冠状动脉疾病和动脉粥样硬化之间的差异

Key Difference – Coronary Artery Disease vs Atherosclerosis

动脉粥样硬化是一个路径ological condition of thearteriesthat is characterized by the buildup of fat deposits inside the arterial wall. When atherosclerosis takes place in the coronary arteries there is an occlusion of the arterial lumen leading to a reduction in the myocardial perfusion which ends up as myocardial ischemia. This condition is identified as the coronary artery disease. Accordingly,atherosclerosis is the pathological event that gives rise to coronary artery disease.这是key differencebetween the coronary artery disease and atherosclerosis.

内容

1.Overview and Key Difference
2.What is Coronary Artery Disease
3.What is Atherosclerosis
4.Side by Side Comparison – Coronary Artery Disease vs Atherosclerosis in Tabular Form
5.Summary

What is Coronary Artery Disease?

心肌肌肉的血液供应通过冠状动脉发生。这些的阻塞血管因此损害了血液供应心肌and ultimately giving rise to心肌缺血is known as the coronary artery disease.

Occlusion of the coronary arteries can happen due to various causes such as atherosclerosis, thromboembolic events, vascular spasms and etc.

Risk Factors

• Nonmodifiable risk factors
• Age
• 男性
• Family history
• 遗传缺陷
• Modifiable risk factors
• Hyperlipidemia
• Hypertension
• 糖尿病
• Smoking
• 缺乏运动
• Homocysteinemia
• 肥胖
• 痛风

Clinical Features

The ischemia associated with CAD gives rise to an ischemic pain that is known asangina。通常情况下，有一个中央后胸痛会辐射到下颌或手臂上。这种疼痛具有令人着迷的性质，通常，出汗与恐惧感一起出汗。患者可能患有困难。

如下所述，心绞痛有不同的变体。

• 劳累的心绞痛– this is a constricting discomfort in the front of the chest that is provoked by physical exertion, cold weather or emotional upheavals. The pain is usually relieved within few minutes after taking a break from the event that triggered it.
• Stable Angina– an angina is described as stable angina when there is no change in its frequency, duration or severity
• 不稳定的心绞痛– an angina of recent onset or a deterioration of a previously stable angina is known as unstable agina.
• 难治性心绞痛- 在患有严重冠状动脉疾病的患者中，无法进行血运重建并且患者对医疗治疗的反应不良。
• 变体的心绞痛– an unprovoked angina is known as a variant angina

In addition to angina, there can be other clinical features such as,

• 疲劳
• Edema of the dependent regions
• Dyspnea
• 矫形
• Paroxysmal nocturnaldyspnea

诊断和调查

Clinical diagnosis is supported by the following investigations

• ECG
• SPECT
• CT coronary angiography
• Stress echocardiography

Management

CAD的管理因血管损害程度而异。控制风险因素非常重要。可以对患者进行医疗疗法，并随后确定症状的任何改善。当医疗干预措施失败时，进行手术干预措施，例如冠状动脉搭桥术经皮冠状动脉干预（PCI）。

什么是动脉粥样硬化？

动脉粥样硬化是一个路径ological condition of the arteries that is characterized by the buildup of fat deposits inside the arterial wall.

There are different factors and comorbidities that contribute to the development of atherosclerosis. These contributory factors can be basically divided into two categories as modifiable factors and nonmodifiable factors.

Modifiable Factors

• Hyperlipidemia
• Hypertension
• 糖尿病
• Inflammation
• Cigarette smoking

不可修改的因素

• 遗传缺陷
• Family history
• 年龄增长
• 男性

Pathogenesis of Atherosclerosis

“Response to injury” is the most widely accepted hypothesis that explains the pathogenesis of this condition by integrating the aforementioned risk factors with the pathological events taking place in the arterial wall. This hypothesis suggests a seven-step mechanism for the development of an atheroma.

1. Endothelial injury and dysfunction which increase the vascular permeability, leukocyte adhesion and the likelihood ofthrombosis。
2. Accumulation of lipids inside the vessel wall.低密度脂蛋白它的氧化形式是大量积累的脂肪类型。
3. 单核细胞粘附的endothelium。These monocytes then migrate into the intima and transform into foam cells or macrophages.
4. Platelet adhesion
5. 在损伤部位积累的血小板，巨噬细胞和其他各种类型的细胞开始释放不同的化学介质，从培养基或循环前体启动平滑肌细胞。
6. 招募的平滑肌细胞增殖，同时合成细胞外基质物质并吸引T细胞走向受损的船只。
7. 脂质会形成动脉粥样硬化的细胞外和细胞内（巨噬细胞和平滑肌细胞）。

Morphology

The two hallmark morphological features of atherosclerosis are the presence of fatty streaks and atheromas.

脂肪条纹包含充满脂质的泡沫巨噬细胞。一开始，它们看起来像微小的黄斑，后来融合形成通常长度约1厘米的条纹。由于它们的表面不足以升高，因此流经血管的血液不会中断。尽管脂肪条纹可以发展为动脉瘤，但大多数人会自发消失。健康婴儿和青少年的主动脉也可以具有这些脂肪条纹。

动脉粥样硬化的并发症

Atherosclerosis mainly affects large arteries such as the aorta and medium-sized arteries like the coronary arteries. Although it is possible for this pathological process to happen anywhere in the body, a person becomes symptomatic only when atherosclerosis damages the arteries supplying the heart, brain and the lower extremities. Therefore, the major complications of atherosclerosis are,

• Myocardial infarction
• Cerebral infarction
• 坏疽of the lower limbs
• 主动脉动脉瘤

What is the Difference Between Coronary Artery Disease and Atherosclerosis?

Coronary Artery Disease vs Atherosclerosis
闭塞血管的阻塞因此损害了心肌的血液供应，并最终导致心肌缺血被称为冠状动脉疾病。	动脉粥样硬化是一个路径ological condition of the arteries that is characterized by the buildup of fat deposits inside the arterial wall.
类型
CAD是一种疾病，是由于冠状动脉造成的动脉粥样硬化引起的。	动脉粥样硬化是导致CAD的病理事件

Summary –Coronary Artery Disease vs Atherosclerosis

闭塞血管的阻塞因此损害了心肌的血液供应，并最终导致心肌缺血被称为冠状动脉疾病。另一方面，动脉粥样硬化是动脉的病理状况，其特征是动脉壁内的脂肪沉积物积聚。冠状动脉疾病是由于动脉粥样硬化引起的，该动脉粥样硬化发生在冠状动脉中。这是两个条件之间的区别。

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参考：

1. Kumar, Parveen J., and Michael L. Clark. Kumar & Clark clinical medicine. Edinburgh: W.B. Saunders, 2012. Print. Ser. 8.

2.Kumar, Vinay, Stanley Leonard Robbins, Ramzi S. Cotran, Abul K. Abbas, and Nelson Fausto. Robbins and Cotran pathologic basis of disease. 9th ed. Philadelphia, Pa: Elsevier Saunders, 2010. Print

Image Courtesy:

1.’2011年全国心脏肺和血液Insitute（NIH）（公共领域）通过Commons Wikimedia
2.’Atherosclerosis, aorta, gross pathology PHIL 846 lores’By PHIL_846_lores, (Public Domain) viaCommons Wikimedia