美国重症医学(FCCM)基础指导急性冠脉综合征.pptVIP

美国重症医学(FCCM)基础指导急性冠脉综合征.ppt

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Acute Coronary Syndromes Objectives Identify patients with acute coronary syndromes Outline acute management of unstable angina, non-Q wave and Q-wave myocardial infarction Identify patients who are candidates for revascularization interventions Recognize high-risk patients and early complications of myocardial infarction Acute Coronary Syndromes Overlapping clinical conditions Unstable angina Non-Q-wave myocardial infarction (MI) Q-wave (ST-segment elevation) myocardial infarction Variable degrees of coronary artery occlusion Process of inflammation, platelet activation/ aggregation, thrombus formation, microembolization Chest Pain Algorithm Patient with chest pain ? History, physical examination, ECG, chest radiograph ? MI with ST-segment elevation present? ? Yes ? To MI ? algorithm No ? Unstable angina present ? No ? Consider alternative evaluation Unstable Angina and Non-Q-Wave Myocardial Infarction Evaluation and management similar Preliminary diagnosis Clinical symptoms Risk factors Electrocardiogram Cardiac enzymes Assess short-term risks Chest Pain Algorithm Chest Pain Algorithm Cautions Nitroglycerin Avoid decrease in blood pressure ? 10% Adjust unfractionated heparin infusion ?-blocker contraindications Heart rate 60 beats/min Moderate-severe heart failure Atrioventricular block first degree Systolic blood pressure 100 mm Hg Peripheral hypoperfusion Bronchospastic disease Q-Wave (ST-segment elevation) Myocardial Infarction Occlusion of coronary artery by thrombus Progression of necrosis with time Diagnosis Clinical symptoms Electrocardiogram Cardiac enzymes Q-Wave (ST-segment elevation) Myocardial Infarction Admit, O2 Aspirin Sublingual, spray and/or iv nitroglycerin Morphine Heparin (unfractionated, low molecular weight) ?-blocker ??? Candidate for thrombolytic? ??? No ??? Emergency consultation/transfer for primary PTCA Definite Indications for Thrombolytic

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