天津医科大学内科学课件 Acute Myocardial Infarction.pptVIP

Acute Myocardial Infarction Definition myocardial necrosis because of sustaining myocardial ischemia. Note: Ischemia Sustaining Acute myocardial infarction Ischemia: Narrowing is the predominant reason for ischemia. Sometimes ischemia is caused by coronary spasm. Acute myocardial infarction Sustaining: last for 20 minutes at least. Epidemiology Incidence: 900,000 people experience AMI annually in America. 450,000 people experience reinfarction. 71 per thousand American in men and 22 per thousand in women from 35 to 84 years old experienced AMI. Epidemiology Mortality: 225,000 people die from it annually 125,000 die before admission to the hospital. Acute myocardial infarction AMI is a life-threatening medical emergency which demands immediate activation of the emergency medical services. Immediate transport by ambulance to a hospital where advanced cardiac life support (ACLS) is available needs to be arranged. The more time that passes before medical attention is sought, the more severe the permanent heart damage is likely to be, and the less likely survival will be. Pathology The underlying mechanism of AMI is the destruction of heart muscle cells due to a lack of oxygen. If these cells are not supplied with sufficient oxygen by the coronary arteries to meet their metabolic demands, they die by a process called infarction. Pathology Atherosclerosis —— plaques —— Plaques rupture —— form a thrombus (blood clot) —— necrosis. Pathogen Plaque development Plaque rupture Plaque development Plaque rupture Diagnosis Diagnosis Case 1: A man, 55-year old, went to emergency room for acute retrosternal pain for 2 hours, with large sweat. ECG : V1-V5 S-T↑; Ⅱ,Ⅲ S-T segment ↓ Past history: Hypertension. Diagnosis Case 2: An old woman, 78-year old, suffered from fatigue for 3 days, accompanied with poor appetite. ECG: Q wave in V1-V3 leads. Past history: cerebral thrombosis. Diagnosis History (present history, past history) Physical Examination