当前课程知识点:Medical Nursing > Unit 5 Care of Patients with Cardiovascular System Diseases (Part Two) > Chapter 4 Care of Patients with Coronary Artery Disease > Overview of coronary heart disease
大家好
这节课我们将学习新的内容
首先来看一个病例
患者 男性 60岁
心前区疼痛1周
加重2天
一周前开始在骑车上坡时
感心前区疼痛 并向左肩放射
经休息可缓解
两天来走路快时
亦有类似情况发作
每次持续3到5分钟
含硝酸甘油迅速缓解
患者为求诊治入院
发病以来 进食好
二便正常 睡眠可
体重无明显变化
既往有高血压病史5年
血压150-180/90-100mmHg
无冠心病史
无药物过敏史
吸烟十几年 1包/天
其父有高血压病史
这个病人有高血压糖尿病
但此次就医原因主要是
冠心病 不稳定性心绞痛
近年来 中国心血管病患病率
处于持续上升阶段
据推算现有
心血管病人数2.9亿
今后10年心血管病患病人数
仍将快速增长
心血管病的死亡
占城乡居民总死亡原因的首位
心脑血管病住院费用年均增速
远高于国内生产总值增速
冠心病作为一种常见的心血管疾病
目前患病人数高达1100万
那么 冠心病是一个什么样的疾病呢
下面 我们一起来学习冠心病
冠心病是冠状动脉粥样硬化性心脏病的简称
是指冠状动脉粥样硬化 使血管腔狭窄或阻塞
和(或)因冠状动脉功能性改变
痉挛导致心肌缺血 缺氧或坏死而引起的心脏病
亦称缺血性心脏病
那么 导致冠心病的原因有哪些呢
虽然本病病因尚未完全明确
但目前认为
是多种因素作用于不同环节所致
这些因素亦称为危险因素或易患因素
主要的危险因素包括
1 血脂异常
血脂代谢异常
是动脉粥样硬化最重要的危险因素
总胆固醇(TC)甘油三酯(TG)
低密度脂蛋白(LDL)或极低密度脂蛋白(VLDL)增高
高密度脂蛋白尤其是它的亚组(HDLⅡ)减低
载脂蛋白A(Apo A)降低和载脂蛋白B(ApoB)增高
都被认为是危险因素
2.高血压
血压增高与本病密切相关
百分之六十到百分之七十的冠状动脉粥样硬化患者有高血压
高血压患者患本病
较血压正常者高3至4倍
收缩压和舒张压增高
都与本病关系密切
3.吸烟
吸烟可造成动脉壁氧含量不足
促进动脉粥样硬化的形成
4糖尿病
糖尿病患者中本病的发病率
较无糖尿病者高3倍
本病患者糖耐量减低者较多见
这几种危险因素我们平常称之为
“三高一吸”
即高血脂 高血压 高血糖 吸烟
此外 还有年龄性别因素(以下是插入的视频)
刚才这个影片 确实展示了当前冠心病的一个危害性。
它确实像一个魔鬼一样 危害着我们的身体健康
我从医20年来
冠心病患者越来越多
并且病情越来越严重
还有 年龄越来越年轻化
其实 男性应该是
55岁以后患病
算是正常年龄
而女性应该是在65岁以上
但是现在35到55岁年龄的病人是越来越多(以上是插入视频)
还有一些次要危险因素包括
肥胖 A型性格 脑力劳动者不健康的生活方式
遗传和家族因素
目前认为高同型半胱氨酸血症也是
冠心病的危险因素之一
现在我们回顾一下上面的病例
有冠心病的危险因素吗
有的 男性 60岁 高血压病史
吸烟 心血管病家族史
动脉粥样硬化究竟是怎样产生的呢
在长时间高脂血症等危险因素作用下
动脉血管发生慢性非特异性炎症
致使动脉内膜受损
使内皮细胞和白细胞表面特性
发生改变
高胆固醇血症增加单核细胞对动脉内皮的粘附力
粘附在内皮细胞的单核细胞数量增多
进入内膜后
单核细胞转化成有清道夫样作用的巨噬细胞
巨噬细胞摄入大量脂肪 氧化低密度脂蛋白
同时
部分血管平滑肌细胞增殖 迁移或吞噬脂质
这样就形成了泡沫细胞
泡沫细胞逐渐凋亡
装满脂质的细胞内容物形成了病变坏死的脂核
逐渐积累便形成脂质条纹
这标志着动脉粥样斑块开始形成
炎症反应持续存在 进一步发展形成了粥样硬化
由于病理解剖和病理生理变化的不同
冠心病有着不同的临床表现
1979年世界卫生组织将冠心病
分为以下五型
1 无症状性心肌缺血
2 心绞痛
3 心肌梗死
4 缺血性心肌病
5 猝死
临床上将本病分为
急性冠脉综合征和慢性冠脉病两大类
急性冠脉综合征是一组
以冠状动脉粥样硬化斑块破裂
继发完全或不完全闭塞性血栓形成为病理基础的临床综合征
包括 不稳定型心绞痛 非ST段抬高性心肌梗死
ST段抬高性心肌梗死
和冠心病猝死
慢性冠脉病包括 稳定型心绞痛
冠脉正常的心绞痛 无症状性心肌缺血
和缺血性心肌病
这一讲
主要学习了冠心病的概念 危险因素
发病机制和分型
其中冠心病的概念 危险因素
是这节课的重点
这一讲课就讲到这里 谢谢大家
-Introduction to Medical Nursing
--Introduction to Medical Nursing
--Introduction to Medical Nursing
-Chapter 1 Overview of Respiratory System Diseases
--Overview of Respiratory System Diseases
--Overview of Respiratory System Diseases
--Overview of Respiratory System Diseases
-Chapter 2 Care of Patients with Pneumonia
--Overview of pneumonia
--Streptococcal Pneumonia
--Other types of pneumonia
--The quality and color of sputum
--Care of Patients with Pneumonia
-Chapter 3 Care of Patients with Lung Abscess
--Introduction of lung abscess
--Introduction of lung abscess
--Treatment and nursing of lung abscess
--Treatment and care of nursing abscess
--Care of Patients with Lung Abscess
-Chapter 4 Care of Patients with Pulmonary Tuberculosis
--Etiology and pathogenesis of pulmonary tuberculosis
--Etiology and pathogenesis of pulmonary tuberculosis
--Clinical manifestation of pulmonary tuberculosis (I)
--Clinical manifestation of pulmonary tuberculosis (I)
--Clinical manifestation of pulmonary tuberculosis (II)
--Clinical manifestation of pulmonary tuberculosis (II)
--Treatment and nursing of pulmonary tuberculosis
--Treatment and nursing of pulmonary tuberculosis
--Care of Patients with Pulmonary Tuberculosis
-Chapter 5 Care of Patients with Chronic Obstructive Pulmonary Disease
