EchocardiographyinAcuteChestPain例析.ppt

ECHOCARDIOGRAPHY IN CLINICALPRACTICE: GENERAL CONSIDERATIONS Vocabulary： myocardial [,ma??kɑrd??l] adj. 心肌的 Ischemia [?skim??] n. [内科] 局部缺血 transthoracic [,tr?nzθ?r?s?k] adj. 经胸廓的 coronary [k?r(?)n(?)r?] adj. 冠状的 papillary [p?p?l?r?] adj. 乳突的；乳头状突起的 stratification [,str?t?f?ke???n] n. 层理；成层 pharmacological [,fɑ?m?k?l?d??k?l] adj. 药理学的 pulmonary [p?lm?n(?)r?] adj. 肺的；有肺的；肺状的 embolism [emb?l?z(?)m] n. 栓塞； Echocardiography in Acute Chest Pain and Myocardial Ischemia PULMONARY EMBOLISM * * * * Chest pain may be cardiac or noncardiac in origin. Echocardiography, although useful, should not interfere with the management of patients with myocardial infarction. It adds little to the diagnosis if ECG and cardiac enzymes are already clearly diagnostic for acute myocardial infarction (Table 8). When doubt exists, e.g., nondiagnostic ECG changes, or when other causes of chest pain are entertained, transthoracic echocardiography can be of value. New regional wall motion abnormalities appearing in previously normal ventricular segments support the diagnosis of acute myocardial ischemia and may precede changes in the ECG. Likewise, other findings may argue against acute coronary syndrome, including pericardial effusion (as might be seen in pericarditis), and right ventricular enlargement (as might be seen in pulmonary embolism). Although new regional wall motion abnormalities can be highly suggestive of acute ischemia or infarction, this diagnosis can be considerably more challenging in patients with prior history of myocardial infarction or abnormal regional wall motion. Following myocardial infarction, echocardiography can have substantial value (Chapter 7). Early and late post-myocardial infarction complications, e.g., ventricular septal defect or papillary muscle rupture can be diagnosed with echocardiography. In the postinfarction period, echocardiography can assist with the diagnosis, risk assessment, and prognosi