.61 5 60 36.05 6.72 70 115.74 19.49 2 80 119.34 21.49 1 2000 236.08 38.45 目前我国每年约有300万人死于心血管病

第一杀手 cardiovascular disease is the NO. 1 killer Half of the old people have hypertension Cardiovascular diseases remain the most common causes of death, responsible for 40% of all deaths, almost 1 million deaths each year. cardiovascular disease is the leading cause of death in most of the developed countries cardiovascular disease is very common in the world. For example, about Half of the old people have hypertension, that is high blood pressure. Every year, about 1,700 million people dead from various kinds of diseas, such as cancer, cerebral disease, traffic accident and also suicide. cardiovascular disease is the leading cause of death in the world, about 1/3 of the deaths are resulted from cardiovascular disease. So it is the number one killer.

心血管病分类 病因分类： 病理解剖分类：心内膜、心肌、心包及大血管等疾病 先天性：心脏及大血管在胎儿期发育异常所致 后天性：出生后心脏受外来或机体内在因素作用致病 病理解剖分类：心内膜、心肌、心包及大血管等疾病 病理生理分类：心力衰竭、休克、冠状循环功能不全、乳头肌功能不全、心律失常、高动力循环状态及心脏压塞等

不同病因心血管病的流行病学 50 9.89 60 15.69 70 20.90 80 23.54 90 24.24 常见病种排序（前六位） 年代 心血管病占内科住院病人百分数（%） 常见病种排序（前六位） 50 9.89 风心病、高心病、梅心病、肺心病、冠心病、先心病 60 15.69 风心病、冠心病、先心病、肺心病、高心病、梅心病 70 20.90 风心病、冠心病、先心病、肺心病、心肌炎、心律失常 80 23.54 冠心病、风心病、先心病、心肌炎、心律失常、高心病 90 24.24 冠心病、心律失常、风心病、高心病、心肌炎、心肌病、先心病、肺心病、心包炎

心血管病的表现 manifestation of cardiovascular diseases 症状symptoms 体征signs 实验室检查 laboratory testing 无创性noninvasive diagnostic testing 有创性invasive diagnostic testing What’s the manifestation of cardiovascular disease. What does it look like? we can find it by these characteristics. Symptoms: discomforts of the patient, for example chest pain. Signs: abnormality found by doctor in the body of the patient, for example hypertension laboratory testing: take some blood sample, or urine sample to test the problem. diagnostic testing, X-ray

常见症状 common symptoms----dyspnea 多数无特异性 劳力性呼吸困难 Exertional Dyspnea 夜间阵发性呼吸困难 Paroxysmal nocturnal Dyspnea 端坐呼吸 Orthopnea Dyspnea Indicates Heart failure Other respiratory system symptoms 紫绀 Cyanosis、 咳嗽(Cough) 咯痰(Sputum)、咯血(Hemoptysis) Let us have a look at the common symptoms of cardiovascular diseases. One of the common symptoms is dyspnea. That is to have difficulty to breath. There are three kinds of dyspnea. Exertional dyspnea -----dypnea is resulted from physical activity. Paroxysmal nocturnal dypnea ------ shortness of breath happened suddenly at midnight. The patient must sit up for breathing. After a while, when dyspnea was relieved, went back to sleep. Orthopnea dyspnea ----- the patient is forced in sitting up position for breathing..

胸痛Chest pain 胸闷chest discomfort 特点： The location is usually retrosternal胸骨后 or left precordial心前区. The pain may radiate 放散 to throat ,lower jaw, shoulders, inner arms, upper abdomen 临床意义： Myocardial ischemia 心肌缺血 Myocardial infarction 心肌梗死 Myocarditis 心肌炎 Pericarditis 心包炎 Chest pain and chest discomfort is another common symptom of cardiovascular disease.

心悸palpitation, 头痛headache, 头昏或眩晕dizziness, 晕厥syncope Palpitations----arrhythmia心律失常 Tachycardia心动过速 Bradycardia心动过缓 Premature beat早搏 Headache, dizziness----hypertension Syncope----arrhythmia, hypotension There are other symptoms. Palpitation: awareness of heart beat give the signal of arrhythmia, irregular heat beats. Tachycardia: heart rate is faster. Bradycardia: heart rate is slower Premature beat: heart beats earlier. Syncope: transient loss of consciousness for a short time Syncope implies arrhythmia, hypotension

体征signs of heart disease 多数具有特异性诊断价值 Blood pressure, cyanosis紫绀， rales heard at the lungs 肺部罗音 enlargement of the heart 心脏扩大 heart murmurs心脏杂音 Arrhythmia心律失常 jugular vein distension 颈静脉怒张 hepatomegaly肝大 positive hepatojugular reflux肝颈静脉回流征 edema水肿