--Care of patients with chronic bronchitis
--Care of patients with chronic bronchitis
--Care of patients with chronic bronchitis
--Introduction of chronic obstructive pulmonary disease
--Introduction of chronic obstructive pulmonary disease
--Care of chronic obstructive pulmonary disease
--Care of chronic obstructive pulmonary disease
--Oxygen
--Care of Patients with Chronic Obstructive Pulmonary Disease
-Chapter 6 Care of Patients with Bronchial Asthma
--Etiology and pathogenesis of bronchial asthma
--Etiology and pathogenesis of bronchial asthma
--Clinical manifestation of bronchial asthma
--Clinical manifestation of bronchial asthma
--Treatment and nursing of bronchial asthma
--Treatment and nursing of bronchial asthma
--Care of Patients with Bronchial Asthma
-Chapter 7 Care of Patients with Chronic Pulmonary Heart Disease
--Etiology and pathogenesis of chronic pulmonary heart disease
--Etiology and pathogenesis of chronic pulmonary heart disease
--Treatment and nursing of chronic pulmonary heart disease
--Treatment and nursing of chronic pulmonary heart disease
--Care of Patients with Chronic Pulmonary Heart Disease
-Chapter 8 Care of Patients with Primary Bronchogenic Carcinoma
--Etiology and pathogenesis of primary bronchogenic carcinoma
--Etiology and pathogenesis of primary bronchogenic carcinoma
--Clinical manifestation and auxiliary examination
--Clinical manifestation and auxiliary examination
--Treatment and nursing of primary bronchogenic carcinoma
--Treatment and nursing of primary bronchogenic carcinoma
--Care of Patients with Primary Bronchogenic Carcinoma
-Chapter 9 Care of Patients with Pleural Effusion
--Etiology, pathogenesis and clinical manifestations
--Etiology, pathogenesis and clinical manifestations
--Treatment and nursing of pleural effusion
--Treatment and nursing of pleural effusion
--Determination of the nature of pleural effusion
--Care of Patients with Pleural Effusion
-Chapter 10 Care of Patients with Respiratory Failure and Acute Respiratory Distress Syndrome
--Etiology and pathogenesis of respiratory failure
--Etiology and pathogenesis of respiratory failure
--Treatment and nursing of respiratory failure patients
--Treatment and nursing of respiratory failure patients
--Care of Patients with Respiratory Failure
--Introduction of acute respiratory distress syndrome
--Introduction of acute respiratory distress syndrome
--Treatment and nursing of acute respiratory distress syndrome
--Treatment and nursing of acute respiratory distress syndrome
--Care of Patients with Respiratory Failure
--Care of Patients with Acute Respiratory Distress Syndrome
-Unit Test: Respiratory System
-Unit Assignment: Respiratory System
-Chapter 1 Care of Patients with Cardiovascular System Diseases
--Overview of Cardiovascular System
--Overview of Cardiovascular System
--Overview of Cardiovascular System
-Chapter 2 Care of Patients with Heart Failure
--Overview of heart failure
--Chronic heart failure (1)
--Chronic heart failure (2)
--Acute heart failure
-Chapter 3 Care of Patients with Arrhythmia
--Overview of arrhythmia
--Sick sinus syndrome
--Supraventricular tachycardia
--Supraventricular tachycardia
--Atrial fibrillation
--Ventricular tachycardia
--Atrioventricular block
--Nursing care of patients with arrhythmia
