冠狀動脈疾病

冠状动脉堵塞
(重定向自冠心病

冠狀動脈疾病(英語:coronary artery disease, CAD)又稱缺血性心臟病(英語:ischemic heart disease, IHD[11]冠狀動脈粥樣硬化心臟病[12]冠狀動脈粥樣硬化心血管疾病(英語:coronary atherosclerotic heart disease, CAHD[13]冠狀動脈心臟病(英語:coronary heart disease[14](簡稱冠心病),涉及心臟動脈的斑塊堆積(動脈粥樣硬化)導致流向心肌的血流降低。冠狀動脈疾病是最常見的心血管疾病[15]。型態包含穩定型心絞痛非穩定型心絞痛英语Unstable angina心肌梗塞猝死[16]。常見的症狀包括胸痛或不適,有時會轉移到肩膀、手臂、背部、頸部或下顎。有些人可能會有胸口灼熱的感覺。通常症狀在運動或情緒壓力下出現,持續時間不超過數分鐘且休息會緩解。有時會伴隨呼吸困難,有時則是毫無症狀[4]。少數人以心肌梗塞為最初的表現。其他可能的併發症包含心臟衰竭心律不整[5]

冠狀動脈疾病
coronary artery disease
同义词Atherosclerotic heart disease,[1]atherosclerotic vascular disease,[2]coronary heart disease[3]
Blausen 0257 CoronaryArtery Plaque.png
冠狀動脈粥樣(atherosclerosis)硬化示意圖
症状胸痛呼吸困难[4]
併發症心臟衰竭心律不整[5]
肇因心臟的動脈英语Coronary arteries 粥樣硬化[6]
风险因子高血壓吸菸糖尿病、缺乏運動、肥胖症高膽固醇血症[6]
診斷方法心电图心脏压力测试英语cardiac stress test, 冠状动脉血管电脑断层扫描英语coronary computed tomographic angiography, 冠状动脉造影英语Coronary catheterization
預防健康的飲食、規律運動、維持健康的體重、不吸菸[7]
治療经皮冠状动脉介入治疗 (PCI), 冠状动脉旁路移植 (CABG)[8]
藥物阿司匹林, β受体阻滞剂, 硝酸甘油英语医用硝酸甘油[8]
盛行率1.1 億 (2015)[9]
死亡數
醫學專科心臟病學心脏外科

危險因子包括:高血壓抽菸糖尿病、缺乏運動、肥胖血液中膽固醇含量過高、營養不良和酗[6][17]。其他的危險因子也包括憂鬱症[18]。潛在的病理機制與冠狀動脈血管粥狀硬化有關[6]心電圖心臟壓力測試冠狀動脈血管攝影英语Coronary catheterization是常見有助於診斷的工具[19]

預防方式包括:健康飲食、規律運動、體重控制以及戒菸[7]。視情況合併使用藥物控制高血糖、高膽固醇或高血壓[7]。只有很有限的證據支持對低風險且沒有症狀的民眾實施篩檢[20]。最初治療和預防措施一樣,包括生活方式調整以及三高(高血糖、高膽固醇或高血壓)的控制[8][21]。進一步的藥物治療包括阿斯匹靈乙型交感神經阻斷劑硝酸甘油的醫療用途[8]。在病況較嚴重的情形下,會考慮進行經皮冠狀動脈介入治療或是冠狀動脈繞道手術[8][22]。對於穩定型心絞痛,經皮冠狀動脈介入治療或是冠狀動脈繞道手術,對於提升存活年限或降低未來心臟病發的效果仍不明確[23]

冠狀動脈疾病在西元2002年是全球第一大死因[24],也是人們住院的主要原因之一[25]。2013年也是全球死因首位,死亡人數自1990年574萬人(12%)攀升至2013年814萬人(16.8%)[15]。而隨著診斷及治療技術進步,經年齡校正後的冠狀動脈疾病死亡率自1980年至2010年則呈現下降趨勢,尤其在已開發國家更為顯著[26]。同時經年齡校正後的冠狀動脈疾病病例數在1990至2010年間亦呈現下降趨勢[27]。根據美國本土於2010年統計,冠狀動脈疾病盛行率於大於65歲族群為20%、45至64歲為7%、18至45歲為1.3%。針對同一年齡層相比,男性的發生率較女性高[28]

治疗编辑

冠狀動脈是主動脈的分支,負責供應足夠氧和營養素予心肌。冠狀動脈被膽固醇或血凝塊阻塞時,會形成斑塊而引致心臟供血不足,患者需要接受俗稱「通波仔」(粵語打通用的氣球)的血管擴張手術以氣球擴張冠狀動脈,使之暢通。若冠狀動脈血液被嚴重阻塞,可引致很嚴重的後果。血液不能供應到心臟會引致劇烈的心絞痛,然後心臟會衰竭,最嚴重的可導致死亡。當冠心病發作時,須立即口含醫師處方的「页面存档备份,存于互联网档案馆)底丸」(粵語舌下丸之義,成分為硝酸甘油),其可扩张血管,以增加冠状动脉血流量。冠心病發作可引致嚴重後果,應立即叫救護車求助。

