冠狀動脈疾病
冠狀動脈疾病 coronary artery disease | |
---|---|
同義詞 | Atherosclerotic heart disease,[1]atherosclerotic vascular disease,[2]coronary heart disease[3] |
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冠狀動脈粥樣(atherosclerosis)硬化示意圖 | |
症狀 | 胸痛、呼吸困難[4] |
併發症 | 心臟衰竭、心律不整[5] |
類型 | 動脈疾病[*]、心血管疾病、疾病 |
病因 | 心臟的動脈 粥樣硬化[6] |
風險因素 | 高血壓、吸煙、糖尿病、缺乏運動、肥胖症、高膽固醇血症[6] |
診斷方法 | 心電圖、心臟壓力測試, 冠狀動脈血管電腦斷層掃描, 冠狀動脈血管攝影 |
預防 | 健康的飲食、規律運動、維持健康的體重、不吸煙[7] |
治療 | 經皮冠狀動脈介入治療 (PCI), 冠狀動脈旁路移植 (CABG)[8] |
藥物 | 阿士匹靈, β受體阻滯劑, 硝酸甘油[8] |
盛行率 | 1.1 億 (2015)[9] |
死亡數 | |
分類和外部資源 | |
醫學專科 | 心臟病學、心臟外科 |
ICD-9-CM | 410-414.99、414.0、414.9、414.00 |
OMIM | 300464、607339、608316、608318、608320、610947、611139、612030、614293 |
MedlinePlus | 007115 |
eMedicine | 349040 |
冠狀動脈疾病(coronary artery disease,CAD)簡稱冠脈病[11][12],是冠狀動脈結構和(或)功能異常,引起冠脈狹窄、痙攣、閉塞、動脈瘤、夾層的疾病[13][14][15]。冠脈病最常見由粥樣硬化引起,其他尚有因痙攣、栓塞、炎症,及先天畸形等所致。由於冠脈病使心肌的血流灌注降低,輕可導致胸痛(心絞痛),重則引起心臟病發作(心肌梗死)。
冠狀動脈心臟病(coronary heart disease,CHD[16][17])簡稱冠心病,是造成心肌缺血和(或)梗死的一組臨床綜合症,屬於最常見的心血管疾病[18]。
臨床上,冠脈病與冠心病兩者範圍常重疊且混用,但前者不一定具有心肌缺血或梗死,且可為後者的早期病變。簡言之,冠脈病含蓋範圍較廣,冠心病屬於一種冠脈病[19]。冠脈病或冠心病有許多異名或近義詞,如:心肌缺血(myocardial ischemia)、缺血性心臟病(ischemic heart disease,IHD)[20]、冠狀動脈粥樣硬化心臟病(coronary atherosclerotic heart disease,CAHD)[21][22]、冠狀動脈粥樣硬化心血管疾病[23]等等。
冠脈病型態包含穩定型心絞痛、非穩定型心絞痛、心肌梗塞和猝死[24]。
症狀
[編輯]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或心律不整[5]。
成因與診斷
[編輯]危險因子包括:高血壓、抽煙、糖尿病、缺乏運動、肥胖、血液中膽固醇含量過高、營養不良和酗酒等[6][25]。其他的危險因子也包括憂鬱症[26]。潛在的病理機制與冠狀動脈血管的粥狀硬化有關[6]。心電圖、心臟壓力測試與冠狀動脈血管攝影(一種血管攝影)是常見有助於診斷的工具[27]。
預防與治療
[編輯]預防方式包括:健康飲食、規律運動、體重控制以及戒煙[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[28]。
由於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,當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。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][29]。進一步的藥物治療包括阿士匹靈、乙型交感神經阻斷劑或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][30]。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[31]。
冠狀動脈球囊粵語稱「通波仔」,冠狀動脈球囊成形術是以氣球(球囊)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「脷底丸」(粵語舌下丸之義),其可擴張血管,以增加冠狀動脈血流量。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
[編輯]- 卡德維爾·愛色斯坦與科林·坎貝爾證明,素食對改善冠心病和動脈硬化有很大效果。他們的同事也從許多研究中確認,素食使得許多患者的病情得以停止發展,甚至出現好轉[32][33]。此類建議(增加素食,減少葷菜)已經在至少50年前就被提出了[34][35]。
- 控制體重
- 停止吸煙、酗酒
- 鍛煉
- 適量的魚油(尤其是海魚,如金槍魚、三文魚)攝入,以補充ω−3脂肪酸[36]
藥物治療
[編輯]手術治療
[編輯]流行病學
[編輯]冠狀動脈疾病在西元2002年是全球第一大死因[38],也是人們住院的主要原因之一[39]。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%)[18]。而隨着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,尤其在發達國家更為顯著[40]。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[41]。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[42]。
參考資料
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外部連結
[編輯]
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- Risk Assessment of having a heart attack or dying of coronary artery disease, from the American Heart Association.
- Coronary Artery Disease. MedlinePlus. U.S. National Library of Medicine. [2022-05-03]. (原始內容存檔於2020-07-29).
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