版权说明：本文档由用户提供并上传，收益归属内容提供方，若内容存在侵权，请进行举报或认领
文档简介
ACUTEMYOCARDIALINFARCTION（AMI）
ACUTEMYOCARDIALINFARCTION（A1DefinitionPrevalence
CauseSymptomsandsignsAuxiliaryexaminations
。Contents
DiagnosisThedifferentialdiagnosiscomplications
Therapy
。DefinitionContentsDiagnosis2DefinitionDeathornecrosisofmyocardialcells.DefinitionDeathornecrosiso3DefinitionFromananatomicormorphologicstandpoint----transmural----nontransmural.DefinitionFromananatomicor4心肌梗死英文课件5DefinitionFromECGfinding--STelevationSTEMI--non-STelevationNSTEMIDefinitionFromECGfinding6PrevalenceTheWorldHealthOrganizationestimatedin2004,that12.2%ofworldwidedeathswerefromischemicheartdisease.PrevalenceTheWorldHealthOr7Leadingcauseofdeathinhigh-ormiddle-incomecountries.
Secondonlyto
lowerrespiratoryinfectionsinlower-incomecountries.Leadingcauseofdeathinhigh8Worldwide,morethan3millionpeoplehaveSTEMIsand4millionhaveNSTEMIsayear.STEMIsoccurabouttwiceasofteninmenaswomen.Worldwide,morethan3million9Ingeneral，MIcanoccuratanyage，butitsincidentriseswithage.Approximately50%ofallMI’sin
theUSoccurinpeopleyoungerthan65yearsofage.Ingeneral，MIcanoccuratany10MortalityThemortalityis50%in24hours.Mortality11CauseCoronaryatherosclerosisFormationofthrombusObstructionofbloodflowMuscledeathincardiacmuscleCauseCoronaryatherosc12Plaquerupture
→adventitialipidcoreCholesterolnuclearthrombosis
Plaquerupture→adventitialipi13Rupturedplaques
Rupturedplaques14Riskfactors
AgeHyperlipidemiaDiabetesmellitusHypertensionSmokingMalegenderFamilyhistoryofatheroscleroticarterialdisease(inheritance)RiskfactorsAge15Inducingfactors
EarlyhoursofthemorningOvereatingHeavyphysicalactivityAgitationRapidriseofbloodpressureDefecatinghardlyShockDehydrationSurgerySeverearrhythmiaInducingfactors
Earlyhours16SymptomsProdromalsymptoms:PainofinfarctionAssociatedsymptomsPainlessinfarctionsuddendeathandEarlyarrhythmiasSymptomsProdromalsymptoms:17Prodromalsymptoms
Occuratrestorwithlessactivitythanusual.Approximatelyonethirdhavehadsymptomsfrom1to4weeksbefore.Prodromalsymptoms
Occuratre18Painofinfarction
AtrestIntheearlymorningSimilartoanginainlocationandradiationbutmoresevere.Nitroglycerinhaslittleeffect,evenopioidmaynotrelievethepain.Painofinfarction
Atrest19Associatedsymptoms
coldsweatweakLight-headednessapprehensivesyncopedyspneaorthopneacoughwheezingnauseaandvomitingabdominalbloatingAssociatedsymptoms
coldsweat20Painlessinfarction
Itisestimatedthatatleast20%ofacuteMIsarepainlessoratypical.ElderlypatientsandpatientswithdiabetesareparticularlypronepainlessoratypicalMI.Painlessinfarction
Itisest21suddendeathandEarlyarrhythmias
About50%occurbeforethepatientsarriveatthehospitals,withdeathpresumablycausedbyventricularfibrillation.suddendeathandEarlyarrhyth22SignsgeneralChestHeartExtremitiesSignsgeneral23Signs
GeneralAnxiousSweatingprofuselybradycardiaortachycardiaLowcardiacoutputArrhythmiaHighorlowbloodpressureRespiratorydistressFeverSignsGeneral24SignsChestRale(pulmonaryedema)
KillipclassificationClassI=absenceofRalesClassII=less50%ofthelungfieldsClassIII=over50%ofthelungfieldsClassIV=cardiogenicshock(rales,hypotension,andsignsofhypoperfusion)SignsChest25SignsHeartAbnormallylocatedventricularimpulse
dyskineticinfractedJugularvenousdistensionrightatrialhypertensionSoftheartsoundsleftventriculardysfunctionSignsHeart26HeartS4atrialgallopsS3ventriculargallopscardiacinsufficiencymitralregurgitationmurmurpapillarymuscledysfunctionrarelyrupturePericardialfrictionrubsHeart27Signs
