循环系统2（Circulatory system 2）.docVIP

循环系统2（Circulatory system 2） One 1. according to the patients medical history, the diagnosis is coronary heart disease and acute inferior myocardial infarction. Diagnosis basis: 53 year old patients have 20 years of smoking history, 2 year history of hypertension, obesity and other risk factors of coronary heart disease; The history of pain in the precordial area, the location, nature, duration, predisposing and relieving factors all support angina pectoris in the past 1 weeks; 6 hours before admission, the upper abdomen suddenly showed severe pain accompanied by chest tightness, palpitations, sweating and other manifestations. The nature and duration of the pain is consistent with acute myocardial infarction, but the pain site is atypical, in the upper abdomen and accompanied by vomiting, but the highest abdominal signs are present. The ECG II, III, AVF ST elevation 0.2~0.4mV, arched elevation, one-way curve and T wave form, V4~6 lead T wave flat. Electrocardiographic findings for acute myocardial infarction. Differential diagnosis: angina pectoris, acute abdomen, including peptic ulcer perforation, acute pancreatitis, gallstones, etc., acute pericarditis, pulmonary infarction, aortic dissection, etc.. 2. the next step: dynamic monitoring of serum myocardial enzymes, EKG, and ECG of right chest leads and posterior wall leads to observe if there was a right ventricular infarction. Bed rest is now difficult to move. After the disease is stable, further examination, such as heart color Doppler ultrasound, chest X-ray, long range electrocardiogram, etc., is carried out to evaluate the heart condition. Principles of treatment and precautions: Bed rest, oxygen inhalation, ECG, blood pressure and respiratory monitoring, eating should not be too full, keep defecate unobstructed; To relieve the pain as soon as possible: pethidine intramuscular or subcutaneous injection of morphine; Third, myocardial reperfusion therapy: in the onset of only 6 hours, patients still feel chest