医学ppt--济南军区冠心病会议新乡卢才义PPT.ppt

* Care should be used with NTG. Do not use if blood pressure is less then 90 systolic or systolic blood pressure is 30 of baseline. Use with extreme caution with bradycardia. If the patient is suspected to have an inferior wall MI involving the right ventricle consider withholding of nitroglycerin. Patients with right ventricular involvement require adequate preload to maintain an adequate blood pressure and nitrates can give these patients extreme hypotension Andreas Grüntzig,德国人，1977年9月15日在瑞士苏黎士，在局麻下，经股动脉穿刺，采用自制球囊导管成功扩张一例冠状动脉狭窄病变 - 1984 Coronary Intervention 基础 经皮穿刺 指引导管 导丝轨道 冠脉内支架 支架内再狭窄 介入治疗技术进步 控制ACS诱发因素 控制高血压病 控制糖尿病 控制高脂血症 控制肥胖症 戒烟 ACS预后因素 心功能 病变部位及范围 年龄 合并症如肾衰、慢阻肺、脑血管病、恶性肿瘤等 出院指导 改变生活方式 控制危险因素 长期口服阿司匹林 口服β受体阻滞剂 合理膳食指导 戒烟 谢 谢 * * Stable Angina may include substernal chest pain radiating to the jaw arm and neck. Stable Angina pain typically lasts for only 1-5 minutes is associated with activity, cold weather and even eating. Unlike unstable angina Stable angina has predictable symptoms for the patient. They usually know that if they climb a flight of stairs that they will get chest pain and the chest pain will be relived by rest or SL NTG EKG may show ST depression that disappears with pain relief. Stable angina is not included in the Acute Coronary Syndrome class * AUDIO Other symptoms associated with acute coronary syndrome include: Dizziness Lightheadedness Nausea Sweating shortness of breath LEARNER NOTES Have learners participate by answering the questions prior to them being shown. GRAPHIC NOTES * * AUDIO It is estimated that 33% of patients with acute coronary syndrome do not have chest pain. “Atypical” chest pain or “angina equivalents” occur in approximately 40% of patients with acute coronary syndrome. In addition to women and elderly patients, atypical chest pain usually occurs in patients with diabetes, hypertension, heart failure, prior stroke, or myocardial infarction.? GRAPHIC NOTES Bullet points appear wit