课件:qianjy冠心病英.ppt

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课件:qianjy冠心病英.ppt

* * * Localization LAD STEMI Laboratory STEMI Laboratory Localization LAD STEMI Laboratory Localization LCX STEMI Laboratory Localization RCA 2.vectrocardiography 3.radionuclide[‘reidi?u’nju:klaid]放射性核素 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 敏感的 Changes of cardiac markers STEMI Laboratory Differential diagnosis 1.angina pectoris:chest pain, complication, general symptoms, elevation of cardia markers, ECG changes 2.acute pericarditis[.perikɑ:daitis]:characteristics[.k?rikt?ristik] of chest pain, time course of chest pain and fever, ECG changes 3.acute pulmonary embolization[emb?laizei??n]:chest pain, hemoptysis, dyspnea, increased load of RV (SIQIII) STEMI Diagnosis 4.Acute abdominal symptom:acute pancreatitis,cholecystitis, cholelithiasis 5.aortic[ei?:tik] dissection:sever chest pain with (tearing-like), radiated to back,with aortic regurgitation[ri.g?:d?itei??n], 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 contraind

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