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ACUTEMYOCARDIALINFARCTION（AMI）
ACUTEMYOCARDIALINFARCTION（A1DefinitionPrevalence
CauseSymptomsandsignsAuxiliaryexaminations
。Contents
DiagnosisThedifferentialdiagnosiscomplications
Therapy
。DefinitionContentsDiagnosis2DefinitionDeathornecrosisofmyocardialcells.DefinitionDeathornecrosiso3DefinitionFromananatomicormorphologicstandpoint----transmural----nontransmural.DefinitionFromananatomicor4心肌梗死英文課件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心肌梗死英文課件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心肌梗死英文課件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心肌梗死英文課件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心肌梗死英文課件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心肌梗死英文課件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心肌梗死英文課件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
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