64 排螺旋CT 在冠心病诊断上的应用张雅君主任医师ST.MICHAEL HOSPITAL 如何控制心脏病的发生如何预防冠心病的发生如何了解自己是否患有冠心病患有冠心病如何治疗健康活到100 岁Topics Risk Factors of Heart Disease Latest Findings in Reducing Heart Disease Latest Advances in Medical Technology in Preventing Heart Disease Conclusion 心肌梗塞64 排CT 适应人群男性年龄大于40 岁，女性年龄大于45 岁平时有胸闷，心悸，胸痛而心电图检查正常或者体检提示有心肌缺血的病人。有肥胖症、高血压、高血脂、糖尿病的病人，应了解冠脉血管受损情况。有冠心病家族史、平时性格过于孤癖、长期心理压力较大的人已确诊冠心病的病人，治疗效果不佳，应进行64 排螺旋CT 检查详细了解冠脉病变。为下一步治疗提供依据。冠状动脉支架术或搭桥术的病人随访，了解再狭窄的情况。Coronary Artery DiseaseComparison between MDCT and Coronary Angiography a A a b b b Lumen Plaque Plaque “Normal Angiogram”by ICA Plaques detected by CTA but are “invisible”in ICA 多功能电脑断层扫描仪——精确度有多少？在影像分析方面的经验决定着CT 扫描的准确程度资深的放射学医师通过对影像数据透彻的分析可使准确度提高我们中心能够提供98-99% 的精确度四维立体冠状动脉CT 血管造影术- 适合哪类人群？患有多种慢性病的人群有严重家族史的人群有患心脏中风疾病风险的中年人群心脏影像心脏影像多功能CT 扫描的优势无创伤性简单快速的检查程序门诊检查，无需住院清晰的心脏血管影像四维立体影像精确到以毫米计算较少的辐射无需开刀Common Risk Factors 常见病因Extensive clinical and statistical studies have identified several factors that increase the risk of stroke. Most of them can be modified, treated or controlled. Some can’t. How Cardiovascular & Stroke Risks Are Related: 心脏病和中风为什么是相关联的Both coronary heart disease and stroke share many of the same risk factors such as cholesterol disorders, high blood pressure, smoking, diabetes, physical inactivity, and being overweight or obese. 结论尽早的检查及诊断可挽救生命血管斑块会从年轻时已经开始逐渐形成，所以更需要尽早检查即使您有血管狭窄的问题存在，及早治疗仍可以降低您患上心脏疾病的风险* * * * * Key Point: As new evidence has emerged, the guidelines for treating elevated cholesterol have evolved to become more intensive. Additional Background Information: Patients at high risk are those with established atherosclerotic vascular disease. A recent update to the American Heart Association/American College of Cardiology (AHA/ACC) guidelines for secondary prevention further supports the intensive reduction of LDL-C in patients with CHD and other atherosclerotic vascular disease. The recommended LDL-C treatment goal in these patients is <100 mg/dL, but a target of <70 mg/dL is now considered a reasonable strategy. Any person at high risk who has lifestyle-related risk factors is a candidate for therapeutic lifestyle changes (TLC) to modify these risk factors, regardless of LDL-C level. Whenever the baseline LDL-C concentration is ≥100 mg/dL, initiation of an LDL-C–lowering drug and dietary therapy is recommended. If baseline LDL-C is 70 to 100 mg/dL, it is now reasonable to lower it to <70 mg/dL.1 According to the NCEP ATP III Update, for patients at moderately high risk (10-year risk 10%─20%), the LDL-C goal remains <130 mg/dL. However, a goal of <100 mg/dL is a therapeutic option. TLC should be initiated in all such persons whose LDL-C level is ≥130 mg/dL. Any person at moderately high risk who has lifestyle-related risk factors is a candidate for TLC to modify these risk factors regardless of LDL-C level. If the LDL-C concentration is ≥130 mg/dL after TLC, initiating treatment with an LDL-C–lowering drug should be considered to achieve and sustain the LDL-C goal of <130 mg/dL. For patients with LDL-C levels of 100 to 129 mg/dL at baseline or on lifestyle therapy, initiating treatment with an LDL-C–lowering drug is a therapeutic option for achieving an LDL-C level <100 mg/dL.2 References: 1.	Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Circulation. 2006;113:2363–2372. 2.	