--Nursing care of patients with arrhythmia
-Chapter 4 Care of Patients with Coronary Artery Disease
--Overview of coronary heart disease
--Overview of coronary heart disease
--Stable angina pectoris
--Unstable angina pectoris
--Acute myocardial infarction (1)
--Acute myocardial infarction (1)
--Acute myocardial infarction (2)
--Acute myocardial infarction (2)
--Acute myocardial infarction (3)
--Acute myocardial infarction (3)
--Difference between angina pectoris and myocardial infarction
-Chapter 5 Care of Patients with Hypertension
--Primary hypertension (1)
--Primary hypertension (2)
--Safe nursing for patients with hypertension
-Chapter 6 Care of Patients with Myocardial Diseases
--Myocardial Diseases (1)
--Myocardial Diseases (2)
--Myocardial Diseases (3)
-Unit Assignment: Cardiovascular System
-Chapter 1 Overview of Digestive System
--Overview of digestive system(I)
--Overview of digestive system(I)
--Overview of digestive system(II)
--Overview of digestive system(II)
--Overview of Digestive System
-Chapter 2 Care of Patients with Peptic Ulcer
--Etiology and clinical manifestation of peptic ulcer
--Etiology and clinical manifestation of peptic ulce
--Treatment and nursing of peptic ulcer
--Treatment and nursing of peptic ulcer
--Care of Patients with Peptic Ulcer
-Chapter 3 Care of Patients with Hepatic Cirrhosis
--Etiology and clinical manifestation of hepatic cirrhosis
--Etiology and clinical manifestation of hepatic cir
--Treatment and nursing of hepatic cirrhosis
--Treatment and nursing of hepatic cirrhosis
--Care of Patients with Hepatic Cirrhosis
-Chapter 4 Care of Patients with Hepatic Encephalopathy
--Etiology and pathogenesis of hepatic encephalopathy
--Etiology and pathogenesis of hepatic encephalopath
--Clinical manifestation,treatment and nursing of hepatic encephalopathy
--Clinical manifestation,treatment and nursing of he
-- Care of Patients with Hepatic Encephalopathy
-Chapter 5 Care of Patients with Upper Gastrointestinal Hemorrhage
--Upper gastrointestinal hemorrhage(I)
--Upper gastrointestinal hemorrhage(I)
--Upper gastrointestinal hemorrhage(II)
--Upper gastrointestinal hemorrhage(II)
--Upper gastrointestinal hemorrhage(Ⅲ)
--Upper gastrointestinal hemorrhage(Ⅲ)
--Upper gastrointestinal hemorrhage
--Care of Patients with Upper Gastrointestinal Hemorrhage
-Unit Test: Digestive System
-Unit Assignment: Digestive System
-Chapter 1 Overview of Urinary System
--Overview of Urinary System
-Chapter 2 Care of Patients with Glomerular Diseases
--Care of Patients with Glomerular Diseases
--Care of Patients with Glomerular Diseases
--Care of Patients with Glomerular Diseases
--Acute Glomerulonephritis
-- Rapidly Progressive Glomerulonephritis
--Rapidly Progressive Glomerulonephritis
--Rapidly Progressive Glomerulonephritis
--Chronic Glomerulonephritis
-Chapter 3 Care of Patients with Nephrotic Syndrome
--Nephrotic Syndrome
-Chapter 4 Care of Patients with Urinary Tract Infection
--Care of Patients with Urinary Tract Infection
--Care of Patients with Urinary Tract Infection
--Care of Patients with Urinary Tract Infection
--Care of Patients with Urinary Tract Infection
--Care of Patients with Urinary Tract Infection
-Chapter 5 Care of Patients with Chronic Renal Failure
