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1、 ACC/AHA/ACP-ASIM:稳定性心绞痛治疗指南100 1ACCIAHA/ACP-ASIMevManagement ofStable Angina 六spirin andiantiranginals Beta blocker andblood pressureCholesterol andcigarettes os1999, 33.72092-2人9lation 1999;99:.23820dWRfdion andexercise 目的。 临床评价。 应激试验。治疗方法妃者随访http:/www.acc.org/clinical/guidelines/index.html Apain
2、or discomfort in the chest oradjacent areas caused by insufficientbloodc ilow te ths Pheart muscls.100 3 Foam， Fatty Intermediate Fibrous “ompcatedCells Streak Lesion ”Atheroma ”Plaque Lesion/ Endothelial DysfunctionFrom First From Third From FourthDecade Decade Decade 。the disease typically cycles
3、in and out of clinicallydefined phases:=- asymptomatic= Stable angina- progressive angina=- acute coronary syndromeunstable angina, NQMI, acute MI100 5100 人TFTACC/AHA Classification Class 1 Conditions for which there is evidence andior generalagreementthat a given procedure or treatment is useful an
4、d effective.Class 中 Conditions for which there is conflicting evidence andfor adivergence of opinion about the usefulnessyfefficacy ofa procedure ortreatment. Class lla: VVeight pf evidencefopinion is in favor of uses|Class llb: Usefuinessfefficacy is less weii estabiished byevidencefopinion.ss/feff
5、icacy.Class 川: Conditions for which there is evidence andyfor generalagreement that the procedureytreatment is not usefulfeffective andinsome cases may be harmful.TFT Clinical Assessment有A_ Recommaeridatioiis forHistory and Physical100 7 。，Inpatients presenting with chest pain一detailed symptom histo
6、ry一focused physical examination一directed risk-factor assessmen。Estimate the probability of significant CAD(i.e., low, intermediate, high)100 8 www,icirculationxcom， *” Quality - squeezing,”griplike,”pressurelike,”suffocating” and heavy”;ora discomfort but not pain. Angina is almost never sharp or st
7、abbing，and usually does not change with position or respiration .*。 Duration - anginal episode is typically minutes in duration. Fleetingdiscomfort or a dull ache lasting for hours is rarely angina*。 Location - usually substernal, but radiation to the neck, jaw, epigastrium，or arms is not uncommon.
8、Pain abova the mandihle, below theepigastrium, or jocalized tc a small area DVerthe !ef lateral chest wall israrely anginal.*。 Provocation - angina is generally precipitated by exertion or emotionalstress and commonly relieved by rest. Sublingual nitroglycerin alsorelieves angina, usually within 30
9、seconds to several minutes. 100 9 ypical angina (definite) 1) substernal chest discomfort with a characteristicquality and duration that is .2) provoked by exertion or emotional stress and3) relieved by rest or nitroglycerinAtypical angina (probable)meets 2 ofthe of characteristicsNoncardiac chest painmeets 1 ofthe typical angina characteristics100 10
