冠心病課件(大醫(yī)英)-wenkub.com
2025-07-23 19:56 本頁面
【正文】 (+) 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。163:23452353. **Eagle K, at al. JAMA. 2022。 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 arms is not unmon. Pain above the mandible, below the epigastrium, or localized to a small area over the left lateral chest wall is rarely anginal. ? Provocation angina is generally precipitated by exertion or emotional stress and monly relieved by rest. Sublingual nitroglycerin also relieves angina, usually within 30 seconds to several minutes. Clinical features Physical examination ? An S4 gallop may be transiently present during an episode, and the patient may be dyspneic or diaphoretic or have a new heart murmur. ? Highrisk features of angina include heart failure and hypotension. A plete physical exam 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。 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）
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