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CaseanalysisCase analysis病例分析病例分析ChiefComplaintsvParoxysmalprecordiumpainfor2months，exacerbationfor16hours.病例分析Chief ComplaintsParoxysmal病例分析病例分析vMedicalhistory：achevlocation、character、degree？radiation？vduration？vInducingandrelieffactor？vtreatmentprocess?病例分析Medical history：ache病例分析病例分析PresentillnessvParoxysmal precordium pain in thepast2months.vBrokeoutafteragitationoroverworked,lastfor2-3minutes，relievedafterrest,didnttreatment.病例分析Present illnessParoxysmal 病例分析病例分析PresentillnessvPrecordium pain aggravated withoutinducingfactor16hoursago,accompanied withbackandbothupper limbs pain,left shoulder andupper limb obviously,accompanied withnausea.vTakenomeprazolecapsule,thesymptomcouldntrelieve,precordiumpain still existed persistently afterlocalhospitaltreatment.病例分析Present illness病例分析病例分析PresentillnessvInemergencyroomofourhospital,vtaken“aspirin300mg,ticagrelor180mg”,“isosorbidemononitrate20mg”intravenousdrip.病例分析Present illness病例分析病例分析vPastMedicalHistory：2014.09.19gastroscope:esophagitis,gastriculcer,erosivegastritis,duodenalbulbinflammation.vFamilyHistory：Hismotherhavehistoryofhypertension,coronaryheartdiseaseanddiabetes.Brotherhashistoryofdiabetesandhypertension.病例分析Past Medical History：2014.病例分析病例分析Physicalexamination：vVitalsigns!vChestandheartexaminationvabdomenexamination病例分析Physical examination：病例分析病例分析vT36.7,P72/min,R20/min,BP117/75mmHg.Regularrespirations.Noedemaineye-lips.Thelipsarered.Nosternumtenderness.Breathingsoundsarerough,withbothbottomofthelungmoistrales.Noabnormalpulsationanupliftinprecordialregion.Theheartpercussednormalinsize.Heartbeat72.Abdomenisflat,Notenderness.Nodistension.病例分析T 36.7,P 72/min,R 20/m病例分析病例分析ChestpainDiagnosisDifferentialdiagnosis病例分析Chest pain DiagnosisDiffe病例分析病例分析gastrointestinalCardiovascularMentalneuromuscularpleuralPulmonaryChestpain病例分析gastrointestinalCardiovasc病例分析病例分析Differentialdiagnosis？pAnginapAcutepericarditispAcutepulmonaryembolismpAcuteabdominalpainpAorticdissection病例分析 Differential diagnosis？病例分析病例分析vAuxiliaryexaminations？病例分析Auxiliary examinations？病例分析病例分析vECG：The most important the most quickly病例分析ECG：The most important theLocationInferiorwallaVFAnteriorwallV16AnteroseptalwallV1-3ApicalorlateralwallV46Posteriorwall-V7-9Right-sided-V4R-V5R15Location Inferior wall 病例分析病例分析cTnI7.092ng/mL,CK-MB156.43ng/mL，MYO251.09ng/ml。vX-ray:heart shadow increased,bronchitis.vUCG：Segmental ventricular wall motion abnormalities,EF：45%.病例分析cTnI 7.092ng/mL,CK-MB 156病例分析病例分析 Diagnosisv1.coronaryheartdiseaseacuteanteriorwallmyocardialinfarctionKillipclassII.v2.bronchialpneumonia.v3.esophagitis,gastriculcer,erosivegastritis,duodenalbulbinflammation.病例分析 Diagnosis 病例分析病例分析vComplications？pDysfunctionorruptureofpapillarymusclepRuptureoftheheartpEmbolismpCardiacaneurysmpPostinfarctionsyndrome病例分析Complications？病例分析病例分析TreatmentvGeneral：Stay in bed monitoring,oxygen Pain relief vanti-ischemiavAnti-plateletvanti-coagulationvReperfusionthrombolytic treatment PCI CABG 病例分析Treatment General：Stay in病例分析病例分析vHowselect thrombolytic treatment or PCI?v3v6v12v24病例分析How select thrombolytic t病例分析病例分析preventionvAAvBBvCCvDDvEE病例分析 Thank You!www.themegallery.co
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