冠心病英文版.ppt

STEMI Laboratory Localization LCX STEMI Laboratory Localization RCA 2.vectorcardiography 3.radionuclide angiography： 4.Echocardiology：distinct region of disordered contraction, LV function, detection complication 5.laboratory examination: blood routine serum cardiac markers STEMI Laboratory marker Range of times to initial elevation （h） Mean time to peak elevations （nonthrombolysis ） Time to return to normal range Myoglobin 1-4 6-7h 24h cTnI* 3-6 24h 7-9d cTnT* 3-6 12h-2d 7-14d CK-MB 3-6 16-24h 3-4d CK-MM 1-6 12h 38h LDH 8-10 24-48h 10-14d Cardiac markers * Most sensitive and specific marker of myocardial damage STEMI Laboratory Differential diagnosis 1.angina pectoris：chest pain, complication, general symptoms, elevation of cardia markers, ECG changes 2.acute pericarditis：characteristics of chest pain, time course of chest pain and fever, ECG changes 3.acute pulmonary embolization: chest pain, hemoptysis, dyspnea, increased load of RV (SIQIII) STEMI Diagnosis 4.Acute abdominal symptom：acute pancreatitis, cholecystitis, cholelithiasis 5.aortic dissection：sever chest pain with (tearing-like), radiated to back，with aortic regurgitation, CT、UCG、MRI、chest X-ray Differential diagnosis STEMI Diagnosis Before admission: tranfer, make diagnosis within 10-20min, initiate reperfusion therapy as soon as possible Monitoring and general treatment: CCU Reperfusion Management of complication others STEMI treatment 1.CCU: hemodynamic monitoring, oxygen 2.Pain relief and anti-ischemia: Morphine: 2-4mg IV Nitrates: not use in inferior MI or suspected RV MI with hypotension ?-blocker: reduce HR, decrease BP, decrease myocardial oxygen consumption, decrease Vf 3. Anti-platelet: aspirin：first dosage 300mg，chewing, 100mg/d forever for patients without contraindication Clopidogrel: 300mg loading, 75mg/d STEMI treatment 4.anti-coagulation: anti-thrombin, heparin, LMWH 5.limitation of infarct size: reperfusion: Fibrinolytic treatment: intravenous，intracoronary rt-PA：100mg，in