--Care of Patients with Chronic Renal Failure
--Care of Patients with Chronic Renal Failure
--Care of Patients with Chronic Renal Failure
--Care of Patients with Chronic Renal Failure
--Care of Patients with Chronic Renal Failure
--Unit Assignment: Urinary System
-Chapter 6 Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
-Chapter 1 Overview of Hematologic System
--Overview of hemopoietic system diseases (I)
--Overview of hemopoietic system diseases (I)
--Overview of hemopoietic system diseases (II)
--Overview of hemopoietic system diseases (II)
--Overview of hemopoietic system diseases (I)
--Overview of hemopoietic system diseases (II)
-Chapter 2 Overview of Anemia
--Overview of Anemia
-Chapter 3 Care of Patients with Iron Deficiency Anemia
--Overview,etiology and pathogenesis,clinical manifestation,auxiliary examination and diagnosis of iron deficiency anemia
--Treatment and nursing of iron deficiency anemia
--Treatment and nursing of iron deficiency anemia
-Chapter 4 Care of Patients with Aplastic Anemia
--Definition, etiology,clinical manifestation,auxiliary examination and diagnosis of aplastic anemia
--Definition, etiology,clinical manifestation,auxiliary examination and diagnosis of aplastic anemia
--Treatment and nursing of aplastic anemia
--Treatment and nursing of aplastic anemia
--Care of Patients with Aplastic Anemia
-Chapter 5 Care of Patients with Hemolytic Anemia
--Nursing of patients with hemolytic anemia
--Nursing of patients with hemolytic anemia
--Care of Patients with Hemolytic Anemia
-Chapter 6 Care of Patients with Hemorrhagic Diseases
--Overview of hemorrhagic diseases
--Overview of hemorrhagic diseases
--Nursing of patients with idiopathic thrombocytopenic purpura
--Nursing of patients with idiopathic thrombocytopenic purpura
--Nursing of patients with anaphylactoid purpura
--Nursing of patients with anaphylactoid purpura
--Overview of hemorrhagic diseases
--Nursing of patients with idiopathic thrombocytopenic purpura
--Nursing of patients with anaphylactoid purpura
-Chapter 7 Care of Patients with Leukemia
--Definition, etiology and classification of leukemia
--Definition, etiology and classification of leukemia
--Definition and clinical manifestation of acute leukemia
--Definition and clinical manifestation of acute leukemia
--Auxiliary examination of acute leukemia
--Auxiliary examination of acute leukemia
--Nursing of acute leukemia(I)
--Nursing of acute leukemia(II)
--Nursing of acute leukemia
--Definition ,clinical manifestation and auxiliary examination of chronic myeloid leukemia
--Definition ,clinical manifestation and auxiliary examination of chronic myeloid leukemia
--Treatment and nursing ofchronic myeloid leukemia
--Treatment and nursing ofchronic myeloid leukemia
--Care of Patients with Leukemia
-Chapter 8 Care of Patients with Lymphoma
--Definition ,clinical manifestation, auxiliary examination,treatment and nursing of lymphoma
--Definition ,clinical manifestation, auxiliary examination,treatment and nursing of lymphoma
--Care of Patients with Lymphoma
-Unit Test: Hematologic System
-Unit Assignment: Hematologic System
-Chapter1 Overview of Endocrine ystem
--Overview of Endocrine System
--Overview of Endocrine System
--Overview of Endocrine System
-Chapter2 Care of Patients with Hypercortisolism
