冠心病課件(大醫(yī)英)(編輯修改稿)
2024-08-22 19:56 本頁面
【文章內(nèi)容簡介】 m is crucial in making an assessment of risk. ? Most pt:() Alternative Diagnoses to Angina for Patients with Chest Pain ? NonIschemic CV – aortic dissection – pericarditis ? Pulmonary – pulmonary embolus – pneumothorax – pneumonia – pleuritis ? Chest Wall – costochondritis – fibrositis – rib fracture – sternoclavicular arthritis – herpes zoster Gastrointestinal ? Esophageal – esophagitis – spasm – reflux ? Biliary – colic – cholecystitis – choledocholithiasis – cholangitis ? Peptic ulcer ? Pancreatitis Psychiatric ? Anxiety disorders – hyperventilation – panic disorder – primary anxiety ? Affective disorders – depression ? Somatiform disorders ? Thought disorders – fixed occlusions Investigation 12 Lead Resting ECG ? should be recorded in all patients with symptoms suggestive of angina pectoris ? normal in ? 50% of patients ? a normal ECG does not exclude severe CAD。 however, it does imply normal LV function with favorable prognosis CHD At rest: ECG 冠心病 Episode of angina:STsegment depression ECG CHD Holter Exercise testing Angina: Exercise Testing High Risk Patients ? Significant STsegment depression at low levels of exercise and/or heart rate130 ? Fall in systolic blood pressure ? Diminished exercise capacity ? Complex ventricular ectopy at low level of exercise Exercise Testing Contraindications ? MI—impending or acute ? Unstable angina ? Acute myocarditis/pericarditis ? Acute systemic illness ? Severe aortic stenosis ? Congestive heart failure ? Severe hypertension ? Uncontrolled cardiac arrhythmias Investigation Echocardiography. ? The stress echocardiogram is a widely performed test used to assess patients for coronary disease. ? Baseline echocardiographic images are obtained at rest to evaluate left ventricular function, wall motion, and valve function. ? Images are then acquired during peak stress (that is, during a GXT or with dobutamine) and pared with those at rest. Regional wallmotion abnormalities with stress indicate areas of hypoperfusion or ischemia. Investigation ? Isotope scanning:obtaining scintiscans of the myocardium at rest and during stress after administration of an intravenous radioactive isotope such as thallium 201 Investigation Coronary angiography. Used to identify foci of coronary disease. It is the evaluation of choice in patients with angina that is (1) poorl
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