西安交通大学医学院急诊医学课件 急性胸痛.pptVIP

* Show ECG. In the event of a large PE the classical changes to be seen: * di * Guideline 8 pages. * Show MRI: class III dissection of aorta. * Acute myocardial infarction and PE is needed us to promptly diagnosis and thormbolysis. * I hope the class just like a brick, today I throw a brick, and tomorrow it will draw a jade. 主动脉夹层发病率、死亡率 发病率：每百万人口五至三十人之间，男性高于女性。 死亡率：急性夹层不治疗，48小时内死亡率约36-72%，一周内死亡率62-91%；院内保守治疗，其平均死亡率也高达27.4%；夹层累及重要血管分支引起脏器缺血，其死亡率更高。 Pathophysiology Damage to the media and high introluminal pressure causing an intimal tear; Blood enters and dissencts the luminal plane of the media creating a fals lumen. Stanford classification Type Aall dissections involving the ascending aorta; Type Ball dissection not involving the ascending aorta. Symptoms Central tearing chest pain radiating to the back; Further complications as the dissection involves branches of the aorta: Coronary ostiamyocardial infarction; Carotid or spinal arterieshemiplegia, dysphasia, or paraplegia; Mesenteric arteriesabdominal pain. Signs shocked, cyanosed, sweating; Blood pressure and pulses differ between extremities： Aortic regurgitation; Cardiac tamponade; Cardiac failure. Investigation CXRwidened mediastinum +/- fluid in costophrenic angle; ECGmay be ST elevation; CT/MRIbest investigations, show aortic false lumen; Transoesophageal echo if available also very sensitive; Echocardiographymay show pericardial effusion if dissection extends proximally; tamponade may occur. Summary The importance of this subject is that this situation represents a medical emergency requiring rapid diagnosis and treatment. It is necessary in this situation to distinguish between: MI; unstable angina; pericaditis; dissection of thoracic aorta; PE; mediastinitis secondary to oesophageal tear; non-cardiac chest pain. 思考题和答案 1、当遇到胸痛患者，首先鉴别什么？为什么？ 答：首先区分心源性和非心源性胸痛。因为在心源