在全身性炎症疾病中冠状动脉微血管功能障碍:从病理生理学和患病率到诊断和管理
Helene DiGregorio1, Kenneth Williams2, Brittany Weber3
1Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
概括
冠状动脉微血管功能障碍 (CMVD) 是自身免疫性疾病患者心血管问题的关键因素. 早期怀疑和仔细诊断CMVD对于管理这些人的心脏健康至关重要.
科学领域:
- 心脏病学 心脏病学
- 类风湿病学 类风湿病学
- 免疫学 免疫学 免疫学
背景情况:
- 自身免疫系统性炎症性疾病与显著的心血管发病率和死亡率有关.
- 冠状动脉微血管功能障碍 (CMVD) 在这些患者观察到的心血管并发症中起着至关重要的作用.
- 在出现心血管症状的自身免疫性疾病患者中,对心血管疾病的高度怀疑指数是合理的.
研究的目的:
- 审查CMVD的病理生理学,重点关注炎症的作用.
- 讨论自身免疫性疾病患者中CMVD的诊断方法.
- 在这个复杂的人群中概述基于证据的CMVD管理策略.
主要方法:
- 文献综述侧重于CMVD的病理生理学,诊断和管理.
- 强调系统性炎症在微血管疾病发展中的作用.
- 评估非侵入性和侵入性诊断测试方式.
主要成果:
- 炎症是CMVD在自身免疫性疾病的发展和进展中的中心机制.
- 在有症状的患者,特别是那些没有阻塞性冠状动脉疾病的患者中,应仔细考虑CMVD的诊断评估.
- 管理策略需要基于证据的方法,适合这些复杂的患者.
结论:
- 在患有自身免疫系统性炎症性疾病的患者中,慢性心血管疾病是心血管风险的重要因素.
- 及时诊断和适当的CMVD管理对于改善心血管结果至关重要.
- 对该群体中CMVD的特定机制和向治疗的进一步研究是有必要的.
相关概念视频
Myocarditis I: Introduction
374
Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...
374
Coronary Artery Disease II: Pathophysiology
374
Coronary Artery Disease (CAD) originates from a series of events that impair the function of coronary arteries, the blood vessels responsible for delivering oxygen-rich blood to the heart muscle. The pathophysiology of CAD is closely linked to atherosclerosis, a chronic inflammatory and lipid-driven condition affecting the vascular endothelium.1. Endothelial DamageThe process begins with damage to the vascular endothelium, which serves as a protective barrier between the blood and the vessel...
374
Coronary Artery Disease I: Introduction
882
Coronary Artery Disease (CAD): An Overview with Scientific InsightsCoronary Artery Disease (CAD), often referred to as C-A-D, is a prevalent blood vessel disorder classified under the broader category of atherosclerosis. Atherosclerosis is a pathological process characterized by the hardening and narrowing of arteries due to the accumulation of atherosclerotic plaques. These plaques are composed of cholesterol, fatty substances, inflammatory cells, calcium, and fibrin, reducing blood flow to...
882
Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
492
The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
492
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
361
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
361
Rheumatic Heart Disease I: Introduction
447
Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
447


