第8版内科学课件急性ST段抬高型心肌梗死.pptVIP

* Acute Coronary Syndrome is a term that refers to a group of clinical conditions that are defined by acute myocardial ischemia and associated with an increased risk of subsequent MI and cardiovascular death ACS includes the following conditions: Unstable Angina (UA) is defined as chest pain lasting greater than 20 minutes that is not relieved by rest. The pain generally appears unexpectedly and usually increases in frequency or intensity over time. Compared to stable angina, chest pain with unstable angina is usually more severe and prolonged. Patients with unstable angina have no evidence of cardiac tissue death Non-ST Segment Elevation Myocardial Infarction (NSTEMI) is defined as a myocardial infarction in which the patient’s electrocardiogram (ECG) reading shows no elevation of the ST segment. Patients will complain of chest pain and will have elevation of cardiac markers in their bloodstream. This elevation in cardiac markers, which reflects damage to the heart, differentiates an unstable angina patient from a patient with a NSTEMI. Although the arterial blockage may not be complete with a NSTEMI, it is sufficient to induce myocardial cell death. (NSTEMI is also sometimes referred to as non-Q wave MI) ST Segment Elevation Myocardial Infarction (STEMI) is defined as a myocardial infarction in which the patient’s ECG reading initially shows an elevation of the ST segment. Patients will experience severe chest pain in addition to having elevated sustained cardiac markers in their bloodstream. Patients with STEMI experience complete occlusion of an artery and more extensive cardiac tissue death. (STEMI is also sometimes referred to as Q-wave MI) * * * * * * * * * * * * * * * * * * * * * * * 支架定位 支架释放 支架置入成功 补救性PCI 溶栓治疗后仍有胸痛，抬高的ST段无明显降低，尽快行冠脉造影，如TIMI 0-II级血流，说明相关动脉未再通，立即施行 延期PCI 溶栓成功，如无缺血再发，7-10天后行冠脉造影，如残留狭窄适宜PCI可行PCI治疗。 转运PCI 没有条件开展介入治疗的医院，如果病人转院到有条件的医院浪费时间不超过60分钟，可以转到有条件的医院行急诊介入治疗。 溶栓治疗时间窗口 起病时间＜12小时，最佳时间＜6小时 溶栓时间越早，冠脉再