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1、急性冠脉综合征（ACS）及其治疗进展5/981MedSlides.com急性冠状动脉综合征的定义和分类定义：急性冠状动脉综合征(acutecoronarysyndomes,ACS)是从不稳定性心绞痛到Q波心肌梗死的一组临床综合征，通常(但并非总是)由于CAD所致，在病理生理上有很多相似之处。急性冠状动脉综合征的分类：★ST段不抬高的急性冠状动脉综合征◆非Q波心肌梗死NSTEMI（CK-MB大于正常上限的2倍）◆不稳定性心绞痛UAP（CK-MB小于正常上限的2倍）★ST段抬高的急性冠状动脉综合征——急性Q波心肌梗死STEMI5/982MedSlides.com
2、国际现状每年:>4millionpatientsareadmittedwithunstableanginaandacuteMI>900,000patientsundergoPTCAwithorwithoutstent5/983MedSlides.comIschemicHeartDisease evaluationBasedonthepatient’shistory/physicalexamelectrocardiogramPatientsarecategorizedinto3groupsnon-cardiacchestpainunstableanginamy
3、ocardialinfarction5/984MedSlides.com急性冠脉综合征（ACS）ACS非ST-segment抬高ST-segment抬高不稳定非-Q波Q-Wave心绞痛AMIAMIECGAcute ReperfusionHistory PhysicalExam5/985MedSlides.comAcuteCoronarySyndromeThespectrumofclinicalconditionsrangingfrom:unstableanginanon-QwaveMIQ-waveMIcharacterizedbythecommonpatho
4、physiologyofadisruptedatherosleroticplaque5/986MedSlides.com5/987MedSlides.comSTEMI和UA/NSTEMI病理5/988MedSlides.com不稳定心绞痛–定义anginaatrest(>20minutes)new-onset(<2months)exertionalangina(atleastCCSCIIIinseverity)recent(<2months)accelerationofangina(increaseinseverityofatleastoneCCSCclas
5、stoatleastCCSCclassIII)AgencyforHealthCarePolicyResearch-1994CanadianCardiovascularSocietyClassification5/989MedSlides.comNon-Q-WaveMIcluestodiagnosisProlongedchestpainAssociatedsymptomsfromtheautonomicnervoussystemnausea,vomiting,diaphoresisPersistentST-segmentdepressionafterresol
6、utionofchestpain5/9810MedSlides.com5/9811MedSlides.comNSTEACS诱发因素Inappropriatetachycardiaanemia,fever,hypoxia,tachyarrhythmias,thyrotoxicosisHighafterloadaorticvalvestenosis,LVHHighpreloadhighcardiacoutput,chamberdilatationInotropicstatesympathomimeticdrugs,cocaineintoxication5/981
7、2MedSlides.comNSTEACS预后预测因素PresenceofST-T-wavechangeswithpainHemodynamicdeteriorationpulmonaryedema,newmitralregurgitation,3rdheartsound,hypotensionOtherpredictorsleftventriculardysfunction,extensiveCAD,age,comorbidconditions(diabetesmellitus,obstructivepulmonarydisease,renalfailur
8、e,malignancy)5/9813MedSlid
