《心肌梗死英》PPT课件.ppt

ACUTEMYOCARDIALINFARCTION（AMI）,DefinitionPrevalenceCauseSymptomsandsignsAuxiliaryexaminations。,Contents,DiagnosisThedifferentialdiagnosiscomplicationsTherapy。,Definition,Deathornecrosisofmyocardialcells.,Definition,Fromananatomicormorphologicstandpoint-transmural-nontransmural.,Definition,FromECGfinding-STelevationSTEMI-non-STelevationNSTEMI,Prevalence,TheWorldHealthOrganizationestimatedin2004,that12.2%ofworldwidedeathswerefromischemicheartdisease.,Leadingcauseofdeathinhigh-ormiddle-incomecountries.Secondonlytolowerrespiratoryinfectionsinlower-incomecountries.,Worldwide,morethan3millionpeoplehaveSTEMIsand4millionhaveNSTEMIsayear.STEMIsoccurabouttwiceasofteninmenaswomen.,Ingeneral，MIcanoccuratanyage，butitsincidentriseswithage.Approximately50%ofallMIsintheUSoccurinpeopleyoungerthan65yearsofage.,MortalityThemortalityis50%in24hours.,Cause,CoronaryatherosclerosisFormationofthrombusObstructionofbloodflowMuscledeathincardiacmuscle,Plaquerupture,adventitia,lipidcore,Cholesterolnuclear,thrombosis,Rupturedplaques,Riskfactors,AgeHyperlipidemiaDiabetesmellitusHypertensionSmokingMalegenderFamilyhistoryofatheroscleroticarterialdisease(inheritance),Inducingfactors,EarlyhoursofthemorningOvereatingHeavyphysicalactivityAgitationRapidriseofbloodpressure,DefecatinghardlyShockDehydrationSurgerySeverearrhythmia,Symptoms,Prodromalsymptoms:PainofinfarctionAssociatedsymptomsPainlessinfarctionsuddendeathandEarlyarrhythmias,Prodromalsymptoms,Occuratrestorwithlessactivitythanusual.Approximatelyonethirdhavehadsymptomsfrom1to4weeksbefore.,Painofinfarction,AtrestIntheearlymorningSimilartoanginainlocationandradiationbutmoresevere.Nitroglycerinhaslittleeffect,evenopioidmaynotrelievethepain.,Associatedsymptoms,coldsweatweakLight-headednessapprehensivesyncope,dyspneaorthopneacoughwheezingnauseaandvomitingabdominalbloating,Painlessinfarction,Itisestimatedthatatleast20%ofacuteMIsarepainlessoratypical.ElderlypatientsandpatientswithdiabetesareparticularlypronepainlessoratypicalMI.,suddendeathandEarlyarrhythmias,About50%occurbeforethepatientsarriveatthehospitals,withdeathpresumablycausedbyventricularfibrillation.,Signs,generalChestHeartExtremities,Signs,GeneralAnxiousSweatingprofuselybradycardiaortachycardiaLowcardiacoutput,ArrhythmiaHighorlowbloodpressureRespiratorydistressFever,Signs,ChestRale(pulmonaryedema),KillipclassificationClassI=absenceofRalesClassII=less50%ofthelungfieldsClassIII=over50%ofthelungfieldsClassIV=cardiogenicshock(rales,hypotension,andsignsofhypoperfusion),Signs,HeartAbnormallylocatedventricularimpulsedyskineticinfractedJugularvenousdistensionrightatrialhypertensionSoftheartsoundsleftventriculardysfunction,HeartS4atrialgallopsS3ventriculargallopscardiacinsufficiencymitralregurgitationmurmurpapillarymuscledysfunctionrarelyrupturePericardialfrictionrubs,Signs,ExtremitiesEdemaCyanosisandcoldtemperaturelowoutputPeripheralpulses,Auxiliaryexaminations,ElectrocadiographyLaboratoryfindingsEchocardiography,Electrocadiogram,ECGchanges:STsegmentelevationQwavedevelopmentTwaveinversion,STsegmentelevation,Qwavedevelopment,Twaveinversion,Location,InferiorwallaVFAnteriorwallV16AnteroseptalwallV1-3ApicalorlateralwallV46Posteriorwall-V7-9Right-sided-V4R-V5R,Laboratoryfindings,Echocardiography,WHODefinitionOfMI,Diagnosis,Chestpain,History、examinationandECG,Acutecoronarysyndrome（ACS）,STsegmentelevation,Non-STsegmentelevation,NSTEMI,UA,NoTnI(TnT),STEMI,TnI(TnT),TnI(TnT),Thedifferentialdiagnosis,AnginaAcutepericarditisAcutepulmonaryembolismAcuteabdominalpainAorticdissection,Complications,DysfunctionorruptureofpapillarymuscleRuptureoftheheartEmbolismCardiacaneurysmPostinfarctionsyndrome,Therapy,GeneraltreamentmeasuresControlofcardiacpainRecanalizationtherapyControlofarrhythmias,ControlofshockControlofheartfailureOthe