--Care of Patients with Hypercortisolism 1
--Care of Patients with Hypercortisolism 1
--Care of Patients with Hypercortisolism 2
--Care of Patients with Hypercortisolism2
--Care of Patients with Hypercortisolism
--Care of Patients with Hypercortisolism
-Chapter3 Care of Patients with Hyperthyroidism
--Care of Patients with Hyperthyroidism 1
--Care of Patients with Hyperthyroidism 1
--Care of Patients with Hyperthyroidism 2
--Care of Patients with Hyperthyroidism 2
--Care of Patients with Hyperthyroidism
--Care of Patients with Hyperthyroidism
-Chapter4 Care of Patients with Diabetes Mellitus
--Care of Patients with Diabetes Mellitus1
--Care of Patients with Diabetes Mellitus 1
--Care of Patients with Diabetes Mellitus2
--Care of Patients with Diabetes Mellitus 2
--Care of Patients with Diabetes Mellitus 3
--Care of Patients with Diabetes Mellitus 3
--Care of Patients with Diabetes Mellitus 4
--Care of Patients with Diabetes Mellitus 4
--Care of Patients with Diabetes Mellitus 5
--Care of Patients with Diabetes Mellitus 5
--Care of Patients with Diabetes Mellitus
--Care of Patients with Diabetes Mellitus
-Unit Review: Endocrine System
--Unit Assignment: Endocrine System
--Unit Test: Endocrine System
-Chapter 1 Overview of Infectious Diseases
--Overview of Infectious Diseases 1
--Overview of Infectious Diseases 1
--Overview of Infectious Diseases 1
--Overview of Infectious Diseases 2
--Overview of Infectious Diseases 2
--Overview of Infectious Diseases 2
--Overview of Infectious Diseases
-Chapter 2 Care of Patients with Viral Hepatitis
--Care of Patients with Viral Hepatitis 1
--Care of Patients with Viral Hepatitis 1
--Care of Patients with Viral Hepatitis 1
--Care of Patients with Viral Hepatitis 2
--Care of Patients with Viral Hepatitis 2
--Care of Patients with Viral Hepatitis 2
--Care of Patients with Viral Hepatitis 3
--Care of Patients with Viral Hepatitis 3
--Care of Patients with Viral Hepatitis 3
--Care of Patients with Viral Hepatitis 4
--Care of Patients with Viral Hepatitis 4
--Care of Patients with Viral Hepatitis 4
--Care of Patients with Viral Hepatitis
-Chapter 3 Care of Patients with Hemorrhagic Fever with Renal Syndrome
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 1
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 1
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 1
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 2
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 2
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 2
-Chapter 4 Care of Patients with Acquired Immune Deficiency Syndrome
--Care of Patients with Acquired Immune Deficiency Syndrome 1
--Care of Patients with Acquired Immune Deficiency Syndrome 1
--Care of Patients with Acquired Immune Deficiency Syndrome 1
--Care of Patients with Acquired Immune Deficiency Syndrome 2
--Care of Patients with Acquired Immune Deficiency Syndrome 2
--Care of Patients with Acquired Immune Deficiency Syndrome 2
-Chapter 5 Care of Patients with Rabies
--Care of Patients with Rabies 1
--Care of Patients with Rabies 1
--Care of Patients with Rabies 1
--Care of Patients with Rabies 2
--Care of Patients with Rabies 2
--Care of Patients with Rabies 2
--Care of Patients with Rabies
-Chapter 6 Care of Patients with Epidemic Encephalitis B
