心絞痛的鑒別心絞痛(完整版)
【正文】 50% stable angina. – Abnormal in 50% angina (normal rest ECG). – Equivocal: QIII, QS in V1, V2. – Pseudonormalization of ST depression or T inversion. ? Chest Xray ECHO ? 本例 : 左室肥厚，左室舒張功能減低。 ? 有心腦血管病陽性家族史。 ? 查體：體胖，無明顯其他陽性發(fā)現(xiàn)。 – 室間隔增厚： 13mm(711mm), 左室后壁10mm(711mm)。 – Acute myocarditis or pericarditis。 – Mental or physical impairment。 – ST elevation in leads without Q waves. Noninvasive Testing: Exercise ECG(5) (Relative indication for stopping): ? SBP drop 10mmHg without ischemia。 – Stress ECHO because of poor images. Invasive Testing Angiography (Indications) ? Typical or atypical symptoms and a high clinical probability of sever CAD. ? Most appropriate for a patient with a highrisk treadmill oute. ? Symptoms suggestive but not characteristic, special occupation, eg. Pilots, firefighters etc. ? A low threshold angiography is appropriate for diabetics. RISK STRATIFICATION ? A. Clinical Assessment ? B. ECG/Chest XRay ? Noninvasive Testing ? Coronary Angiography and Left Ventriculography Risk Stratification (Clinical Assessment) ? Prognosis of CAD for Death or Nonfatal MI: – LV function: the strongest predictor, EF is the most monly used。 阻滯劑 ? 硝酸甘油 ? 積極治療 24小時(shí)無效時(shí)需冠狀動(dòng)脈造影 PTCA和 CABG ? CABG： – 左主干病變。 – 二支病變，但其中一支病變在前降支近段。 – General health and noncoronary orbidity. Risk Stratification (Clinical Assessment) ? Clinical Parameters Predictive of Severe (left main or three vessel) CAD – Age, – Gender, – Typical angina, – Previous MI, – DM and use of insulin Risk Stratification (ECG/Chest Xray) ? ECG – Evidence of ? 1 previous MI, – Persistent STT inversion, – LBBB, LAB+RBBB, II or III AVB, Af, VT, – LV hypertrophy, ? Chest Xray – Cardiomegaly, LV aneurysm, PV congestion – Coronary calcification Risk Stratifica
試題試卷相關(guān)推薦
鄂ICP備17016276號(hào)-1