课件：冠状动脉粥样硬化性心脏病基础知识.ppt

* ESC和ACC/AHA 指南都推荐使用危险评分来进行ACS病人的危险分层 本张幻灯片介绍了TIMI危险评分 (published by the TIMI group at the Brigham and Womens’ hospital). 前面提到的血栓和缺血的指征也考虑在内 TIMI危险评分在0到7范围内波动，0代表危险最小，7代表危险最大 评分标准不仅包括病人自身特征，比如年龄，冠心病史，阿斯匹林的应用，还包括临床症状 包括心肌酶升高以及ST段改变 如右图所示，危险分值在4或4以上的患者发生死亡或者心梗的概率呈指数级增长 * * * * This flow diagram illustrates the procedure for the diagnosis of patients suspected of having an ACS. As in the ESC guidelines, ECG and troponin plays a significant role in determining the diagnosis of ACS and which particular ACS.. In patients with no ST-elevation on ECG, the presence of other ST or T wave alterations will assessed as well as signs of continuing angina, cardiac biomarkers and hemodynamic instability will lend to a definite diagnosis of ACS. In patients with no ST or T wave deviations, positive stress test and recurrent ischemic pain can also help to confirm an ACS diagnosis. * The management of patients with different manifestations of ACS is governed by different sets of guidelines which take into account the exact nature of the event Recent European Society of Cardiology (ESC) guidelines for the management of unstable angina and NSTEMI are summarized on this slide These guidelines currently suggest clopidogrel should not be started in patients who might possibly go for CABG; however, data from the CURE trial, published in August 2004, suggests that the benefit of using clopidogrel early in these patients outweighs the risk of increased bleeding1 Reference Fox et al. Circulation 2004; 110: 1202?1208. * * This slide highlights the spectrum of ACS. * * 心电图对于ACS患者的诊断和危险分层都很重要 上图是心电图的一些例子。首要的是要明白心电图的各个组成部分。请看幻灯片上面的图片，正常的心电图 P波代表心房收缩 QRS波代表心室收缩 T波代表心室复极化，心肌恢复到原来状态 ST段是心电图上S波（心室收缩的末端）和T波（复极-为心室再次收缩做好准备）之间的部分 在心肌缺血事件中，ST段可能被压低，例如左下图NSTE ACS的例子 可能会同时存在T波倒置 严重心肌缺血的STEMI患者的心电图（如右下图所示）可以看到明显的ST段抬高 * * 在这部分，我们将探讨心脏生化标志物的作用 心脏生化标志物是当心肌由于缺血（或者介入治疗）受到损伤而释放入血的酶类 心脏标志物在NSTE ACS患者的诊断和危险分层中起到关键作用 区分 UA和NSTEMI 危险分层的参照指标 下面将会讨论到的生化标志物是肌酸激酶（CK)和肌钙蛋白 (troponin) * * 肌酸激酶(CK)是存在于