Grundy SM, Cleeman JI, Merz CNB, et al, for the Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227–239. * Key Points: Clinical trial evidence led to proposed modifications of ATP III LDL-C goals and cut points for TLC and drug therapy.1 AHA/ACC recently updated guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease. These guidelines include recommendations regarding lipid management.2 Additional Background Information: Factors that place patients in the very high-risk category include the presence of established cardiovascular disease (CVD) plus the following: 1) multiple major risk factors, especially diabetes; 2) severe and poorly controlled risk factors, especially continued cigarette smoking; 3) multiple risk factors of the metabolic syndrome, especially high triglycerides (TG) ≥200 mg/dL plus non–high-density lipoprotein cholesterol (HDL-C) ≥130 mg/dL with HDL-C <40 mg/dL; and 4) acute coronary syndromes.1 For high-risk patients, the recommended LDL-C treatment goal remains <100 mg/dL. However, an optional target of <70 mg/dL is a reasonable clinical strategy for persons considered to be at very high risk. Any person at high risk who has lifestyle-related risk factors is a candidate for TLC to modify these risk factors, regardless of LDL-C level. As before, whenever the baseline concentration is ≥130 mg/dL, simultaneous initiation of an LDL-C–lowering drug and dietary therapy is recommended. If LDL-C is 100 to 129 mg/dL, the same now holds.1 Patients at high risk include those with established atherosclerotic vascular disease. A recent update to the AHA/ACC guidelines for secondary prevention further supports the intensive reduction of LDL-C in patients with CHD and other atherosclerotic vascular disease. The recommended LDL-C treatment goal in these patients is <100 mg/dL, but a target of <70 mg/dL is now considered a reasonable strategy. Any person at high risk who has lifestyle-related risk factors is a candidate for TLC to modify these risk factors, regardless of LDL-C level. Whenever the baseline LDL-C concentration is ≥100 mg/dL, initiation of an LDL-C–lowering drug and dietary therapy is recommended. If baseline LDL-C is 70 to 100 mg/dL, it is now reasonable to lower it to <70 mg/dL.2 References: 1.	Grundy SM, Cleeman JI, Merz CNB, et al, for the Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227–239. 2.	Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Circulation. 2006;113:2363–2372. 在新加坡。。。在中国。。。英年早逝震惊中国河南17 岁高中生两周前突然出现心脏猝死，没有任何迹象没有胸部疼痛发生在健康的人群中在慢跑或长跑时心脏病发作与突发性猝死什么原因呢？。。。传说心脏病及中风只会发生在那些血管有严重阻塞的人身上通常会发生在那些上了年纪的人群事实动脉血管的阻塞程度是由多年的累积所造成的大多数心脏病发作是由于血管壁的屯积物然破裂，血小板凝聚形成斑块而造成血管阻塞Likelihood of Plaque Rupture Does NOT correlate with the Severity of Coronary Artery Stenosis 冠状动脉狭窄的严重程度与血栓破裂没有关系动脉粥样硬化管腔变窄血栓形成正常血管血管内皮损伤胆固醇聚集原因。。。2/3 的心脏病突然发作是因为心脏血管只有40-60% 的阻塞阻塞不严重时是没有明显症状的对那些心血管阻塞程度已经超过70% 的病患更需要例行常规检查Risk factors for stroke that can't be changed: 不能改变的原因Age 年龄Heredity (family history) 家族史Prior stroke, TIA or heart attack 以前发生过中风，一过性脑缺血，心脏病Risk factors that can be changed, treated or controlled: 可控制的因素High blood pressure 高血压Cigarette smoking 吸烟Diabetes mellitus 糖尿病Carotid or other artery disease 颈动脉和其他血管疾病Other heart disease 心脏病High blood cholesterol 高血脂Poor diet 不健康的饮食习惯Physical inactivity and obesity 缺乏运动及肥胖Main Cause of Heart Attack