健康的生活方式编辑

药物治疗编辑

相關治療手術编辑

参考资料编辑

  1. ^ Coronary heart disease - causes, symptoms, prevention. Southern Cross Healthcare Group. [15 September 2013]. (原始内容存档于2014年3月3日). 
  2. ^ Faxon, David P.; Creager, Mark A.; Smith, Sidney C.; Pasternak, Richard C.; Olin, Jeffrey W.; Bettmann, Michael A.; Criqui, Michael H.; Milani, Richard V.; Loscalzo, Joseph; Kaufman, John A.; Jones, Daniel W. Atherosclerotic Vascular Disease Conference: Executive Summary: Atherosclerotic Vascular Disease Conference Proceeding for Healthcare Professionals From a Special Writing Group of the American Heart Association. Circulation. 2004-06, 109 (21). ISSN 0009-7322. doi:10.1161/01.CIR.0000128517.52533.DB (英语). 
  3. ^ Coronary heart disease. NIH. [15 September 2013]. (原始内容存档于2013-09-12). 
  4. ^ 4.0 4.1 What Are the Signs and Symptoms of Coronary Heart Disease?. NHLBI, NIH. September 29, 2014 [23 February 2015]. (原始内容存档于2015-02-24). 
  5. ^ 5.0 5.1 Coronary Artery Disease (CAD). cdc.gov. March 12, 2013 [23 February 2015]. (原始内容存档于2015-03-02). 
  6. ^ 6.0 6.1 6.2 6.3 Mendis, Shanthi; Puska,, Pekka; Norrving, Bo. Global atlas on cardiovascular disease prevention and control (PDF) 1st ed. Geneva: World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization. 2011: 3–18 [2015-03-29]. ISBN 9789241564373. (原始内容存档 (PDF)于2014-08-17). 
  7. ^ 7.0 7.1 7.2 How Can Coronary Heart Disease Be Prevented or Delayed?. NHLBI, NIH. [25 February 2015]. (原始内容存档于2015-02-24). 
  8. ^ 8.0 8.1 8.2 8.3 8.4 How Is Coronary Heart Disease Treated?. NHLBI, NIH. September 29, 2014 [25 February 2015]. (原始内容存档于2015-02-24). 
  9. ^ Vos, Theo; Allen, Christine; Arora, Megha; Barber, Ryan M.; Bhutta, Zulfiqar A.; Brown, Alexandria; Carter, Austin; Casey, Daniel C.; Charlson, Fiona J.; Chen, Alan Z.; Coggeshall, Megan. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016-10-08, 388 (10053). ISSN 0140-6736. PMC 5055577 . PMID 27733282. doi:10.1016/S0140-6736(16)31678-6 (English). 
  10. ^ Wang, Haidong; Naghavi, Mohsen; Allen, Christine; Barber, Ryan M.; Bhutta, Zulfiqar A.; Carter, Austin; Casey, Daniel C.; Charlson, Fiona J.; Chen, Alan Zian; Coates, Matthew M.; Coggeshall, Megan. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016-10-08, 388 (10053). ISSN 0140-6736. PMC 5388903 . PMID 27733281. doi:10.1016/S0140-6736(16)31012-1 (English). 
  11. ^ Bhatia, Sujata K. Biomaterials for clinical applications Online-Ausg. New York: Springer. 2010: 23 [2015-03-29]. ISBN 9781441969200. (原始内容存档于2014-11-02). 
  12. ^ Coronary heart disease - causes, symptoms, prevention. Southern Cross Healthcare Group. [15 September 2013]. (原始内容存档于2016-04-04). 
  13. ^ Faxon, David P.; Creager, Mark A.; Smith, Sidney C.; Pasternak, Richard C.; Olin, Jeffrey W.; Bettmann, Michael A.; Criqui, Michael H.; Milani, Richard V.; Loscalzo, Joseph; Kaufman, John A.; Jones, Daniel W. Atherosclerotic Vascular Disease Conference. Circulation. 2004-06-01, 109 (21). doi:10.1161/01.CIR.0000128517.52533.DB. 
  14. ^ Coronary heart disease. ADAM. [15 September 2013]. (原始内容存档于2013-09-12). 
  15. ^ 15.0 15.1 Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2015-01-10, 385 (9963). ISSN 0140-6736. PMC 4340604 . PMID 25530442. doi:10.1016/S0140-6736(14)61682-2 (English). 
  16. ^ Wong, Nathan D. Epidemiological studies of CHD and the evolution of preventive cardiology. Nature Reviews Cardiology. 2014-05, 11 (5). ISSN 1759-5002. PMID 24663092. doi:10.1038/nrcardio.2014.26 (英语). 
  17. ^ Mehta, Puja K.; Wei, Janet; Wenger, Nanette K. Ischemic heart disease in women: A focus on risk factors. Trends in Cardiovascular Medicine. 2015-02-01, 25 (2). ISSN 1050-1738. PMC 4336825 . PMID 25453985. doi:10.1016/j.tcm.2014.10.005 (英语). 
