急性心肌梗死ami诊断和治疗进展（英文ppt课件）

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1、AcuteMyocardialInfarctionDEFINITIONAcutemyocardialinfarction(MI)isdefinedasdeathornecrosisofmyocardialcells.Itisadiagnosisattheendofthespectrumofmyocardialischemiaoracutecoronarysyndromes.Myocardialinfarctionoccurswhenmyocardialischemiaexceedsacriticalthresholdandoverwhelmsmyocardialcellula

2、rrepairmechanismsthataredesignedtomaintainnormaloperatingfunctionandhemostasis.Ischemiaatthiscriticalthresholdlevelforanextendedtimeperiodresultsinirreversiblemyocardialcelldamageordeath.1-3DEFINITION(Cntd.)Myocardialinfarctioncanbesubcategorizedonthebasisofanatomic,morphologic,anddiagnosti

3、cclinicalinformation.Fromananatomicormorphologicstandpoint,thetwotypesofMIaretransmuralandnontransmural.AtransmuralMIischaracterizedbyischemicnecrosisofthefullthicknessoftheaffectedmusclesegment(sInanontransmuralMI,theareaofischemicnecrosisislimitedtoeithertheendocardiumortheendocardiumandm

4、yocardium.ThepresenceorabsenceofQwavesdoesnotdistinguishatransmuralfromanon-transmuralMIasdeterminedbypathology.4DEFINITION(Cntd.II)AmorecommonclinicaldiagnosticclassificationschemeisalsobasedonECGfindingsasameansofdistinguishingbetweentwotypesofMI—onethatismarkedbySTelevationSTEMIandonetha

5、tisnotNSTEMIThedistinctionbetweenanST-elevationMIandanon-ST-elevationMIalsodoesnotdistinguishatransmuralfromanon-transmuralMI.ThepresenceofQwavesorSTsegmentelevationisassociatedwithhigherearlymortalityandmorbidity;ACSTypesPREVALENCEIngeneral,MIcanoccuratanyage,butitsincidenceriseswithage.Th

6、eactualincidenceisdependentuponpredisposingriskfactorsforatherosclerosis,whicharediscussedbelow.Approximately50%ofallMI'sintheUSoccurinpeopleyoungerthan65yearsofage.However,inthefuture,asdemographicsshiftandthemeanageofthepopulationincreases,alargerpercentageofpatientspresentingwithMIwillbe

7、olderthan65yearsDIAGNOSISIdentifyingapatientwhoiscurrentlyexperiencingaMIcanbeextremelystraightforward,verydifficult,orsomewhereinbetween.AstraightforwarddiagnosisofMIcanusuallybemadeinpatientswhohaveanumberofatheroscleroticriskfactorsalongwiththepresenc