情绪压抑和神紧张引起的心肌缺血—一个无形的杀手英文.ppt

1、 Wei Jiang, MDAssociate Professor Internal Medicine Psychiatry 25:247-53 A 64yo WF presents to a local ER, complaining of 2-h substernal chest pain Mild dyspnea with HR 72 bpm, BP 136/72 mm Hg, RR 20/min, T 97.9F, and O2 saturation 96% on RA No past medical history, postmenopausal, walks daily, and

2、on balanced diet 12-lead EKG shows ST elevation in leads V3-V6, troponin 3.5 ng/dL and CPK 275 m/L, LVEF 40% with moderate ventricle dysfunction, apical akinesis, and preserved basal function by Echocardiograpm The patient received news that her daughter had been severely injured in a car accident s

3、everal hours before her onset of chest painA Typical Case:“I have always been impressed by the probability of an important relationship between personality attributes, stress coping strategies and heart disease with myocardial infarction in particular. I have witnessed several friends die suddenly t

4、his way. They did not smoke, were not overweight, and their cholesterol levels were unremarkable. But I knew them to be under considerable strain as the result of professional and personal stressors, and I have always believed that their lack of insight, resilience, and emotional resourcefulness, al

5、ong with their characteristic pattern of responding to stress with helpless anger, significantly contributed to their demise.” _An anonymous CardiologistA Quote from a Cardiologist Ampulla cardiomyopathy (Takotusbo cardiomyopathy) -reversible left ventricular dysfunction: with ST segment elevation8

6、elderly women and one middle-aged man are studied. All coronary arteriograms are normal, though 7 of them had ST elevation on electrocardiogram. Coronary spasm was positive in only 2 of the 7 patients who received provocation testsBiopsy specimens revealed focal myocyte injuryNormal coronary arterio

7、grams during ST elevation and the presence of pathologic myocardial lesions were not consistent with a concept of stunned myocardium. The presence of myocardial lesions suggested that focal and disseminated myocardial damage had occurred.Kawai, et al. Jpn Circ J 2000;64:237Autopsy Findings following

8、 an Earthquake Formal autopsy findings from 111 earthquake-related deaths The median extrication time for 99 of 102 victims buried or trapped in collapsed buildings was 2.1 (range 0.1-7.8) days Deaths were cause by blunt injuries, asphyxia and myocardial infarction. Injuries impaired the airway, bre

9、athing, circulation, and brain or spinal functions in 10.5, 61.9, 46.6 and 57.1% of the victims, respectively. Papadopoulos et al. J Surgery. 2004;91:1633-40Kloner et al J Am Coll Cardiol. 1998;32:553-4Increased MI following an Earthquake _ U.S.AIncreased MI following an Earthquake _ JapanMatsuo et

10、al. Int J Hematol 1998; 67: 1239 Tsai et al. Psychosomatics. 45(6):477-82, 2004 Nov-Dec.Increased MI following an Earthquake _ TaiwanMental stress-Induced Myocardial Ischemic Activity Myocardial Ischemia occurs when the demand on the myocardium is not met by the blood supply High myocardium demandan

11、ything increases activities of myocardium, most notably, physical exercise or condition causing elevation of heart rateLow blood supplyconstriction of coronary arteries anatomically or hemodynamically Myocardial Ischemia occurs transiently in relationship of the alteration of the balance between demand and supplyMechanism of Myocardial IschemiaDemand HR Double ProductSupplyStenosisVessel Constriction