ExtremitiesEdemaCyanosisandcoldtemperaturelowoutputPeripheralpulsesSignsExtremities28AuxiliaryexaminationsElectrocadiographyLaboratoryfindingsEchocardiographyAuxiliaryexaminationsElectro29ElectrocadiogramECGchanges:STsegmentelevationQwavedevelopmentTwaveinversionElectrocadiogramECGchanges:30STsegmentelevationSTsegmentelevation31心肌梗死英文课件32
33QwavedevelopmentQwavedevelopment34Twaveinversion
Twaveinversion
35Location
Inferiorwall——ⅡⅢaVFAnteriorwall——V1－6Anteroseptalwall——V1-3Apicalorlateralwall—V4－6Posteriorwall-----V7-9
Right-sided
----V4R-V5RLocationInferiorwall——ⅡⅢ36LaboratoryfindingsMarkerTimetoappearanceDurationofelevation6hr12hrSpecificityTroponinI2-6hr5-10d75%90%-100%98%TroponinT2-6hr5-14d80%95%-100%95%CK-MB3-6hr2-4d65%95%95%myoglobin1-2hr<1d85%90%80%LaboratoryfindingsMarkerTi37心肌梗死英文课件38EchocardiographyBedsideassessmentofleftventricularglobalandregionalfunction.Diagnosingpostinfarction,mitralregurgitationorventricularseptaldefect.EchocardiographyBedsideassess39
40WHODefinitionOfMITypicalsymptomsofchestpain≥30minutes
CharacteristicriseandfallofserumenzymelevelsTypicalECGchangeswithdevelopmentofSTelevationorQwavesDiagnosisWHODefinitionOfMITypicalsy41ChestpainHistory、examinationandECGAcutecoronarysyndrome（ACS）STsegmentelevation
Non-STsegmentelevation
NSTEMIUANoTnI(TnT)STEMITnI(TnT)TnI(TnT)ChestpainHistory、examinati42Thedifferentialdiagnosis
AnginaAcutepericarditisAcutepulmonaryembolismAcuteabdominalpainAorticdissectionThedifferentialdiagnosis
An43Complications
DysfunctionorruptureofpapillarymuscleRuptureoftheheartEmbolismCardiacaneurysmPostinfarctionsyndromeComplications
Dysfunctionor44TherapyGeneraltreamentmeasuresControlofcardiacpainRecanalizationtherapyControlofarrhythmias
ControlofshockControlofheartfailureOthertherapiesTherapiesofcomplicationsTherapyGeneraltreamentmeasu45Prevention
Aaspirin
anti－anginaltherapy
Bbeta-blocker
bloodpressurecontrol
Ccholesterollowing
cigarettesquiting
Ddietcontrol
diabetestreatment
Eeducation
exercisePreventionAaspirin46
ThankYouThankYou47DefinitionDeathornecrosisofmyocardialcells.DefinitionDeathornecrosiso48DefinitionFromananatomicormorphologicstandpoint----transmural----nontransmural.DefinitionFromananatomicor49心肌梗死英文课件50Worldwide,morethan3millionpeoplehaveSTEMIsand4millionhaveNSTEMIsayear.STEMIsoccurabouttwiceasofteninmenaswomen.Worldwide,morethan3million51MortalityThemortalityis50%in24hours.Mortality52Painlessinfarction
Itisestimatedthatatleast20%ofacuteMIsarepainlessoratypical.ElderlypatientsandpatientswithdiabetesareparticularlypronepainlessoratypicalMI.Painlessinfarction
Itisest53SignsHeartAbnormallylocatedventricularimpulse
dyskineticinfractedJugularvenousdistensionrightatrialhypertensionSoftheartsoundsleftventriculardysfunctionSignsHeart54WHODefinitionOfMITypicalsymptomsofchestpain≥30minutes
CharacteristicriseandfallofserumenzymelevelsTypicalECGchangeswithdevelopmentofSTelevationorQwavesDiagnosisWHODefinitionOfMITypicalsy55ACUTEMYOCARDIALINFARCTION（AMI）
ACUTEMYOCARDIALINFARCTION（A56DefinitionPrevalence
CauseSymptomsandsignsAuxiliaryexaminations
。Contents
DiagnosisThedifferentialdiagnosiscomplications
Therapy
。DefinitionContentsDiagnosis57DefinitionDeathornecrosisofmyocardialcells.DefinitionDeathornecrosiso58DefinitionFromananatomicormorphologicstandpoint----transmural----nontransmural.DefinitionFromananatomicor59心肌梗死英文课件60DefinitionFromECGfinding--STelevationSTEMI--non-STelevationNSTEMIDefinitionFromECGfinding61PrevalenceTheWorldHealthOrganizationestimatedin2004,that12.2%ofworldwidedeathswerefromischemicheartdisease.PrevalenceTheWorldHealthOr62Leadingcauseofdeathinhigh-ormiddle-incomecountries.