The establishment of a correct and complete cardiac diagnosis needs to investigate: The history, include the family history Physical examination(remain the basis for the diagnosis) ECG Chest roentgenogram Noninvasive graphic examinations Specialized invasive examinations

心血管病诊断-器械检查 传统检查：动脉血压测定、静脉压测定、心脏X线及心电图检查 新的检查方法：又分为侵入性和非侵入性两大类 侵入性检查：心导管和选择性心血管造影、心腔内心电图、希氏束电图、心脏电生理检查、心内膜心肌活组织检查以及心脏和血管腔内超声显像、心血管内镜检查 非侵入性检查：各种心电图、动态血压监测、超声心动图、CT

心血管病的诊断 diagnosis of cardiovascular disease 病因诊断（etiological diagnosis） 病理解剖诊断（pathological diagnosis） 病理生理诊断（pathophysiological diagnosis） 心功能不全（分级）（functional disability)

心血管病诊断举例 examples of cardiovascular disease diagnosis 需将病因、病理解剖和病理生理分类诊断先后列出。 先天性心脏病 congenital heart disease 房间隔缺损 atria septum defect 房性早搏 atria premature beat 慢性充血性心力衰竭(心功能II级) congestive heart failure (class II) The final diagnosis of cardiovascular disease consist of three parts, etiological diagnosis, pathological diagnosis and pathophysiological diagnosis. There are the examples of cardiovascular diagnosis. 先天性心脏病 congenital heart disease (etiological diagnosis) 房间隔缺损 atria septum defect (pathological diagnosis ) 房性早搏 atria premature beat (pathophysiological diagnosis ) 慢性充血性心力衰竭(心功能II级) congestive heart failure (pathophysiological diagnosis ) 冠心病 coronary artery disease 急性前壁心肌梗死 acute anterior wall myocardial infarction 室性早搏 ventricular premature beat 窦性心动过速 sinus tachycardia 急性左心衰 acute left heart failure

心血管病诊断举例 examples of cardiovascular disease diagnosis 冠心病 coronary artery disease 急性前壁心肌梗死 acute anterior wall myocardial infarction 室性早搏 ventricular premature beat 窦性心动过速 sinus tachycardia 急性左心衰 acute left heart failure

心血管病的预后 器质性心血管病较严重，常影响患者的劳动力，预后也较差，并有猝死可能。但不同病种间预后不一，在常见的心脏病中： 先心病多可手术纠治，预后较好； 慢性肺心病多有严重呼吸系统病变，预后差，住院病死率最高； 风心病、高心病、冠心病皆可通过有效治疗而使预后改善。 心血管病的病程中发生并发症常使预后更为严重。

心血管病的预防 预防心血管病主要在消除病因。如消除梅毒、维生素B1缺乏和贫血，则不会发生梅心病、维生素B1缺乏性和贫血性心脏病；有效防治慢性支气管炎可望减少肺心病；防治各种有关的危险因素可减少冠心病的发生。

心血管病的治疗 病因治疗 解剖病变的治疗：介入或外科手术 病理生理治疗：对于目前尚无法或难于根治的心血管病，主要纠正其病理生理变化，如休克、心力衰竭、心律失常。多用药物，也可机械辅助循环、人工心脏起搏、电复律等 康复治疗：动静结合，心理康复

心血管病的治疗 基因治疗：药物涂层支架；将携带血管内皮生长因子（VEGF）的载体通过不同的途径注入心肌，促进心肌小血管的新生以治疗心肌缺血

心血管病研究进展 心血管疾病的进展主要体现在以下三个方面： 1.对发病机制认识不断深入； 2.早期诊断率提高：心梗和心衰标志物提高了心梗和心衰的诊断率；肢体动脉检测通过测定脉搏波传导速度等指标可早期诊断动脉硬化

心血管病研究进展 3.治疗方式更加多样化 A：药物-冠心病：强化抗凝，强化降脂 心力衰竭：以ACEI和β阻滞剂为基石 B：介入性治疗(intervention therapy) 冠心病：PTCA， 支架植入术等 心律失常：射频消融，起搏器，ICD 心瓣膜病和先心：PBMV，PDA, ASD和VSD 封堵术，经皮主动脉瓣及二尖瓣置换术等

心血管病研究进展 C:手术治疗 冠心病：by-pass；室壁瘤切除术 心瓣膜病：人工心瓣膜置换术，瓣膜成形术 心肌病与心力衰竭：肥厚心肌切除术，化学消融术，心肌减积手术，心脏移植 D:细胞治疗 E:基因治疗