心肌梗死英文課件

ACUTE

MYOCARDIALINFARCTION

（AMI）

1DefinitionPrevalenceCauseSymptoms and

signs

2ContentsDiagnosisThe

differential

diagnosiscomplicationsTherapyAuxiliary

examinations。。DefinitionDeath

or

necrosis

of

myocardial

cells.

3Definition

4From

an

anatomic

ormorphologicstandpoint----

transmural----non

transmural.

5DefinitionFrom

ECG

finding--ST

elevation

STEMI--non-ST

elevation

NSTEMI

6PrevalenceThe

World

Health

Organization

estimated

in

2004,

that

12.2%ofworldwide

deaths

were

from

ischemicheart

disease.

7Leading

cause

of

death

in

high-

ormiddle-income

countries.Second

only

to

lower

respiratoryinfections

in

lower-incomecouncounttriesries..

8Worldwide,

more

than

3

million

peoplehave

STEMIs

and

4

million

haveNSTEMIs

a

year.STEMIs

occur

about

twice

as

often

inmen

as

women.

In

general，MI

can

occur

at

any

age，but

its

incident

rises

with

age.Approximately

50%

of

all

MI’s in

the

USoccur

in

people

younger

than

65

yearsof

age.

10MortalityThe

mortality

is

50%

in

24

hours.

11CauseCoronary

atherosclerosisFormation

of

thrombusObstruction

of

blood

flowMuscle

death

in

cardiac

muscle

12Plaque

ruptureadventitiathrombosisCholelsiptidecroorel

nuclear→13Ruptured

plaques

14Risk

factorsAgeHyperlipidemiaDiabetes

mellitusHypertensionSmokingMale

genderFamily

history

of

atherosclerotic

arterialdisease

(inheritance)

15Inducing

factorsOvereatingHeavy

physical

activityAgitationRapid

rise

of

bloodpressureEarly

hoursof the

morning

?

Defecating

hardlyShockDehydrationSurgerySevere

arrhythmia

16Symptoms

17Prodromal

symptoms:Pain

of

infarctionAssociated

symptomsPainless

infarctionsudden

death

and

Early

arrhythmiasProdromal

symptoms

18Occur

at

rest

or

with

less

activity

thanusual.Approximately

one

third

have

hadsymptoms

from

1

to

4

weeksbefore.Painof

infarction

19At

restIn

the

early

morningSimilar

to

angina

in location

and

radiationbut

more

severe.Nitroglycerin

has

little

effect

,even

opioidmay

not

relieve

the

pain

.Associated

symptoms

20cold

sweatweakLight-headednessapprehensivesyncopedyspneaorthopneacoughwheezingnausea

and

vomitingabdominal

bloatingPainless

infarction

21It

is

estimated

that

at

least

20%

ofacuteMIs are

painless

or

atypical

.Elderly

patients

and

patients

withdiabetes

are particularly

prone

painlessor

atypical

MI.sudden

death

and

EarlyarrhythmiasAbout

50%

occur

before

the

patients

arriveat

the

hospitals,with

death

presumablycaused

by

ventricular

fibrillation

.

22SignsgeneralChestHeartExtremities

23Signs

24GeneralAnxiousSweating

profuselybradycardiaortachycardiaLow

cardiacoutputArrhythmiaHigh

or

low blood

pressureRespiratory

distressFeverSigns

25ChestRale(pulmonary

edema

)Killip

classificationClass

I

=absence

of

RalesClass

II=less

50%

of

the

lung

fieldsClass

III=over

50%

of

the

lung

fieldsClass

IV=cardiogenic

shock(rales,hypotensiand

signs

of hypoperfusion

)Signs

26HeartAbnormally

located

ventricular

impulse dyskinetic

infractedJugular

venous

distension right

atrialhypertensionSoft

heart

soundsleft

ventricular

dysfunctionHeart

27S

4

atrial

gallopsS3

ventricular

gallops cardiac

insufficiencymitral

regurgitation

murmur papillary

muscle

dysfunction rarely

rupturePericardial

friction

rubsSigns

28ExtremitiesEdemaCyanosis

and

coldtemperaturelow

outputPeripheral

pulsesAuxiliary

examinations

29ElectrocadiographyLaboratory

findingsEchocardiographyElectrocadiogramECG

changes:ST

segmentelevationQ

wavedevelopmentT

waveinversion

30ST

segmentelevation31

32

33Q

wavedevelopment

34T

waveinversion

35LocationInferior

wall

——Ⅱ

Ⅲ

aVFAnterior

wall

——V1－6Anteroseptal

wall

——V1-3Apical

or

lateral

wall

—V4－6Posteriorwall-----V7-9Right-sided ----V4R-V5R

36Laboratory

findings

37MarkerTime

toappearanceDuration

ofelevation6hr12hrSpecificityTroponin

I2-6hr5-10d75%90%-100%98%Troponin

T2-6hr5-14d80%95%-100%95%CK-MB3-6hr2-4d65%95%95%myoglobin1-2hr<1d85%90%80%

38EchocardiographyBedside

assessment

of

leftventricular

global

and

regionalfunction

.Diagnosing

postinfarction

,mitralregurgitation

or

ventricular

septaldefect

.

39

40?WHO

Definition

Of

MITypical

symptoms

of

chestpain≥30minutesCharacteristic

rise

and

fall

ofserum

enzyme

levelsTypical

ECG

changes

withdevelopment

of

ST

elevation

orQ

waves

41DiagnosisChest

painHistory

、examination

and

ECGAcute

coronary

syndrome

（ACS）ST

segment

elevationNon-ST

segment

elevationNSTEMIUANoTnI(TnT)STEMITnI(TnT)TnI(TnT)

42The

differential

diagnosisAnginaAcute

pericarditisAcute

pulmonary

embolismAcute

abdominal

painAo