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1、EmergencyofCardiovascularSystemDepartmentofEmergency,XuanwuHospitalofCapitalMedicalUniversityAcutecoronarysyndromeArrhythmiaAcuteheartfailureHypertensiveemergencyPart1AcutecoronarysyndromeAgroupofclinicalsyndromecausedbyacutemyocardialischemia.Coronaryatherosclerosis
2、isthepathologicalbasisofthiskindofdisease.Itoccursbecauseofacutemyocardialhypoxia,andtheimbalanceofmyocardialoxygensupplyanddemand.MostofthediseasedeterioratefromchronicstableanginaConceptIntroductionACSisadynamicevolutionaryprocess.Itcanbedividedintounstableangina,n
3、onST-segmentelevationmyocardialinfarctionandSTsegmentelevationmyocardialinfarctionaccordingtotheseverityofacutemyocardialhypoxia,thedurationandtheimbalanceofoxygensupplyTheresultofongoingischemiaismyocardialinfarctionregardlessofanykindsofmyocardialischemia.Thepathog
4、enesisofACSisadynamicprocess.Sowewillbeabletosavepartoftheischemicmyocardium,reducedinfarctsize,orevenavoidtheoccurrenceofmyocardialinfarctionifearlyidentificationandrapideffectivetreatmentsarecarriedout.Type1:IncludingunstableanginaandnonSTsegmentelevationmyocardial
5、infarction.TheLumenofbloodvesselinNon-STsegmentelevationmyocardialinfarctionisincompleteocclusionbecauseoftheplateletthrombus,knownasawhitethrombus.Type2:theSTsegmentelevationmyocardialinfarction.Thethrombusisfibrin-based,alsoknownasredthrombus,totalocclusionofthelum
6、en.ClinicalClassificationACSdependsontwokindsoffactors:One:theformationofcoronaryatheroscleroticplaques.Second:includingplaquerupture,plateletactivation,leadingtothrombosis,resultinginlumenobstruction.Generally,atheroscleroticplaquescancausevascularstenosis,butnotcom
7、pletelyblocked,andifthereisthrombosis,itiseasytoblockthevessellumen.MechanismInaddition,duetotheimpairedendothelial,prostacyclinandrelaxingfactor(EDRF)releasereduced,andangiotensinⅡ(AngⅡ)generationincreased,whichleadtovasoconstriction,plateletaggregationandaccelerate
8、thrombosis.DiagnosisanddifferentialdiagnosisAccordingtohistoryandclinicalmanifestations,ECGchangesandcardiacmarkerssuchastroponinT(
