제3장 심혈관계 질환

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부산가톨릭대학교 물리치료학과

김 난 수

제3장 심혈관계 질환

(Cdiovascular Disease)

심 호 흡 계 물 리 치 료

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1. 허혈성 심장질환

• 고콜레스테롤혈증

• 죽상동맥경화증

• 협심증

• 심근경색

• 돌연사

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Atherosclerosis

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협심증 (Angina Pectoris)

 Angina pectoris is the medical term for chest pain or discomfort

due to coronary heart disease.

 Angina is a symptom of a condition called myocardial ischemia.

 It occurs when the heart muscle (myocardium) doesn't get as much blood (hence as much oxygen) as it needs.

 This usually happens because one or more of the heart's arteries (coronary blood vessels that supply blood to the heart muscle) is

narrowed or blocked. Insufficient blood supply is called ischemia.

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Typical Angina Pain Areas

http://www.empowher.com/media/reference/angina 5

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 Stable angina —has a predictable pattern. You generally know what brings it on and relieves it. You may also know what the intensity will be. Normally the chest discomfort is relieved with rest, nitroglycerin or both.

 Unstable angina —is more unpredictable or severe. Chest pain may occur while resting or even sleeping (nocturnal

angina). The discomfort may last longer and be more intense than that of stable angina.

- Unstable angina may be a sign that you are about to have a

heart attack . It should be treated as an emergency.

 Variant or prinzmetal's angina —occurs when you are at rest.

It most often occurs in the middle of the night. It can be quite severe. Variant angina is due to transient coronary artery spasm.

Types of angina

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High Cholesterol

Stable Angina

Unstable Angina

Acute Myocardial Infarction

Acute Heart Failure

Congestive Heart Failure

Cardiac Arrhythmias

• Formation of atherosclerotic plaques

• No Symptoms

• Partial occlusion of coronary artery

• Symptoms only during exertion

• Partial occlusion of coronary artery with sudden, intermittent

vasoconstriction.

• Symptoms increase in frequency and begin to occur at rest

• Complete occlusion of coronary artery

• Cell death and myocardial damage

• Consequences of damage to the heart

TYPICAL

PROGRESSION OF EVENTS IN CORONARY

HEART DISEASE

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TREATMENT OF CORONARY HEART DISEASE

1. PREVENTATIVE DRUG TREATMENT:

– CHOLESTEROL REDUCING DRUGS

2. DRUGS USED TO TREAT STABLE ANGINA PECTORIS:

– BETA BLOCKERS – NITRATES

– CALCIUM CHANNEL BLOCKERS (CCBs)

3. DRUGS USED TO TREAT UNSTABLE ANGINA

– ANTI-PLATELET DRUGS (ASPIRIN)

4. DRUGS USED TO TREAT ACUTE MI:

– FIBRINOLYTICS (t-PA)

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심근경색

(Myocardiac Infarction)

Time is muscle;

the longer you wait,

the more heart muscle you can lose

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돌연심장사 (Sudden Cardiac Death)

심실세동(ventricle fibrillation)

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울혈성심부전

( Congestive Heart Failure)

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Right vs. Left Sided Heart Failure

• Right Heart Failure - The

inability of the right side of the heart to adequately pump venous blood into the pulmonary

circulation. This causes a back-up

of fluid in the body, resulting in

swelling and edema.

• Left Heart Failure - The inability of the left side of the heart to pump into the systemic circulation. Back- up behind the left ventricle causes

accumulation of fluid in the lungs.

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Category Systolic (mm Hg) Diastolic (mm Hg)

Normal* less than 120 and less than 80

Prehypertension 120–139 or 80–89

Hypertension

Stage 1 140–159 or 90–99

Stage 2 160 or higher or 100 or higher

고혈압

(Classification of blood pressure for adults age 18 years and older)

(From the Seventh Report of the Joint National Committee on Detection,

Evaluation, and Treatment of High Blood Pressure : American Heart Association)

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가와사키병

(Kawasaki disease)

 소아에서 발생하는 원인 불명의 급성 열성 혈관염으로 피부 점막과 심장 등에 발생하며 심장 관상동맥 질환의 원인이 됨

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 버거씨병은 주로 하지 또는 상지의 동맥 중에서 비교적 직경이 작은 중소 동맥에 염증이 생겨 동맥의 흐름 방해를 유발하는 질환으로 다른 말로 폐쇄성 혈전혈관염 이라함

버거씨병

(Buerger's disease)

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 다리의 피부 바로 밑으로 보이는 정맥이 늘어나서 피부 밖으로 돌출되어 보이는 질환

하지정맥류 (varicose vein)

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레이노 증후군

(raynaud’s phenomenon)

 추위나 심리적 변화로 인해 손가락이나 발가락 혈관에 허혈 발작이 생기고 피부 색조가 변하는 질환

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부 정 맥 (arrhythmia)

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심막삼출

(Pericardial Effusion)

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판막성 심장질환

(Valvular Heart Disease)

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심근병증(Cardiomyopathies)

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급성심근염 (Acute Myocarditis)

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심막염

(Pericarditis)

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류마티스성 심장질환 (Rheumatic heart disease)

Diseased Heart Valve

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감염성 심장내막염

(Infective endocarditis)

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Reference

• 심장호흡계 물리치료 중재학. 대한심장호흡물리치료 학회. 범문에듀케이션. 2014

• 김경 외. 심장호흡물리치료. 정담미디어. 2013

• 심폐물리치료학. 이석민 외. 현문사. 2014

• https://www.wkhs.com/heart/services/diagnostic_tests/Elec trocardiogram_EKG.aspx?chunkiid=12056

• http://www.empowher.com/media/reference/angina

• http://www.freewebs.com/drfahd/congestiveheartfailure.ht m

• https://www.wkhs.com/heart/services/diagnostic_tests/Elec trocardiogram_EKG.aspx?chunkiid=12056

• http://en.wikipedia.org/wiki/Hypertension

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