Secondonlyto
lowerrespiratoryinfectionsinlower-incomecountries.Leadingcauseofdeathinhigh63Worldwide,morethan3millionpeoplehaveSTEMIsand4millionhaveNSTEMIsayear.STEMIsoccurabouttwiceasofteninmenaswomen.Worldwide,morethan3million64Ingeneral，MIcanoccuratanyage，butitsincidentriseswithage.Approximately50%ofallMI’sin
theUSoccurinpeopleyoungerthan65yearsofage.Ingeneral，MIcanoccuratany65MortalityThemortalityis50%in24hours.Mortality66CauseCoronaryatherosclerosisFormationofthrombusObstructionofbloodflowMuscledeathincardiacmuscleCauseCoronaryatherosc67Plaquerupture
→adventitialipidcoreCholesterolnuclearthrombosis
Plaquerupture→adventitialipi68Rupturedplaques
Rupturedplaques69Riskfactors
AgeHyperlipidemiaDiabetesmellitusHypertensionSmokingMalegenderFamilyhistoryofatheroscleroticarterialdisease(inheritance)RiskfactorsAge70Inducingfactors
EarlyhoursofthemorningOvereatingHeavyphysicalactivityAgitationRapidriseofbloodpressureDefecatinghardlyShockDehydrationSurgerySeverearrhythmiaInducingfactors
Earlyhours71SymptomsProdromalsymptoms:PainofinfarctionAssociatedsymptomsPainlessinfarctionsuddendeathandEarlyarrhythmiasSymptomsProdromalsymptoms:72Prodromalsymptoms
Occuratrestorwithlessactivitythanusual.Approximatelyonethirdhavehadsymptomsfrom1to4weeksbefore.Prodromalsymptoms
Occuratre73Painofinfarction
AtrestIntheearlymorningSimilartoanginainlocationandradiationbutmoresevere.Nitroglycerinhaslittleeffect,evenopioidmaynotrelievethepain.Painofinfarction
Atrest74Associatedsymptoms
coldsweatweakLight-headednessapprehensivesyncopedyspneaorthopneacoughwheezingnauseaandvomitingabdominalbloatingAssociatedsymptoms
coldsweat75Painlessinfarction
Itisestimatedthatatleast20%ofacuteMIsarepainlessoratypical.ElderlypatientsandpatientswithdiabetesareparticularlypronepainlessoratypicalMI.Painlessinfarction
Itisest76suddendeathandEarlyarrhythmias
About50%occurbeforethepatientsarriveatthehospitals,withdeathpresumablycausedbyventricularfibrillation.suddendeathandEarlyarrhyth77SignsgeneralChestHeartExtremitiesSignsgeneral78Signs
GeneralAnxiousSweatingprofuselybradycardiaortachycardiaLowcardiacoutputArrhythmiaHighorlowbloodpressureRespiratorydistressFeverSignsGeneral79SignsChestRale(pulmonaryedema)
KillipclassificationClassI=absenceofRalesClassII=less50%ofthelungfieldsClassIII=over50%ofthelungfieldsClassIV=cardiogenicshock(rales,hypotension,andsignsofhypoperfusion)SignsChest80SignsHeartAbnormallylocatedventricularimpulse
dyskineticinfractedJugularvenousdistensionrightatrialhypertensionSoftheartsoundsleftventriculardysfunctionSignsHeart81HeartS4atrialgallopsS3ventriculargallopscardiacinsufficiencymitralregurgitationmurmurpapillarymuscledysfunctionrarelyrupturePericardialfrictionrubsHeart82Signs
