培训课件--急性心肌梗塞诊断与处理.ppt

E——适量运动(Exercise) 健康教育(Education) AMI的二级预防 谢谢！ * 此图表明了斑块形成过程。早期阶段以损伤处出现少量泡沫细胞为主。以后脂质沉积产生脂质条纹。然后，脂质沉积在血管壁的细胞外间隙。在30岁后，可形成粥样斑块或肉眼看不见的脂质核心。应注意到，在此时斑块的主要生长方式为脂质沉积。40岁后，由于在粥样斑块核心上，含有平滑肌细胞和胶原的基质增多，故可见更多的纤维斑块。最后，如果斑块不稳定，可能被侵蚀或破裂。一旦斑块内溶物接触血液，可能导致血小板激活及血栓形成。 Stary, et al. Circulation 1995; 92: 1355-1374 * Slide 3 Atherothrombosis: a Generalized and Progressive Process Atherothrombosis is the common underlying disease process for MI, ischemia and vascular death. ACS are classic examples of atherothrombosis (plaque rupture and thrombus formation). ACS (in common with ischemic stroke and critical leg ischemia) are typically caused by rupture or erosion of an atherosclerotic plaque followed by formation of a platelet-rich thrombus. Atherosclerosis is an ongoing process affecting mainly large and medium-sized arteries, which can begin in childhood and progress throughout a person’s lifetime. Stable atherosclerotic plaques may encroach on the lumen of the artery and cause chronic ischemia, resulting in (stable) angina pectoris or intermittent claudication, depending on the vascular bed affected. Unstable atherosclerotic plaques may rupture, leading to the formation of a platelet-rich thrombus that partially or completely occludes the artery and causes acute ischemic symptoms. * * * * * * * * * * PTCA - Percutaneous Transluminal Coronary Angioplasy A catheter is inserted through the artery, past the obstruction. A balloon on the catheter is inflated to compress the plaque and overstretch the vessel. PTCA causes a controlled injury to the vessel wall. In atherosclerotic lesions, plaque fracture and arterial wall stretching are the mechanisms enlarging the lumen. Enlarging the narrowed vessel restores blood and oxygen flow to the tissue. * When the balloon is inflated, the vessel is totally blocked, which results in ischemia. The patient may have angina or experience a drop in blood pressure as well as arrhythmias. An ECG is continuously and carefully watched on