冠心病課件(大醫(yī)英)(存儲版)
【正文】 EMI 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 。291:27272733. Unstable Angina ? Chest pain syndrome, either new onset or progressive angina ? Transient STsegment depression on the electrocardiogram (ECG) ? Without evidence of myocardial infarction by CK, CKMB, or Troponin NSTEMI ? Chest pain syndrome, either new onset or progressive angina ? Transient or persistent STsegment depression on the electrocardiogram (ECG) ? With evidence of myocardial infarction by CK, CKMB, or Troponin Unstable Angina/NSTEMI ? Significant likelihood of occurrence of major cardiac events A. Incidence of MI: 8 to 10% B. Mortality: 2 to 5% Unstable Angina/NSTEMI: Pathophysiology ? Acute plaque fissuring and rupture ? Superimposed thrombus ? Transient occlusion ? Mediatorinduced vasospasm may be present Determinants of Plaque Vulnerability ? Lipidrich core size ? Cap thickness ? Cap inflammation and repair 斑塊破裂引起急性嚴重事件 不穩(wěn)定 心絞痛 心肌梗死 猝死 穩(wěn)定性 (勞力性 ) 心絞痛 不穩(wěn)定斑塊的進展過程 穩(wěn)定斑塊的進展過程 Nissen SE. Am J Cardiol. 2022。326:310318. Davies et al. Circulation. 1990。 TIA, 一過性腦缺血發(fā)作 缺血性腎病 缺血性腸病 Coronary Artery Disease 冠心病 Clinical classification(1979 WHO) Asymptomatic CHD(隱匿型） Angina pectoris CHD（心絞痛型） Myocardial infarction CHD(心肌梗死型） Ischemic cardiomyopathy CHD（缺血性心肌病型） Sudden death CHD（猝死型） Classification of IHD ? Chronic ischemic syndrome: stable angina asymptomatic CHD ischemic cardiomyopathy CHD ? Acute coronary syndrome: unstable angina STEMI/NSTEMI 急性冠脈綜合癥的病理生理學(xué) Fuster et al. N Engl J Med. 1992。163:23452353. **Eagle K, at al. JAMA. 2022。 (+) followup studies Stress test。291:27272733. management ? Admitted to hospital ? Best rest,Oxygen ? Antiplatelet:asprin, Clopidogrel , GP IIb/IIIa inhibitors ? Anticoagulant: UFH or LMWH ? Bblocker ? Nitrates (intravenous) ? CCB ? Statins ? ACEI ? Coronary revascularisation Definite ACS Possible ACS (–) ECG。 or a disfort but not pain. Angina is almost never sharp or stabbing, and usually does not change with position or respiration. ? Duration anginal episode is typically minutes in duration. Fleeting disfort or a dull ache lasting for hours is rarely angina ? Location usually substernal, but radiation to the neck, jaw, epigastrium, or a
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