  18. ^ Charlson, Fiona J.; Moran, Andrew E.; Freedman, Greg; Norman, Rosana E.; Stapelberg, Nicolas JC; Baxter, Amanda J.; Vos, Theo; Whiteford, Harvey A. The contribution of major depression to the global burden of ischemic heart disease: a comparative risk assessment. BMC Medicine. 2013-11-26, 11 (1). ISSN 1741-7015. PMC 4222499 . PMID 24274053. doi:10.1186/1741-7015-11-250. 
  19. ^ How Is Coronary Heart Disease Diagnosed?. NHLBI, NIH. September 29, 2014 [25 February 2015]. [永久失效連結]
  20. ^ Desai, Chintan S.; Blumenthal, Roger S.; Greenland, Philip. Screening low-risk individuals for coronary artery disease. Current Atherosclerosis Reports. 2014-04, 16 (4). ISSN 1534-6242. PMID 24522859. doi:10.1007/s11883-014-0402-8. 
  21. ^ Boden, William E.; Franklin, Barry; Berra, Kathy; Haskell, William L.; Calfas, Karen J.; Zimmerman, Franklin H.; Wenger, Nanette K. Exercise as a therapeutic intervention in patients with stable ischemic heart disease: an underfilled prescription. The American Journal of Medicine. 2014-10, 127 (10). ISSN 1555-7162. PMID 24844736. doi:10.1016/j.amjmed.2014.05.007. 
  22. ^ Deb, Saswata; Wijeysundera, Harindra C.; Ko, Dennis T.; Tsubota, Hideki; Hill, Samantha; Fremes, Stephen E. Coronary artery bypass graft surgery vs percutaneous interventions in coronary revascularization: a systematic review. JAMA. 2013-11-20, 310 (19). ISSN 1538-3598. PMID 24240936. doi:10.1001/jama.2013.281718. 
  23. ^ Rezende, Paulo Cury. Conservative strategy for treatment of stable coronary artery disease. World Journal of Clinical Cases. 2015, 3 (2). ISSN 2307-8960. PMC 4317610 . PMID 25685763. doi:10.12998/wjcc.v3.i2.163 (英语). 
  24. ^ Finegold, Judith A.; Asaria, Perviz; Francis, Darrel P. Mortality from ischaemic heart disease by country, region, and age: Statistics from World Health Organisation and United Nations. International Journal of Cardiology. 2013-09-30, 168 (2). ISSN 0167-5273. PMC 3819990 . PMID 23218570. doi:10.1016/j.ijcard.2012.10.046 (English). 
  25. ^ World Health Organization Department of Health Statistics and Informatics in the Information, Evidence and Research Cluster. The global burden of disease 2004 update. Geneva: WHO. 2004. ISBN 92-4-156371-0. 
  26. ^ Moran, Andrew E.; Forouzanfar, Mohammad H.; Roth, Gregory A.; Mensah, George A.; Ezzati, Majid; Murray, Christopher J.L.; Naghavi, Mohsen. Temporal Trends in Ischemic Heart Disease Mortality in 21 World Regions, 1980 to 2010: The Global Burden of Disease 2010 Study. Circulation. 2014-04-08, 129 (14). ISSN 0009-7322. PMC 4181359 . PMID 24573352. doi:10.1161/CIRCULATIONAHA.113.004042 (英语). 
  27. ^ Moran, Andrew E.; Forouzanfar, Mohammad H.; Roth, Gregory A.; Mensah, George A.; Ezzati, Majid; Flaxman, Abraham; Murray, Christopher J.L.; Naghavi, Mohsen. The Global Burden of Ischemic Heart Disease in 1990 and 2010: The Global Burden of Disease 2010 Study. Circulation. 2014-04-08, 129 (14). ISSN 0009-7322. PMC 4181601 . PMID 24573351. doi:10.1161/CIRCULATIONAHA.113.004046 (英语). 
  28. ^ Centers for Disease Control and Prevention (CDC). Prevalence of coronary heart disease--United States, 2006-2010. MMWR. Morbidity and mortality weekly report. 2011-10-14, 60 (40). ISSN 1545-861X. PMID 21993341. 
  29. ^ Resolving the Coronary Artery Disease Epidemic through Plant-Based Nutrition. [2012-01-31]. (原始内容存档于2012-01-06). 
  30. ^ Preventive Cardiology; 2001; 4: p171-177
  31. ^ Morrison, Lester M. DIET IN CORONARY ATHEROSCLEROSIS. Journal of the American Medical Association. 1960-06-25, 173 (8). ISSN 0002-9955. doi:10.1001/jama.1960.03020260024006 (英语). 
  32. ^ 32.0 32.1 Coronary artery disease: Treatments and drugs. MayoClinic.com. [2012-01-31]. (原始内容存档于2013-12-19). 
  33. ^ Fish oil: MedlinePlus Supplements. [2012-01-31]. (原始内容存档于2015-07-05). 

外部链接编辑