内科学教学课件：Coronary heart diseases.pptVIP

1.Dysfunction rupture of a papillary[p?pil?ri] muscle： rare but fatal complication cause acute massive mitral regurgitation[ri.g?:d?i‘tei??n],反流 pulmonary[p?lm?n?ri] edema[i:di:m?] 2.rupture of ventricular wall： occurs most commonly within 1 week free wall rupture; rupture of interventricular septum 3.embolization[emb?laizei??n]： LV mural [‘mju?r?l]附壁 thrombus[θr?mb?s] cause arterial embolization DVT (deep vein thrombus) cause pulmonary embolization 4.cardiac aneurysm： persistant ST elevation cause mural[‘mju?r?l]附壁thrombus, heart failure, and arrhythmias 5.post-MI syndrome(Dressler syndrome)： fever, chest pain, repeated pericarditis, pleuritis[plu?raitis], pneumonia STEMI Clinical manifestation complications Anterior AMI STEMI Laboratory Inferior AMI STEMI Laboratory Localization LAD STEMI Laboratory STEMI Laboratory Localization LAD STEMI Laboratory Localization LCX STEMI Laboratory Localization RCA 2.radionuclide[‘reidi?u’nju:klaid]放射性核素 angiography： 3.Echocardiology：distinct region of disordered contraction, LV function, detection complication 4.laboratory examination: blood routine serum cardiac markers STEMI Laboratory marker Range of times to initial elevation （h） Mean time to peak elevations （nonthrombolysis ） Time to return to normal range Myoglobin 1-4 6-7h 24h cTnI* 3-6 24h 7-9d cTnT* 3-6 12h-2d 7-14d CK-MB 3-6 16-24h 3-4d CK 1-6 12h 38h LDH 8-10 24-48h 10-14d Cardiac markers * Most sensitive and specific marker of myocardial damage STEMI Laboratory 敏感的 Differential diagnosis 1.angina pectoris：chest pain, complication, general symptoms, elevation of cardia markers, ECG changes 2.acute pericarditis[.perikɑ:daitis]：characteristics[.k?rikt?ristik] of chest pain, time course of chest pain and fever, ECG changes 3.acute pulmonary embolization[emb?laizei??n]:chest pain, hemoptysis, dyspnea, increased load of RV (SIQIII) STEMI Diagnosis 4.Acute abdominal symptom：acute pancreatitis,cholecystitis, cholelithiasis 胰腺炎，胆囊炎，胆石症 5.aortic[ei?:tik] dissecti