心脏破裂相关因素分析.pptVIP

心脏破裂 相关知识点Myocardial Rupture 病理生理Pathophysiology 病理表现 Pericardial tamponade 心包填塞 Ventricular septal defect (VSD) with left-to-right shunt 室间隔缺损，左向右分流 Acute mitral regurgitation (MR) 急性二尖瓣返流 Formation of a pseudoaneurysm 假性室壁瘤形成 发生机制 hemodynamic factors increased intracavitary pressure 血流动力学因素 （心腔压力增加） regional myocardial structural weakness 局部心肌结构脆弱 myocyte necrosis 心肌细胞坏死 collagen matrix resolution 胶原基质降解 intense inflammation 强烈炎症反应 MI常见并发症Complications of myocardial infarction pump failure （left ventricular or right ventricular ） 泵衰竭（左室or右室） 死亡主要原因 LV aneurysm (expansion) 左室室壁瘤（梗死扩展） reinfarction (infarct extension) 再梗（梗死延展） systemic emboli 栓塞 ischemia 缺血 myocardial rupture (free wall, ventricular septal, and papillary muscle) 心肌破裂（游离壁、室间隔、乳头肌） pericardial effusion; and Pericarditis 心包积液 /心包炎 二尖瓣返流主要原因Major causes of mitral regurgitation b. Papillary muscle rupture 乳头肌断裂 c. Rupture of a head of a chordae tendineae 腱索断裂 d. Ischemia/scar of the papillary muscle 乳头肌缺血和疤痕形成 e. Mitral annulus dilatation 二尖瓣瓣环扩大 f. Change in the global geometry of the left ventricle with tethering of the mitral leaflets 左室几何形态改变对二尖瓣叶牵拉 g. Pre-existing MR 以前存在二尖瓣返流 心肌破裂危险因素Risk factors for myocardial rupture Relatively small first AMI Female sex Age older than 60 years Hypertension Use of nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids during the acute phase of AMI (interference with the healing process) Late thrombolysis (11 hours) Postinfarction angina Elevated peak serum C-reactive protein levels 保护性因素（不易破裂因素）Protective factors LV hypertrophy History of previous infarcts Congestive heart failure (CHF) History of chronic ischemic heart disease (well-developed coronary collateral circulation) Early use of beta