心血管系统急症ppt课件_1.pptVIP

Emergency of Cardiovascular System;Acute coronary syndrome Arrhythmia Acute heart failure Hypertensive emergency ;Part 1 Acute coronary syndrome;A group of clinical syndrome caused by acute myocardial ischemia. Coronary atherosclerosis is the pathological basis of this kind of disease. It occurs because of acute myocardial hypoxia, and the imbalance of myocardial oxygen supply and demand. Most of the disease deteriorate from chronic stable angina ;Introduction;Type 1: Including unstable angina and non ST segment elevation myocardial infarction. The Lumen of blood vessel in Non-ST segment elevation myocardial infarction is incomplete occlusion because of the platelet thrombus, known as a white thrombus. Type 2: the ST segment elevation myocardial infarction. The thrombus is fibrin-based, also known as red thrombus, total occlusion of the lumen. ;ACS depends on two kinds of factors: One:the formation of coronary atherosclerotic plaques. Second: including plaque rupture, platelet activation, leading to thrombosis, resulting in lumen obstruction. Generally, atherosclerotic plaques can cause vascular stenosis, but not completely blocked, and if there is thrombosis, it is easy to block the vessel lumen.;;Diagnosis and differential diagnosis According to history and clinical manifestations, ECG changes and cardiac markers such as troponin T (TnT) and troponin I (TnI) Troponin is the main basis for the identification of unstable angina and non ST segment elevation myocardial infarction. They increased when acute myocardial infarction occur. The specificity of TnI is higher than TnT. ;Unstable angina: 1. Electrocardiographic ST segment elevation or depression 2. Not elevated cardiac markers Non-ST elevation myocardial infarction 1. Electrocardiographic ST segment depression 2. Elevated cardiac markers ST-segment elevation myocardial infarction 1. Electrocardiographic ST-segment elevation 2. Elevated cardiac markers;Treatment 1．Pre-hospital treatment Includin