情绪压抑和精神紧张引起的心肌缺血—一个无形的杀手（英文课件）.ppt

Wei Jiang, MDAssociate Professor  Internal Medicine Psychiatry Behavioral Sciences Duke University Medical Center Purgason K. Dimensions of Critical Care Nursing. 2006;25:247-53 A 64yo WF presents to a local ER, complaining of 2-h substernal chest pain Mild dyspnea with HR 72 bpm, BP 136/72 mm Hg, RR 20/min, T 97.9°F, and O2 saturation 96% on RA No past medical history, postmenopausal, walks daily, and on balanced diet 12-lead EKG shows ST elevation in leads V3-V6, troponin 3.5 ng/dL and CPK 275 μm/L, LVEF 40% with moderate ventricle dysfunction, apical akinesis, and preserved basal function by Echocardiograpm The patient received news that her daughter had been severely injured in a car accident several hours before her onset of chest pain “I have always been impressed by the probability of an important relationship between personality attributes, stress coping strategies and heart disease with myocardial infarction in particular. I have witnessed several friends die suddenly this way. They did not smoke, were not overweight, and their cholesterol levels were unremarkable. But I knew them to be under considerable strain as the result of professional and personal stressors, and I have always believed that their lack of insight, resilience, and emotional resourcefulness, along with their characteristic pattern of responding to stress with helpless anger, significantly contributed to their demise.” ___An anonymous Cardiologist Ampulla cardiomyopathy (Takotusbo cardiomyopathy) --reversible left ventricular dysfunction: with ST segment elevation 8 elderly women and one middle-aged man are studied. All coronary arteriograms are normal, though 7 of them had ST elevation on electrocardiogram. Coronary spasm was positive in only 2 of the 7 patients who received provocation tests Biopsy specimens revealed focal myocyte injury Normal coronary arteriograms during ST elevation and the presence of pathologic myocardial lesions