急性心肌梗死acute myocardial 课件.pptVIP

Acute Myocardial Infarction David Putnam, MD Albany Medical College Acute MI Any degree of myocardial necrosis caused by myocardial ischemia and detected using a sensitive and specific preferred biomarker, such as cardiac troponin. Acute Myocardial Infarction Annual incidence in US: 900,000 Mortality: 225,000 Pre-admission mortality: 125,000 Acute MI: Pathophysiology Acute plaque fissuring and rupture Superimposed thrombus Transient or permanent occlusion Acute Myocardial Infarction Lipid-rich soft plaques surrounded by a thin fibrous cap are more dangerous in terms of thrombus than collagen-rich and hard plaques. Small, vulnerable plaques are responsible for causing MI Acute MIInitial Recognition and Management Time is of the essence Initial evaluation ideally should be accomplished within 10 minutes Goal: treatment within 1 hour after symptom onset Acute MI: Diagnostic Criteria Clinical history of ischemic-type chest discomfort Changes on serially obtained ECG tracings Rise and fall in serum cardiac markers Acute MI: ECG Changes Correlation of ECG Changes and Areas of Damage Acute Anterior MI Acute Anterior Wall MI Acute Anterior Wall MI Acute Inferior MI Acute Inferior Wall MI Acute Posterior MI Acute Inferior Wall MI with Posterior Extension Right Ventricular Infarction ST segment elevation V4R highly predictive of RV infarct Higher in-hospital mortality Higher incidence of in-hospital complications NEJM 1993(APR);328:981-8. Acute Right Ventricular Wall MIRight Sided Leads Chest Pain Patients in the Emergency Room 10% have ST-segment elevation 10% have non-diagnostic ECG changes 30% have cardiac ischemia without infarction 50% have symptoms of non-cardiac origin ARCH INT MED 1987;147:843. Acute MI: Initial ECGNon-diagnostic ECG’s Normal Subtle ST-T changes Isolated T-wave changes Negative U-waves Normalization of previous abnormal ST-segment and T-waves Conduction defects “Silent” areas: right, posterior Acute MI: Serum Markers Acute MI