--Care of Patients with Epidemic Encephalitis B 1
--Care of Patients with Epidemic Encephalitis B 1
--Care of Patients with Epidemic Encephalitis B 2
--Care of Patients with Epidemic Encephalitis B 2
--Care of Patients with Epidemic Encephalitis B
-Chapter 7 Care of Patients with Epidemic Cerebrospinal Meningitis
--Care of Patients with Epidemic Cerebrospinal Meningitis 1
--Care of Patients with Epidemic Cerebrospinal Meningitis 1
--Care of Patients with Epidemic Cerebrospinal Meningitis 2
--Care of Patients with Epidemic Cerebrospinal Meningitis 2
--Care of Patients with Epidemic Cerebrospinal Meningitis
-Chapter 8 Care of Patients with Cholera
--Care of Patients with Cholera
--Care of Patients with Cholera
--Care for patients with cholera
-Chapter 9 Care of Patients with Bacillary Dysentery
--Care of Patients with Bacillary Dysentery
--Care of Patients with Bacillary Dysentery
--Care of Patients with Bacillary Dysentery
-Chapter 10 Care of Patients with Schistosomiasis
--Care of Patients with Schistosomiasis 1
--Care of Patients with Schistosomiasis 1
--Care of Patients with Schistosomiasis 2
--Care of Patients with Schistosomiasis 2
--Care for patients with schistosome
-Chapter 11 Care of Patients with COVID-19
--Care of Patients with COVID-19
--Care of Patients with COVID-19
-Chapter 12 Psychological Coping Modes to the Epidemic of COVID-19
--Psychological Coping Modes to the Epidemic of COVID-19
--Psychological Coping Modes to the Epidemic of COVID-19
-Unit Test: Infectious Diseases
--Unit Test: infective disease
-Unit Assignment: Infectious Diseases
--Unit Assignment: Infectious Diseases
-Chapter 1 Overview of Nervous System Diseases
--Overview of Nervous System Diseases(I)
--Overview of Nervous System Diseases(I)
--Overview of Nervous System Diseases(I)
--Overview of Nervous System Diseases(II)
--Overview of Nervous System Diseases(II)
--Overview of Nervous System Diseases(II)
-Chapter 2 Care of Patients with Facial Neuritis
--Care of Patients with Facial Neuritis
--Care of Patients with Facial Neuritis
--Care of Patients with Facial Neuritis
-Chapter 3 Care of Patients with Cerebrovascular Diseases (Episode 1)
--Overview of Cerebral Vascular Diseases (I)
--Overview of Cerebral Vascular Diseases (I)
--Overview of Cerebral Vascular Diseases (I)
--Overview of Cerebral Vascular Diseases(II)
--Overview of Cerebral Vascular Diseases(II)
--Overview of Cerebral Vascular Diseases(II)
--Intracerebral Hemorrhage(I)
--Intracerebral Hemorrhage(II)
--Intracerebral Hemorrhage(II)
--Intracerebral Hemorrhage(II)
-Chapter 4 Care of Patients with Cerebrovascular Diseases (Episode 2)
--Subarachnoid Hemorrhage
--Transient Ischemic Attack
--Cerebral Thrombosis(I)
--Cerebral Thrombosis(II)
-Chapter 5 Care of Patients with Epilepsy
--Care of Patients with Epilepsy(I)
--Care of Patients with Epilepsy(I)
--Care of Patients with Epilepsy(II)
--Care of Patients with Epilepsy(II)
--Care of Patients with Epilepsy
-Chapter 6 Care of Patients with Parkinson Disease
--Care of Patients with Parkinson Disease(I)
--Care of Patients with Parkinson Disease(I)
--Care of Patients with Parkinson Disease(II)
--Care of Patients with Parkinson Disease(II)
--Care of Patients with Parkinson Disease
-Unit Assignment: Nervous System
--Unit Assignment: Nervous System