缺血性心脏病-教学20101216.pptVIP

* * Lecture Notes * Cardiac biomarkers in ST-elevation myocardial infarction (STEMI).Typical cardiac biomarkers that are used to evaluate patients with STEMI include the MB isoenzyme of CK (CK-MB) and cardiac specific troponins. The horizontal line depicts the upper reference limit (URL) for the cardiac biomarker in the clinical chemistry laboratory. The URL is that value representing the 99th percentile of a reference control group without STEMI. The kinetics of release of CK-MB and cardiac troponin in patients who do not undergo reperfusion are shown in the solid green and red curves as multiples of the URL. Note that when patients with STEMI undergo reperfusion, as depicted in the dashed green and red curves, the cardiac biomarkers are detected sooner, rise to a higher peak value, but decline more rapidly, resulting in a smaller area under the curve and limitation of infarct size. Modified with permission from Alpert et al. J Am Coll Cardiol 2000;36:959 and Wu et al. Clin Chem 1999;45:1104. Case discussion 2 临床表现 男性，65岁， 发作性胸痛8小时 既往史： 吸烟：20支/日，30年； 高血压病史10年 辅助检查 心电图：V2-V5 st段抬高 心肌标志物：TNI:7.8ng/ml 如何治疗？ 治疗原则 冠状动脉血运重建治疗 恢复心肌血流和再灌注 溶栓 PCI CABG STEMI -- Management Anti-ischemic agents Anticoagulants Provide facilities for defib Antiplatelet agents Coronary revascularization ( Reperfusion Strategy-Reopen IRA) Detect and Treat complications early Long-term management A triple coronary artery bypass graft operation Management coronary artery bypass grafting 确诊ST段抬高心肌梗死 一般治疗（抗血小板、抗凝、 B阻断剂） 治疗原则 12小时以内 12小时以上 再灌注治疗 溶栓治疗 冠脉介入治疗 是 否 是 保守治疗 Management --PCI Case discussion 2 临床表现 男性，65岁 发作性胸痛8小时 既往史： 吸烟：20支/日，30年； 高血压病史10年 辅助检查 心电图：V2-V5 st段抬高 心肌标志物：TNI:7.8ng/ml 治疗 直接PCI 二级预防药物 STEMI Complications Electronic – Arrhythmias Mechanical COMMON ARRHYTHMIAS IN ACUTE MYOGARDIAL INFARCTION Ventricular fibrillation Ventricular tachycardia Accelerated idioventricular rhythm Ventricular ectopics Atrial fibrillation Atrial tachycardia Si