心肌梗死英文课件

,#,本作品采用,知识共享署名,-,非商业性使用,2.5,中国大陆许可协议,进行许可。,专业交流,模板超市,设计服务,NordriDesign,中国专业,PowerPoint,媒体设计与开发,本作品的提供是以适用知识共享组织的公共许可（简称“,CCPL”,或“许可”）条款为前提的。本作品受著作权法以及其他相关法律的保护。对本作品的使用不得超越本许可授权的范围。,如您行使本许可授予的使用本作品的权利，就表明您接受并同意遵守本许可的条款。在您接受这些条款和规定的前提下，许可人授予您本许可所包括的权利。,查看全部,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,#,A,CUTE MYOCARDIAL INFARCTION,（,AMI,）,ACUTE MYOCARDIAL INFARCTION（A,1,Definition,Prevalence,Cause,Symptoms,and signs,Auxiliary examinations,。,Contents,Diagnosis,The differential diagnosis,complications,Therapy,。,DefinitionContents Diagnosis,2,Definition,Death or necrosis of myocardial cells.,Definition Death or necrosis o,3,Definition,From an anatomic or morphologic standpoint,-transmural,-non transmural.,Definition From an anatomic or,4,心肌梗死英文课件,5,Definition,From ECG finding,-ST elevation STEMI,-non-ST elevation NSTEMI,Definition From ECG finding,6,Prevalence,The,World Health Organization,estimated in 2004,that 12.2%of worldwide deaths were from ischemic heart disease,.,Prevalence The World Health Or,7,L,eading cause of death in high-or middle-income countries,.,S,econd only to,lower respiratory infections in lower-income countries.,Leading cause of death in high,8,Worldwide,more than 3 million people have STEMIs and 4 million have NSTEMIs a year.,STEMIs occur about twice as often in men as women.,Worldwide,more than 3 million,9,In general,，,MI can occur at any age,，,but its incident rises with age.,Approximately 50%of all MIs in,the US occur in people younger than 65 years of age.,In general，MI can occur at any,10,Mortality,The mortality is 50%in 24 hours.,Mortality,11,Cause,Coronary atherosclerosis,Formation of thrombus,Obstruction of blood flow,Muscle death in cardiac muscle,Cause Coronary atherosc,12,Plaque rupture,adventitia,lipid core,Cholesterol,nuclear,t,hrombosis,Plaque rupture adventitialipi,13,Ruptured plaques,Ruptured plaques,14,Risk factors,Age,Hyperlipidemia,Diabetes mellitus,Hypertension,Smoking,Male gender,Family history of atherosclerotic arterial disease(inheritance),Risk factors Age,15,Inducing factors,Early hours of the morning,Overeating,Heavy physical activity,Agitation,Rapid rise of blood,pressure,Defecating hardly,Shock,Dehydration,Surgery,Severe arrhythmia,Inducing factors Early hours,16,Symptoms,Prodromal symptoms:,Pain of infarction,Associated symptoms,Painless infarction,sudden death and Early arrhythmias,Symptoms Prodromal symptoms:,17,Prodromal symptoms,Occur at rest or with less activity than usual.,Approximately one third have had symptoms from 1 to 4 weeks before.,Prodromal symptomsOccur at re,18,Pain of infarction,At rest,In the early morning,Similar to angina in location and radiation but more severe.,Nitroglycerin has little effect,even opioid may not relieve the pain.,Pain of infarction At rest,19,Associated symptoms,cold sweat,weak,Light-headedness,apprehensive,syncope,dyspnea,orthopnea,cough,wheezing,nausea and vomiting,abdominal bloating,Associated symptomscold sweat,20,Painless infarction,It is estimated that at least 20%of acute MIs are painless or atypical.,Elderly patients and patients with diabetes are particularly prone painless or atypical MI.,Painless infarction It is est,21,sudden death and Early arrhythmias,About 50%occur before the patients arrive at the hospitals,with death presumably caused by ventricular fibrillation.,sudden death and Early arrhyth,22,Signs,general,Chest,Heart,Extremities,Signs general,23,Signs,General,Anxious,Sweating profusely,bradycardia,or tachycardia,Low cardiac output,Arrhythmia,High or low,blood pressure,Respiratory distress,Fever,Signs General,24,Signs,Chest,Rale(pulmonary edema),Killip classification,Class I=absence of Rales,Class II=less 50%of the lung fields,Class III=over 50%of the lung fields,Class IV=cardiogenic shock(rales,hypotension,and signs of hypoperfusion),Signs Chest,25,Signs,Heart,Abnormally located ventricular impulse,dyskinetic infracted,Jugular venous distension,right atrial hypertension,Soft heart sounds,left ventricular dysfunction,Signs Heart,26,Heart,S 4 atrial gallops,S3 ventricular gallops,cardiac insufficiency,mitral regurgitation murmur,papillary muscle dysfunction,rarely rupture,Pericardial friction rubs,Heart,27,Signs,Extremities,Edema,Cyanosis and cold temperature,low output,Peripheral pulses,Signs Extremities,28,Auxiliary examinations,Electrocadiography,Laboratory findings,Echocardiography,Auxiliary examinations Electro,29,Electrocadiogram,ECG changes:,ST segment elevation,Q wave development,T wave inversion,ElectrocadiogramECG changes:,30,ST segment elevation,ST segment elevation,31,心肌梗死英文课件,32,33,Q wave development,Q wave development,34,T wave inversion,T wave inversion,35,Location,Inferior wall aVF,Anterior wall V,1,6,Anteroseptal wall V,1-3,Apical or lateral wall V,4,6,Posterior wall-V,7-9,Right-sided,-V,4R,-V,5R,Location Inferior wall ,36,Laboratory findings,Marker,Time to appearance,Duration of elevation,6hr,12hr,Specificity,Troponin I,2-6hr,5-10d,75%,90%-100%,98%,Troponin T,2-6hr,5-14d,80%,95%-100%