医学培训课件 急性心梗.pptVIP

*WallAffectedLeadsShowingSTSegmentElevationLeadsShowingReciprocalSTSegmentDepressionSuspectedCulpritArterySeptalV1,V2NoneLeftAnteriorDescending(LAD)AnteriorV3,V4NoneLeftAnteriorDescending(LAD)AnteroseptalV1,V2,V3,V4NoneLeftAnteriorDescending(LAD)AnterolateralV3,V4,V5,V6,I,aVLII,III,aVFLeftAnteriorDescending(LAD),Circumflex(LCX),orObtuseMarginalExtensiveanterior(AnteroseptalwithLateralextension)V1,V2,V3,V4,V5,V6,I,aVLII,III,aVFLeftmaincoronaryartery(LCA)InferiorII,III,aVFI,aVLRightCoronaryArtery(RCA)orCircumflex(LCX)LateralI,aVL,V5,V6II,III,aVFCircumflex(LCX)orObtuseMarginalPosterior(UsuallyassociatedwithInferiororLateralbutcanbeisolated)V7,V8,V9V1,V2,V3,V4PosteriorDescending(PDA)(branchoftheRCAorCircumflex(LCX))Rightventricular(UsuallyassociatedwithInferior)II,III,aVF,V1,V4RI,aVLRightCoronaryArtery(RCA)*LabStudiesTroponinICreatinekinase–MB(CK-MB)MyoglobinCompletebloodcountChemistryprofileK+,Mg2+levelsCreatininelevelsC-reactiveprotein(CRP)Erythrocytesedimentationrate(ESR)Lactatedehydrogenase(LDH)*三、血清酶的改變與其臨床意義急性心肌梗塞時血清酶之變化CPK（MB）GOTtroponinLDH參考值25-175IU/L5-40IU/L1.0ng/mL90-200IU/L開始上升3-6小時6-10小時4小時24-72小時達到高峰18小時12-48小時2-3天3-4天回復正常2-3天3-4天7-14天14天*Troponin(心肌旋轉蛋白)Troponins是由I、T及C三個不同的蛋白質所組成的，存在心肌及骨骼肌TroponinI分子量24KD可以抑制肌肉中actin及myosin之間的交互作用TroponinT分子量37KD結合myosin的Tropomysin上TroponinC分子量18KD與鈣結合，引起肌肉收縮CardiacTroponinI要比CardiacTroponinT對於心肌更具特異性。Troponins對於心肌細胞損傷的偵測有非常優越的敏感度及特異性，是相當理想的心臟標記。*肌胺酸動酶的同位酶

(CKisoenzyme)BBMB2.3-9.5U/LMM腦、肺、膀胱、腸組織中MB存於心肌中骨骼肌，其次為心肌*Cardiacenzymereleasepattern.(A=myoglobin,B=troponinafterSTEMI,C=CK-MB,D=troponinafterNSTEMI.)(fromHollander,et.al,AnEmergencyPhysiciansGuidetoCardiacTroponins)troponinCK-MB**ImagingStudies:ChestradiographyEchocardiogra