ExtremitiesEdemaCyanosisandcoldtemperaturelowoutputPeripheralpulsesSignsExtremities83AuxiliaryexaminationsElectrocadiographyLaboratoryfindingsEchocardiographyAuxiliaryexaminationsElectro84ElectrocadiogramECGchanges:STsegmentelevationQwavedevelopmentTwaveinversionElectrocadiogramECGchanges:85STsegmentelevationSTsegmentelevation86心肌梗死英文课件87
88QwavedevelopmentQwavedevelopment89Twaveinversion
Twaveinversion
90Location
Inferiorwall——ⅡⅢaVFAnteriorwall——V1－6Anteroseptalwall——V1-3Apicalorlateralwall—V4－6Posteriorwall-----V7-9
Right-sided
----V4R-V5RLocationInferiorwall——ⅡⅢ91LaboratoryfindingsMarkerTimetoappearanceDurationofelevation6hr12hrSpecificityTroponinI2-6hr5-10d75%90%-100%98%TroponinT2-6hr5-14d80%95%-100%95%CK-MB3-6hr2-4d65%95%95%myoglobin1-2hr<1d85%90%80%LaboratoryfindingsMarkerTi92心肌梗死英文课件93EchocardiographyBedsideassessmentofleftventricularglobalandregionalfunction.Diagnosingpostinfarction,mitralregurgitationorventricularseptaldefect.EchocardiographyBedsideassess94
95WHODefinitionOfMITypicalsymptomsofchestpain≥30minutes
CharacteristicriseandfallofserumenzymelevelsTypicalECGchangeswithdevelopmentofSTelevationorQwavesDiagnosisWHODefinitionOfMITypicalsy96ChestpainHistory、examinationandECGAcutecoronarysyndrome（ACS）STsegmentelevation
Non-STsegmentelevation
NSTEMIUANoTnI(TnT)STEMITnI(TnT)TnI(TnT)ChestpainHistory、examinati97Thedifferentialdiagnosis
AnginaAcutepericarditisAcutepulmonaryembolismAcuteabdominalpainAorticdissectionThedifferentialdiagnosis
An98Complications
DysfunctionorruptureofpapillarymuscleRuptureoftheheartEmbolismCardiacaneurysmPostinfarctionsyndromeComplications
Dysfunctionor99TherapyGeneraltreamentmeasuresControlofcardiacpainRecanalizationtherapyControlofarrhythmias
Cont
温馨提示
- 1. 本站所有资源如无特殊说明，都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等，如果需要附件，请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸，网页内容里面会有图纸预览，若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间，仅对用户上传内容的表现方式做保护处理，对用户上传分享的文档内容本身不做任何修改或编辑，并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容，请与我们联系，我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 2024年山东客运从业资格证实际操作试题及答案
- 2024年信用借款合同签完多久放款(2730字)
- 2024年标准钢材购销合同书范本
- 港航实务 皮丹丹 教材精讲班课件 79-第6章-6.1-工程招标投标
- 2024年五金电器购销简单合同范本
- 2024年品质保证协议书转让协议
- 2024年水电承包合同
- 2024年经营合作协议范本
- 2024年简易个人房屋装修合同
- 2024年杂志约稿合同模板
- 新视野大学英语视听说教程ppt课件
- 攻城掠地数据以及sdata文件修改教程
- 医疗废物转运箱消毒记录表
- 最新投标书密封条
- 看守所岗位职责
- 2019年青年英才培养计划项目申报表
- Sentaurus在ESD防护器件设计中的应用PPT课件
- 《抛物线焦点弦的性质探究》学案
- 人教版小学二年级数学上册全册教案【表格式】
- 佛山岭南新天地项目概况.
- 喷码机操作手册
评论
0/150
提交评论