心肌梗死英文课件.ppt

Signs general Chest Heart Extremities Signs General Anxious Sweating profusely bradycardia or tachycardia Low cardiac output Arrhythmia High or low blood pressure Respiratory distress Fever Signs Chest Rale(pulmonary edema ) Killip classification Class I =absence of Rales Class II=less 50% of the lung fields Class III=over 50% of the lung fields Class IV=cardiogenic shock(rales,hypotension , and signs of hypoperfusion ) Signs Heart Abnormally located ventricular impulse dyskinetic infracted Jugular venous distension right atrial hypertension Soft heart sounds left ventricular dysfunction Heart S 4 atrial gallops S3 ventricular gallops cardiac insufficiency mitral regurgitation murmur papillary muscle dysfunction rarely rupture Pericardial friction rubs Signs Extremities Edema Cyanosis and cold temperature low output Peripheral pulses Auxiliary examinations Electrocadiography Laboratory findings Echocardiography Electrocadiogram ECG changes: ST segment elevation Q wave development T wave inversion ST segment elevation Q wave development T wave inversion Location Inferior wall ——Ⅱ Ⅲ aVF Anterior wall —— V1－6 Anteroseptal wall ——V1-3 Apical or lateral wall —V4－6 Posterior wall-----V7-9 Right-sided ----V4R-V5R Laboratory findings Marker Time to appearance Duration of elevation 6hr 12hr Specificity Troponin I 2-6hr 5-10d 75% 90%-100% 98% Troponin T 2-6hr 5-14d 80% 95%-100% 95% CK-MB 3-6hr 2-4d 65% 95% 95% myoglobin 1-2hr 1d 85% 90% 80% Echocardiography WHO Definition Of MI Diagnosis Chest pain History 、examination and ECG Acute coronary syndrome （ACS） ST segment elevation Non-ST segment elevation NSTEMI UA No TnI(TnT) STEMI TnI(TnT) TnI(TnT) The differential diagnosis  Angina Acute pericarditis Acute pul