冠心病課件(大醫(yī)英)-全文預(yù)覽
【正文】 toms Suggestive of ACS Acute Coronary Syndromes M a n a g e m e n tS T E l e v a t i o n M IT h r o m b o l y t i c t h e r a p yP r i m a r y i n t e r v e n t i o nN o n S T E l e v a t i o n M I a n d U S AL M W HP l a t e l e t i n h i b i t o r sR o l e o f ca t h e t e r i za t i o nASAA n t i t h r o m b i nB e t a b l o ck e rN i t r a t e sPreparation for Discharge After UA/NSTEMI ? Antiplatelet Rx – ASA 75 162 mg/day – Clopidogrel 75 mg/day ? Beta Blocker ? ACEI / ARB – Especially if DM, HF, EF 40%, HTN ? Statin – LDL 100 mg/dL (ideally 70 mg/dL) ? Secondary Prevention Measures – Smoking Cessation – BP 140/90 mm HG or 130/80 mm HG for DM or chronic kidney disease – HbA1C 7% – BMI – Physical Exercise 3060 min at least 5 days/wk No ST Elevation ST Elevation Acute Coronary Syndrome Unstable Angina NQMI Qw MI NSTEMI Myocardial Infarction Davies MJ Heart 83:361, 2022 Ischemic Disfort Presentation Working Dx ECG Biochem. Marker Final Dx Hamm Lancet 358:1533,2022 Thank you 。 (–) followup studies Recurrent pain。163:23452353. **Eagle K, at al. JAMA. 2022。 coronary artery bypass grafting (CABG) 冠心病 CABG 冠心病 PTCA 冠心病 PTCA Before PTCA after PTCA 冠心病 PTCA/S Acute coronary syndrome ? Unstable angina ? NonST elevation myocardial infarction (NSTEMI) ? ST elevation myocardial infarction(STEMI) Unstable Angina/NSTEMI Unstable Angina Clinical Presentation and Classification ? Diagnosis of unstable angina refers to new or worsening symptoms of myocardial ischemia: – rest angina – newonset severe angina – increasing angina 評(píng)估住院期間和出院后長期缺血風(fēng)險(xiǎn) ? 評(píng)估住院期間死亡風(fēng)險(xiǎn) (cindex )* 及出院后 6個(gè)月死亡風(fēng)險(xiǎn) (cindex )** ? 多個(gè)大型數(shù)據(jù)庫中驗(yàn)證其有效性 (cindices分別為 *和 **) ? 評(píng)價(jià)死亡 /再發(fā)心梗的長期風(fēng)險(xiǎn) 網(wǎng) 絡(luò) 版可下 載 *Granger CB, et al. Arch intern Med. 2022。86(suppl):12H17H 不穩(wěn)定斑塊 斑塊破裂 血栓形成 穩(wěn)定斑塊 斑塊體積增加 管腔狹窄 Stable angina pectoris ETIOLOGY – .Ischemia is secondary to coronary artery disease in 95% of patients. The leading cause is certainly atherosclerotic coronary artery disease – .A decreased oxygen supply or an increase in oxygen demand can lead to a worsening of symptoms. – .Ischemia can occur in patients with normal coronary arteries Clinical menifestation chest disfort ? Quality squeezing, griplike, pressurelike, suffocating and heavy”。82(suppl 104). From First Decade From Third Decade From Fourth Decade Endoth
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