心肌梗死lecture-课件

心肌梗死lectureAcuteMyocardialInfarction急性心肌梗死

Let’slearnsomeNew

words

infarction梗死myocardial心肌的ischemic[is’kemik]局部缺血的necrosis[ne’krəusis]坏死coronary冠状动脉的segment段

myocardium心肌atherosclerotic

[,æθərəusklə'rɔtik]动脉粥样硬化的Scarhealing瘢痕愈合enzyme酶arrhythmia[ə‘riθмiə]心率失常accompanied伴随Nitroglycerin[naitrəu'glisərin]硝酸甘油nausea['nɔ:ziə]恶心electrocardiogram

[i,lektrəu'kɑ:diəuɡræm]心电图dizziness['dizinis]

头晕Gastrointestinal胃肠道Shit大便Coagulative[kəu'ægjuleitiv]

凝固性fibrosis纤维化Let’slearnsomeNew

wordsUrineoutput尿量Pathological病理的hiked

[haik]

抬高inversion倒置serum['siərəm,'si:r-]

血清pericardial心包的subendocardial心内膜下tranquilizer镇静剂urokinase[,juərəu'kaineis]尿激酶streptokinase[,streptəu'kaineis,-'ki-,-neiz]链激酶haemorrhage['heməridʒ]出血的reperfusion再灌invasion发病unobstructed通畅Thrombolytic溶栓troponin['trɔpənin]肌钙蛋白dynamic[dai'næmik]动态的Let’slearnsomeNewwords

infarction梗死myocardial

心肌的ischemic[is’kemik]局部缺血的necrosis[ne’krəusis]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Scarhealing瘢痕愈合enzyme酶Arrhythmia[ə'riθмiə]angina[æn'dʒainə]accompanied伴随Nitroglycerin[naitrəu'glisərin]硝酸甘油nausea['nɔ:ziə]恶心electrocardiogram心电图dizziness头晕Gastrointestinal胃肠道Urineoutput尿量Pathological[,pæθə'lɔdʒikəl]病理的hiked抬高inversion倒置serum['siərəm,'si:r-]血清Layer层percutaneous[,pə:kju:'teiniəs]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['trɔpənin]肌钙蛋白dynamic[dai'næmik]动态的ContentsDefinitionandcauses

1Clinicalmanifestations2Laboratorytests3treatment4causesdefinition

Acutemyocardialinfarctionreferstoischemicmyocardialnecrosisusually局部缺血的坏死resultingfromabruptreductionincoronary冠状动脉的bloodflowtoasegment

ofmyocardiumcausesincentives:enoughtoeat,Sleep,shit

Basiccause：Coronaryatherosclerotic

[,æθərəusklə'rɔtik]，SeverenarrowingcausesHistologic组织学changes

Coronaryarteryocclusion[ə'klu:ʒən,ɔ-]ScarhealingBegintoabsorb,fibrosis

[fai'brəusis]Myocardialcoagulativenecrosis

[kəu'ægjuleitiv]Myocardialbegantonecrosis

6~8w

1~2w1~12h20~30minClinicalcharacteristics：1Lastingseverechest3Electrocardiogramseriesevolution.2Elevatedserum['siərəm,'si:r-]myocardialenzymes4OftenaccompaniedbyArrhythmia,heartfailure,shockorevensuddendeath.【

Clinicalmanifestations】1.Newhappenanginapectorisororiginalangina[æn'dʒainə]aggravating,nitroglycerinpooreffects2.

Withnausea,vomiting,sweating,bloodpressuredrops,arrhythmia,heartfailure3.Obviouselectrocardiogram

ST-TchangeProdromal(前驱的)symptoms

二、

symptoms

1.

Chestpain:Typical:longtime(severalh~severald),includingthenitroglycerin

invalidNottypical:abdomen,jaw下颌,backpain;2.Systemicsymptom:fever,dizziness['dizinis],weakness.。3.Gastrointestinalsymptoms:胃肠道症状：

[,ɡæstrəuin'testinəl]

4、

Arrhythmia[ə'riθмiə]:allkindsofarrhythmia

①

Ventricular

[ven'trikjulə]arrhythmia室性心律失常

②

Sinus

['sainəs]tachycardia

[,tæki'kɑ:diə]窦性心动过速

③

Slowarrhythmia缓慢心律失常5、

Heartfailure①

Acuteleftheartfailure

②Acuterightheartfailure

6、

Hypotensionandshock：

Lowbloodpressure,nomicrocirculationdysfunction障碍；Shock：1.SBP<80mmHg；2.Pulsefinefast,complexion

[kəm'plekʃən]ispale,skinwetandsweat；3.Fidgeting

['fidʒit],andSlowresponse烦躁不安、神志迟钝；4.

Urineoutput↓(<20ml/h);【Laboratorytests】

一、

electrocardiogram

1、

characteristically特征性改变：

①PathologicalQwave；

②st-segmentoutliningtheupwardhiked

[haik]

ST段弓背向上抬高；③

Twaveinversion

。

二.Myocardialnecrosismarkers（心肌坏死标记物）

RisetimepeaktimedroptonormalMuscleredprotein

2h12h24-48htroponin[‘trɔpənin]

3-4h11-24h7-10d

CK-MB

4h16-24h3-4d

(肌酸激酶同工酶)【Laboratorytests】

。三、

Otherinspection

WBC(rise)↑；ESR↑：

1~2daysafterillnessappeared,1~3weekscontinued.Grossanatomyclassification1.Haveq-wavemyocardialinfarction:infarctioninvolvingtheroomwall,canspreadalllayerspericardial;[,peri'kɑ:diəl,-diæk]心包膜2.Noq-wavemyocardialinfarction:Smallrangemyocardialinfarction,subendocardialinfarction

.

心内膜下【treatment】

Treatmentisdesignedtorelievedistress,reverseischemia,limitinfarctsize,reduceheartwork,preventandtreatcomplications.【treatment】

一、

Monitoringandgeneraltreatment

1、

Monitoring.：

2、

Rest:physicalandmental；

3、

oxygenuptake：

4、

diet：

5、

Urineunobstructed：

二.relievepain：

1.PaiTiDing(pethidine):50~100mg，im(intramuscular

);

morphine：5～10mg(milligram)，im。

2.tranquilizer镇静剂：5～10mg，im或iv。

3.nitroglycerin硝酸甘油(0.3~0.6mg)

i.v.gtt。

4.TraditionalChinesemedicine:JiuXinWanofrapidly-availablecontainingororal：速效救心丸含化或口服。

三.Myocardialreperfusion：

1、

ThrombolyticTherapy溶栓疗法：（1）

indication：①

Persistentchest(morethan)>30min;②

invasion发病(lessthan)

<6h;④age(lessthan)

<70yr。（2）

Thrombolysisdrug①urokinase[,juərəu'kaineis]

②streptokinase[,streptəu'kaineis,-'ki-,-neiz]（3）

contraindication

['kɔntrə,indi'keiʃən]：①age>70yr；②Havehaemorrhage

tendency；

['heməridʒ]

2.Percutane