Pandect of Pandect of Cardiovascular Cardiovascular

DiseaseDiseaseSecond affiliated Hospital of Second affiliated Hospital of Zhejiang University school of Zhejiang University school of

medicinemedicine

Wang JianWang Jian’’anan

GeneralityGenerality

Cardiovascular systemCardiovascular system ：： Heart, Heart, vessels, nervous-fluid system, et al.vessels, nervous-fluid system, et al.

FunctionFunction ：： transportation, transportation, neuroendocrineneuroendocrine

Cardiovascular diseaseCardiovascular disease ：： heart heart disease and vascular diseasedisease and vascular disease

ClassificationClassification

一、一、 Pathogenic ClassiticationPathogenic Classitication（一）（一） congenital heart&vascular diseasecongenital heart&vascular disease　　　　　　 A A congenital heart defectcongenital heart defect (CHD) is a defect in (CHD) is a defect in

the structure of the heart and great vessels of a the structure of the heart and great vessels of a newborn. newborn.

ClassificationClassification

（二）（二） Acquired heart&vascular diseaseAcquired heart&vascular disease　　　　　　 AHD includs:AHD includs:11 、、 AtherosclerosisAtherosclerosis ；；22 、、 Rheumatic Heart diseaseRheumatic Heart disease ；；33 、、 Primary HypertensionPrimary Hypertension ；；44 、、 Pulmonary heart diseasePulmonary heart disease ；；55 、、 Septic heart diseaseSeptic heart disease ；；66 、、 Endocritic heart diseaseEndocritic heart disease ；；77 、、 Hemopathological heart diseaseHemopathological heart disease ；；88 、、 Nutritional and metabolic heart diseaseNutritional and metabolic heart disease ；；99 、、 Cardiovascular neurosisCardiovascular neurosis ；；1010 、、 OthersOthers

ClassificationClassification

二、二、 pathoanatomic classificationpathoanatomic classification

11 、、 endocardic diseaseendocardic disease

22 、、 myocardial diseasemyocardial disease

33 、、 pericardial diseasepericardial disease

44 、、 vascular diseasevascular disease

55 、、 congenital malformation congenital malformation diseasedisease

ClassificationClassification

三、三、 Pathophysiological CalssificationPathophysiological Calssification　　　　 11 、、 heart failureheart failure　　　　 22 、、 shockshock　　　　 33 、、 cononary dysfunction diseasecononary dysfunction disease　　　　 44 、、 muscuil papillares dysfunctionmuscuil papillares dysfunction　　　　 55 、、 arrhythmiaarrhythmia　　　　 66 、、 hyperdynamic circulationhyperdynamic circulation　　　　 77 、、 temaponadetemaponade　　　　 88 、、 othersothers

Standard Diagnosis Standard Diagnosis stylestyle

Including: pathogenic, Including: pathogenic, pathoanatomic and pathoanatomic and pathophysiological diagnosis.pathophysiological diagnosis.

exampleexample ：：　　　　 Rheumatic Heart DiseaseRheumatic Heart Disease

　　　　　　　　 Severe mitral stenosis with moderate Severe mitral stenosis with moderate insufficiency; Enlarged left atrium insufficiency; Enlarged left atrium and ventricleand ventricle

　　　　　　　　 Heart function III degree(NYHA)Heart function III degree(NYHA) atrial Fibrillationatrial Fibrillation

0 5 10 15 20 25 30

28.7Atherosclerosis with thrombosis*

17.8epidemics

12.6Cancer

9.1trauma

6PulmonaryDisease

5.1AIDS

Atherosclerosis with Atherosclerosis with thrombosisthrombosis**

the biggest case of deaththe biggest case of death11††

1. The World Health Report, 2002, WHO Geneva

mortality (%)

(% all death)

Time trend： Epidemological four periods

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

第一期 第二期 第三期 第四期

（低发期） （上升期） （高峰期） （下降期）

死亡构成

Developed Countries

Such as ： U.S.A

Developing Countries

Such as ： China

我国心血管疾病流行概况

“No.1 Human Killer”

Almost every 1 of 3 death in the real world is due to the Cardiovescular Disease.

DiagnosisDiagnosis

As other disease, the diagnosis of As other disease, the diagnosis of cardiovascular diseases need cardiovascular diseases need history, symptoms, signs, Lab history, symptoms, signs, Lab examinations, device-based examinations, device-based examinations, et al.examinations, et al.

Examinations for Examinations for DiagnosisDiagnosis

一、一、 invasive examinationsinvasive examinations　　　　 Percutanious Coronary Percutanious Coronary

InterventionIntervention 、、 Swan-Ganz catheterSwan-Ganz catheter 、、 eletrophysiological eletrophysiological studystudy 、、 myocardical biopsymyocardical biopsy 、、 inter-inter-luminal\vascular echocardiographyluminal\vascular echocardiography 、、cardiovascular endoscopycardiovascular endoscopy…………

Examination for Examination for DiagnosisDiagnosis

　二、　二、 non-invasive examinationsnon-invasive examinations

　　　　　　 ECGECG 、、 ABPMABPM 、、 ECHO\DopplerECHO\Doppler 、、CTCT 、、 CTACTA 、、 MRIMRI 、、 MRAMRA 、、 ECTECT 、、 DDSASA 、、 PETPET 、、 SPECTSPECT 。。

　　　　　　 Stress examinationsStress examinations

J. Am. Coll. Cardiol. 2005;46;552-557

功能学评价－活动平板功能学评价－活动平板

功能学评价－应激超声功能学评价－应激超声

应激超声应激超声 评价运动前后各心室评价运动前后各心室壁的活动情况，以判壁的活动情况，以判断有无相应心肌缺血断有无相应心肌缺血

可以用腺苷等药物替可以用腺苷等药物替代运动（代运动（ 88 ～～ 1010分分钟）钟）

可以加用超声造影剂可以加用超声造影剂更好的显像更好的显像

操作过程可参考活动操作过程可参考活动平板的运动试验方案平板的运动试验方案

功能学检查－功能学检查－ SPECTSPECT 与与 PETPET

可以同时进行运动试验可以同时进行运动试验

PrognosisPrognosis

Quite different according to the Quite different according to the disease and the stagedisease and the stage

What ancient Chinese What ancient Chinese doctors did about doctors did about preventive medicinepreventive medicine

………… 是故圣人是故圣人不治已病治未病，不治已乱治未不治已病治未病，不治已乱治未乱乱，此之谓也。夫病已成而后药之，乱已，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，成而后治之，譬犹渴而穿井，斗而铸锥，不亦晚乎！（不亦晚乎！（《《素问素问 ·· 四气调神大论四气调神大论》》） ）

Risk factorsRisk factors hypertensionhypertension SmokingSmoking Age Age （（ Main Risk FactorsMain Risk Factors ）） gendergender familial historyfamilial history Diabetes and insulin resistanceDiabetes and insulin resistance （（ Risk EquivalentsRisk Equivalents

）） mallipodemiamallipodemia Obesity and overweightObesity and overweight Lack exerciseLack exercise Serum fibrinogen Serum fibrinogen Region and raceRegion and race Others, Others,

Preventive medicinePreventive medicine

一、一、 pathogenic therapypathogenic therapy

二、二、 anatomic therapyanatomic therapy

三、三、 pathophysiological therapypathophysiological therapy

四、四、 RehabilitationRehabilitation

Up to DateUp to Date

New TheoriesNew Theories New DiagnosisNew Diagnosis methodsmethods New therapyNew therapy　　 new medicinenew medicine　　 new device-based new device-based therapytherapy