心肌梗死lectureppt课件

,1,Small lecture Department: the first aid center Presenter : Li Li Counselor: Deng hen Hui,,Acute Myocardial Infarction,急性心肌梗死,Lets learn some New words,infarction 梗死 myocardial 心肌的 ischemic iskemik局部 缺血的 necrosis nekrusis坏死 coronary 冠状动脉的 segment 段 myocardium心肌 atherosclerotic ,rusklrtik动脉粥样硬 化的 Scar healing 瘢痕愈合 enzyme 酶,arrhythmiarii心率失常 accompanied 伴随 Nitroglycerinnaitruglisrin 硝酸甘油 nausea n:zi恶心 electrocardiogram i,lektruk:diurm心电图 dizziness dizinis 头晕 Gastrointestinal胃肠道 Shit 大便 Coagulative kugjuleitiv 凝固性 fibrosis 纤维化,Lets learn some New words,Urine output 尿量 Pathological 病理的 hiked haik 抬高 inversion 倒置 serum sirm, si:r- 血清 pericardial 心包的 subendocardial 心内膜下 tranquilizer 镇静剂 urokinase ,jurukaineis尿激酶,streptokinase ,streptukaineis, -ki-, -neiz链激酶 haemorrhage hemrid出血的 reperfusion 再灌 invasion发病 unobstructed 通畅 Thrombolytic 溶栓 troponin trpnin肌钙蛋白 dynamic dainmik动态的,Lets learn some New words,infarction梗死 myocardial 心肌的 ischemic iskemik局部缺血的 necrosisnekrusis坏死 coronary冠状动脉的 segment段 myocardium心肌 atherosclerotic动脉粥样硬化的 Shit大便 Coagulative凝固性 fibrosis 纤维化 Scar healing 瘢痕愈合 enzyme酶 Arrhythmiarii anginandain,accompanied伴随 Nitroglycerinnaitruglisrin硝酸甘油 nausea n:zi恶心 electrocardiogram心电图 dizziness头晕 Gastrointestinal胃肠道 Urine output尿量 Pathological ,pldikl病理的 hiked 抬高 inversion倒置 serum sirm, si:r-血清 Layer层 percutaneous,p:kju:teinis经由皮肤的,pericardial心包的 subendocardial心内膜下 tranquilizer镇静剂 urokinase 尿激酶 streptokinase 链激酶 haemorrhage出血的 reperfusion 再灌 invasion发病 unobstructed 通畅 Thrombolytic 溶栓 troponin trpnin肌钙蛋白 dynamic dainmik动态的,,Contents,causes,definition Acute myocardial infarction refers to ischemic myocardial necrosis usually 局部缺血的 坏死 resulting from abrupt reduction in coronary 冠状动脉的 blood flow to a segment of myocardium,,causes,,Histologic 组织学changes Coronary artery occlusion klu:n, -,,Clinical characteristics：,,【 Clinical manifestations 】,1.New happen angina pectoris or original anginandainaggravating , nitroglycerin poor effects,2. With nausea, vomiting, sweating, blood pressure drops, arrhythmia, heart failure,3.Obvious electrocardiogram ST - T change,Prodromal (前驱的) symptoms,二、 symptoms 1. Chest pain: Typical: long time (several h several d), including the nitroglycerin invalid Not typical: abdomen, jaw下颌, back pain; 2.Systemic symptom:fever, dizzinessdizinis,weakness. 。 3.Gastrointestinal symptoms:胃肠道症状： ,struintestinl,4、 Arrhythmiarii: all kinds of arrhythmia Ventricular ventrikjul arrhythmia室性心律失常 Sinus sains tachycardia ,tkik:di窦性心动过速 Slow arrhythmia 缓慢心律失常 5、 Heart failure Acute left heart failure Acute right heart failure,6、 Hypotension and shock ： Low blood pressure, no microcirculation dysfunction障碍； Shock：1.SBP80mmHg； 2.Pulse fine fast, complexion kmplekn is pale, skin wet and sweat ； 3. Fidgeting fidit, and Slow response烦躁不安、神志迟钝； 4. Urine output(20ml/h);,【Laboratory tests 】 一、 electrocardiogram 1、 characteristically特征性改变： Pathological Q wave ； st-segment outlining the upward hiked haik ST段弓背向上抬高； T wave inversion 。,二.Myocardial necrosis markers （ 心肌坏死标记物） Rise time peak time drop to normal Muscle red protein 2h 12h 24-48h troponin trpnin 3-4h 11-24h 7-10d CK-MB 4h 16-24h 3-4d ( 肌酸激酶同工酶),【 Laboratory tests 】,。 三、 Other inspection WBC(rise)；ESR： 1 2 days after illness appeared, 1 3 weeks continued.,Gross anatomy classification 1.Have q-wave myocardial infarction: infarction involving the room wall, can spread all layers pericardial; ,perik:dil,-dik 心包膜 2.No q-wave myocardial infarction: Small range myocardial infarction, subendocardial infarction . 心内膜下,【treatment】 Treatment is designed to relieve distress, reverse ischemia, limit infarct size, reduce heart work, prevent and treat complications.,【treatment】 一、 Monitoring and general treatment 1、 Monitoring. ： 2、 Rest: physical and mental ； 3、 oxygen uptake： 4、 diet： 5、 Urine unobstructed ：,二. relieve pain： 1.PaiTiDing(pethidine):50100 mg，im(intramuscular ); morphine：510 mg (milligram) ，im。 2.tranquilizer镇静剂：510 mg，im 或 iv。 3.nitroglycerin硝酸甘油(0.30.6mg) i.v.gtt。 4.Traditional Chinese medicine: JiuXinWan of rapidly-available containing or oral ：速效救心丸含化或口服。,三. Myocardial reperfusion ： 1、 Thrombolytic Therapy溶栓疗法： （1） indication ： Persistent chest (more than)30min; invasion发病(less than) 6h; age (less than) 70yr。,（2） Thrombolysis drug urokinase ,jurukaineis streptokinase ,streptukaineis, -ki-, -neiz （3） contraindication kntr,indikein ： age70yr； Have haemorrhage tendency ； hemrid,2.P