冠心病課件(大醫(yī)英)-資料下載頁(yè)
2024-08-04 19:56本頁(yè)面
【正文】 and repair 斑塊破裂引起急性嚴(yán)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(jìn)展過(guò)程 穩(wěn)定斑塊的進(jìn)展過(guò)程 Nissen SE. Am J Cardiol. 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 Physical Examinaton ? Not that helpful ? May have evidence of CHF: JVD, rales, edema ? May have S4 ? May have murmur of mitral regurgitation from papillary muscle dysfunction Investigation ? ECG ? Cardiac Enzyme or Troponin ? Coronary angiography Acute Coronary Syndromes 評(píng)估住院期間和出院后長(zhǎng)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(kù)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(zhǎng)期風(fēng)險(xiǎn) 網(wǎng) 絡(luò) 版可下 載 *Granger CB, et al. Arch intern Med. 2022。163:23452353. **Eagle K, at al. JAMA. 2022。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。 Normal biomarkers Observe。 repeat ECG, markers at 48 hrs No recurrent pain。 (–) followup studies Recurrent pain。 (+) followup studies Stress test。 ? LV function if ischemia (–) test: outpt followup (+) test Admit, Use Acute Ischemia Pathway ST ? Use MI Guidelines No ST ? STT ?’s, chest pain, ? markers Initial Chest Pain Evaluation Symptoms 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
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