急性心肌梗塞诊断与处理详解.ppt

急性心肌梗塞诊断与处理 杨焯富 几个概念 动脉粥样硬化 冠状动脉粥样硬化性心脏病 急性冠脉综合征 急性心肌梗塞 动脉粥样硬化的过程 Atherosclerotic plaque formation 动脉粥样硬化 : 一个血管疾病的全身性及进展性过程 冠状动脉粥样硬化性心脏病（coronary atherosclerotic heart disease） 指冠状动脉粥样硬化使血管腔阻塞，导致心肌缺 血、缺氧而引起的心脏病，它和冠状动脉功能 性改变（痉挛）一起，统称冠状动脉性心脏病 （coronary heart disease），简称冠心病， 亦称缺血性心脏病（ischemic heart disease）。 可分为五种临床类型：无症状型、心绞痛型、 心肌梗死型、缺血性心肌病型和猝死型。 急性冠脉综合征(acute coronary syndromes, ACS) 是一组冠状动脉粥样硬化斑块破裂、血栓形成或血管痉挛而致急性或亚急性心肌缺血的临床综合征 。 临床表现可为不稳定型心绞痛、急性心肌梗死或心源性猝死，约占所有冠心病患者的30％。 急性心肌梗塞 心肌梗死是由于持久而严重的急性 心肌缺血引起的部分心肌坏死 急性期是指发病后4周内 急性和陈旧性 透壁性和非透壁性 Q波性和无Q波性 ST段抬高性和非ST抬高性 Mechanisms Pathology Progression of myocardial necrosis after coronary artery occlusion Pathology Pathological changes of myocardium Coagulation necrosis, myocytolysis, scar formation. Classification: Q-wave-Transmural infarction(Q-wave) and subendocardial (non-Q-wave)infarction ST-segment-Non-ST elevation MI and ST elevation MI Pathophysiology Disturbance of LV systolicdiastolic function Decreased LVEF, CO, SV,BP AND PEAK dp/dt-Depending on location, severity and extent of infarction RV infarction is far more less, mainly with manifestations of RV failure Pathophysiology Ventricular remodeling (VR) As a consequence of MI, the changes in LV size, shape, and thickness involving both the infarcted and the noninfarcted segments of the ventricle are collectively referred to as VR. A combination of changes in LV dilation and hypertrophy of residual noninfarcted myocardium is responsible for remodeling. Pathophysiology Pump failure Killip Class: Class I = no evidence of HF Class II = LHF, rales less than 50% Class III = pulmonary edema Class IV = cardiogenic shock Dynamic change Complications Treatment alternativesPTCA Cardiac Bypass surgery A——抗血小板药物(anti-platelet) 阿司匹林(Aspirin): 75 mg～150mg/日长期应用 可降低