2014年 · 第42卷第06期

After the publication of the American College of Cardiology (ACC) /American Heart Association (AHA) 2013 Guidelines for the Treatment of Blood Cholesterol to Reduce the Risk of Atherosclerotic Cardiovascular Disease in Adults (the "New Guidelines"), it caused widespread controversy. Relevant academic institutions and experts in China have also discussed and questioned the "new guidelines", and their opinions are basically consistent. The "new guidelines" are not applicable to clinical practice in China.

pulmonary hypertension due to left heart disease (LHD – PH) is caused by left heart disease and is one of the common types of pulmonary hypertension. In the current European, US and Chinese guidelines for pulmonary hypertension, LHD – PH is classified as the second largest category^[1,2,3]The mean pulmonary artery pressure (mPAP) ≥25 mmHg (1 mmHg =0.133 kPa) with left atrial pressure or pulmonary capillary wedge pressure (PCWP)>15 mmHg at rest was the hemodynamic characteristic. The high morbidity and mortality of LHD-PH, and the increased awareness of LHD-PH has made rapid progress in this field.

Hereditary pulmonary hypertension is a kind of malignant pulmonary vascular disease characterized by pulmonary arteriolar remodeling, which causes progressive increase of pulmonary artery pressure and pulmonary vascular resistance and ultimately leads to right heart failure and death. The natural prognosis is extremely poor, with a median survival time from diagnosis to death of only 2.8 years and less than 10 months in pediatric patients^[1]。 DRESDALE et al.^[2]Familial pulmonary hypertension was first reported in 1954. After the Dana Point meeting in 2008, the designation hereditary pulmonary hypertension replaced familial pulmonary hypertension, mainly considering that 10% to 20% of patients with idiopathic pulmonary hypertension (IPAH) have genetic mutations that may be passed on to offspring, resulting in an increased risk of disease^[2]。

The patient was an 80-year-old female who was admitted to the hospital on 25-Jun-2013 due to chest pain for 6 h. The patient was admitted to the hospital with persistent chest pain, pale complexion and sweating profusely. Physical examination revealed that the patient had a blood pressure of 88/62 mmHg (1 mmHg =0.133 kPa), a heart rate of 62 beats/min, and no dry or wet rales were heard in either lung. ECG showed ST segment elevation 0.15~0.2 mV in leads Ⅱ, Ⅲ and aVF, V_3R~ V_5RThe ST segment elevation of the lead was 0.1 mV, and "acute inferior wall and right ventricular myocardial infarction" was considered. Aspirin tablets 300 mg chewed and clopidogrel 300 mg orally were given, and appropriate fluid rehydration and dopamine booster treatment were given. He had a history of hypertension for 10 years, and the highest blood pressure was 180/112 mmHg. He was usually treated with perindopril tablets + amlodipine tablets, and his blood pressure was controlled. Another patient had a history of atrial fibrillation for 5 years, and he was usually not treated with antithrombotic drugs. Emergency coronary angiography showed no obvious abnormalities in the left main trunk, anterior descending artery and circumflex artery, blood flow TIMI grade 3, right coronary artery was thick, posterior trigeminal anterior occlusion, blood flow TIMI grade 1, and a large number of thrombosis were seen (FIG. 1a), the thrombus was aspirated and a large number of thrombus were extracted. Reexamination and angiography showed that the thrombus shadow at the lesion disappeared, the blood vessels were smooth, no obvious stenosis was seen, and the blood flow was slow (FIG. 1b）。 Intracoronary intravascular ultrasound (IVUS) examination showed that the intima of the lesion was intact and there was no plaque rupture (Figure 2), without stent placement. Transthoracic cardiac ultrasound was performed on the 3rd postoperative day, which revealed a slightly stronger echo in the free wall of the left atrium, considering thrombosis (Figure 3）。 Comprehensive analysis of the above findings shows that the etiology of this case of myocardial infarction is highly considered to be caused by atrial fibrillation and coronary embolism.

Diabetes is an important public health problem in Europe and globally. Some 52 million people in Europe had diabetes in 2011, rising to 64 million in 2030, and half the population is unaware they have it. In addition, a large number of people are in a state of prediabetes. Diabetic patients have an increased risk of cardiovascular disease, and more than 60% of diabetic patients suffer from and eventually die from cardiovascular disease. Screening for diabetes in healthy people, cardiovascular risk assessment in diabetic patients, early diagnosis and active intervention are important strategies to reduce the burden of disease and reduce fatal and disabling events.

There are many opinions on the significance of "decreasing" and "reaching the standard" of low density lipoprotein cholesterol (LDL-C) in lipid-lowering treatment. For example, LDL-C should be reduced as low as possible, or a little lower is better, etc. Specific LDL-C should be reduced to the standard value, in low-risk groups is<4.14 mmol/L (160 mg/dl), Intermediate risk population<3.37 mmol/L (130 mg/dl), High-risk population<2.59 mmol/L (100 mg/dl), Very high-risk population<1.80 or 2.07 mmol/L (70 or 80 mg/dl). All the above statements have some basis. In short, it is the mainstream understanding in today's medical field that lipid regulation must meet the standard.

Syncope is a transient loss of consciousness caused by transient global brain ischemia, often accompanied by loss of autonomic muscle tone, with the characteristics of rapid onset, transient, self-limiting and complete recovery^[1]。 The most common type of syncope in all age stages is neuromediated syncope^[1]Including vasovagal syncope (VVS), carotid sinus allergy syndrome and episodic syncope, among which VVS is the most common, with an incidence of 40%^[2]。 At present, there are few studies on VVS in the elderly, and there are still many controversies about the views of this group of people. This paper will make a review of the research on VVS in the elderly.