冠心病課件(大醫(yī)英)(參考版)
2024-08-06 19:56本頁面
【正文】 ? 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 。 (–) followup studies Recurrent pain。 Normal biomarkers Observe。163:23452353. **Eagle K, at al. JAMA. 2022。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(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)展過程 穩(wěn)定斑塊的進(jìn)展過程 Nissen SE. Am J Cardiol. 2022。 coronary artery bypass grafting (CABG) 冠心病 CABG 冠心病
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