急性冠脉综合征 讲课PPT课件.ppt

3.急检肾功，离子，凝血，传染病等检查 4.征得患方同意后，行术前准备及术前教育，于介入导管室行冠脉造影检查 行PCI术后 术后患者胸闷痛消失，ST段回落 第二日复查 病情平稳后 * 1.患者可烦躁不安，出汗，恐惧，有濒死感，少数患者无疼痛，部分患者可表现为急性心衰，晕厥，休克 2.发热 体温一般38度，很少超过39度，持续约1周 5.血压低于80mmHg,伴烦躁不安，面色苍白，皮肤湿冷，脉细而快，大汗淋漓，尿量减少（20m/h），神志迟钝，甚至晕厥，为休克表现 * 超急性期 数小时内 急性期 数小时 ST段抬高 数小时至2天内 Q波形成 亚急性期 数日至2周 ST段回落至基线 T波平坦倒置 慢性期 数周至数月 T波可直立或倒置 * * * * * * * Slide 4 Pathophysiology of ACS Various factors affect the risk that an atherosclerotic plaque will rupture, including the tensile strength of the fibrous cap and the shear stresses to which it is subjected. Unstable plaques at high risk of rupture typically have a large lipid core, a thin cap and contain large numbers of macrophages but relatively few smoothmuscle cells. Rupture or fissure of the plaque exposes the thrombogenic core of the lesion and leads to adhesion and aggregation of platelets and thrombus formation. A large fissure typically results in the formation of a large thrombus that completely occludes the coronary artery, causing acute MI, characterized by persistent ST-segment elevation and subsequent development of new Q-waves on the electrocardiogram (ECG). A smaller fissure may result in a mural thrombus that partially or transiently occludes the artery, causing acute myocardial ischemia without persistent ST-segment elevation. The clinical diagnosis is unstable angina, or if thereis biochemical evidence of myocardial damage, non-Q-wave MI. ACS is a classic example of atherothrombosis (plaque rupture and thrombus formation). References Fuster V, Badimon L, Badimon JJ et al. N Engl J Med 1992;326:310–318. Davies MJ. Circulation 1990;82(Suppl 3):II38–46. * 乳头肌功能失调或断裂 心脏破裂 栓塞 心室壁瘤 心肌梗死后综合征 心肌梗死并发症 一、乳头肌功能失调或断裂　 总发生率50%，主要由于乳头肌缺血、坏死而无力收缩，引起二尖瓣脱垂及关闭不全，心尖区出现收缩期杂音。产生心力衰竭。轻者可恢复，重症可引起急性肺水肿，导致死亡。 二、心脏破裂　 多为心室游离壁破裂，形成心包积血等导致急性心包填塞而猝死 室间隔梗塞穿孔时，在胸骨左缘第3、4肋间出现响亮的收缩期杂音 三、栓塞　 心内膜附壁血栓的脱落，引起脑、肾、脾或四肢等动脉栓塞症状。 下肢静脉血栓脱落，导致肺栓塞 四、心室壁瘤　 5－20％，梗塞部位在心脏内压