A myocardial infarction patient’s current anxiety: Assessed with a phenomenological method

The aim of the present study was to illustrate how a patient with a myocardial infarction history may experience current anxiety. We conducted the assessment using a phenomenological method. The participant was a 62-year old man, chronically ill due to two myocardial infarctions and heart failure. Five categories emerged from the data: distress, worthlessness, insecurity, indifference, and lack of strength, illustrating feelings embedded in the current anxiety. These feelings relate to past and present experiences as well as to an insecure future. The findings are not generalizable in a statistical manner, but they are an illustration of the importance of identifying a cardiac patient’s current anxiety from a holistic perspective, in order to understand what is occurring emotionally and to understand the need for emotional support. Qualities in the caring relationship may create possibilities for this patient to receive and perceive emotional support.     

Spouses' conceptions of the pre-hospital phase when their partners suffered an acute myocardial infarction - A qualitative analysis.

BACKGROUND: Delay from onset of acute myocardial infarction symptoms to the delivery of medical care is a major determinant of prognosis. Although studies have explored patient reasons for delay, there are only limited data concerning experiences of the spouse. AIM: Was to describe spouses' conceptions of the pre-hospital phase when their partners suffered an acute myocardial infarction. METHOD: A phenomenographic approach was applied. Fifteen spouses were interviewed <48 h after the partner's hospital admittance. FINDINGS: Two categories with underlying sub-categories conceptualised the spouses' experiences. The category being resourceful contained: sharing the experience, having knowledge, understanding the severity, being rational, and consulting others. The category respecting independence contained: accepting the need for control, marital roles and experiences, restraining emotions, and seeking agreement. CONCLUSION: Our findings suggest that spouses have a strong influence on the course of events. When accepting the partner's need for control through following earlier marital roles and experiences, restraining own emotions and seeking agreement, this seemed to contribute to delay. However, when the spouse was resourceful by sharing the experience, having knowledge, understanding the severity, being rational and consulting others when needed, this seemed to have a positive influence on the pre-hospital time.     

急性下壁或下后壁心肌梗塞并发右室梗塞心电图诊断指标的探讨

本文对125例首次急性下壁或下后壁心肌梗塞(MI)患者记录常规12导联心电图(ECG),并加作 V_7～V_9、V_3R～V_7R、CR_3R～CR_7R,发现合并右室梗塞者43例。结果提示:急性下壁或下后壁 MI时,除 STⅢ/Ⅱ>1可作为右室梗塞的诊断依据之一外,STaVL↓/aVF↑≤50%,STV_2+V_3↓/Ⅱ+Ⅲ↑≤50%可作为常规12导联 ECG 诊断右室梗塞的参考条件。     

Women's experience of myocardial infarction

Background: Heart disease is a major cause of mortality in women. Women have a poorer prognosis than men after myocardial infarction (MI) and research to date has failed to find a definitive explanation. Women have been identified as late presenters for emergency care after acute myocardial infarction. The aim of this study was to discover the underlying processes that effect women's decisions to seek medical help for symptoms of MI. Methods: Qualitative analysis, of semistructured face‐to‐face interviews with 16 women aged between 48 and 82 years, admitted to a major teaching hospital with MI. Results: The women delayed presentation from 1 h to 168 h (median 6.25 h). The decision to seek help was influenced by beliefs about personal susceptibility to MI and beliefs about the way MI presents. Symptoms were diverse and were rarely as described in current health promotion literature. Conclusion: The pivotal factor for early presentation is that women, and their significant others, recognise the variety of signs and symptoms of MI and their personal susceptibility. A theoretical model, adapted from the Self Regulation Model of Illness Cognition of Leventhal et al. is proposed to explain the women's response and also areas of intervention.     

1例急性心肌梗死合并交感风暴患者的抢救配合

交感风暴是一种恶性心律失常,又称儿茶酚胺风暴、室速风暴、置入型心律转复除颤器(Implantable cardioverter defibrillator,ICD)风暴,其发生原因是由于交感神经过度兴奋,心脏电活动出现急剧严重的紊乱,表现为快速室速和室颤反复发作。2006年《室性心律失常的诊疗和心源性猝死防治指南》首次将"交感风暴"定义为24h内自发2次或2次以上室速或室颤需要紧急处理的临床症候群[1],其     

男性心肌梗死患者患病体验质性研究的Meta整合

目的系统总结男性心肌梗死患者患病的真实体验,为制定科学的临床护理措施,提高男性患者的生存质量提供循证依据。方法计算机检索中国知网、万方、中国生物医学文献数据库、VIP、PubMed、Web of Science、Medline、OVID数据库关于男性心肌梗死患者患病真实体验的研究,时间从建库至2020年2月。采用澳大利亚循证卫生保健中心质性研究质量评价标准评价文献质量,采用汇集性整合的方法对结果进行整合。结果共纳入8篇研究,提取27个研究结果,归纳为8个类别,最终整合为3个结果:①男性对疾病的感知并做出应对策略;②传统男性形象与生活的改变;③反思与生活重建。结论临床护理工作者应重视男性心肌梗死患者的患病体验与需求,加强对患者院前症状的识别与负性情绪的疏导,并关注男性患者积极心理变化,提高其生活质量与促进男性角色重建。     

Prehospital experiences of older men with a first myocardial infarction: a qualitative analysis within the Northern Sweden MONICA Study

Scand J Caring Sci; 2011; 25; 787–797
Prehospital experiences of older men with a first myocardial infarction: a qualitative analysis within the Northern Sweden MONICA Study Aim: To explore older men’s prehospital experiences of their first myocardial infarction (MI). Background: The delay between the onset of symptoms to the initiation of medical care is a major determinant of prognosis in MI. The majority of people experiencing MI are men. But few studies have been conducted solely on men’s experiences before seeking medical care for MI. The objective of this study was to explore older men’s experiences of symptoms and their reasoning during the prehospital phase of their first MI. Method: Data collection was carried out through individual interviews with 20 men representing the age range 65–80 (mean 71) years. The participants were interviewed 3 days after admission for a confirmed first MI. The interviews were designed to prompt the men to describe their symptoms and their reasoning up to the decision to seek care. A qualitative content analysis was used to analyse the interviews. Findings: The prehospital phase in older men was found to be a complex and extended journey. The symptoms were perceived from diffuse ill‐being to a cluster of alarming symptoms. The participants dealt with conceptions about MI symptoms. They were unsure about the cause of their symptoms, which did not correspond to their expectations about an MI, and whether they should seek medical care. They had difficulty making the final decision to seek care and strived to maintain a normal life. They initially tried to understand, reduce or treat the symptoms by themselves. The decision to seek medical care preceded a movement from uncertainty to conviction. Conclusions: Understanding older men’s prehospital experiences of MI is essential to reduce their patient decision times. This requires knowledge about the complexity and dynamic evolvement of symptoms, beliefs and strategies to maintain an ordinary life.     

The experiences of female spouses of survivors of acute myocardial infarction: a pilot study of Lebanese-born women in south-western Sydney, Australia

The experiences of female spouses of survivors of acute myocardial infarction: a pilot study of Lebanese-born women in south-western Sydney, Australia ¶ Lebanese migrants form a significant proportion of the population in south-western Sydney (SWS), and in New South Wales, Australia. This pilot study was undertaken in south-western Sydney, a rapidly expanding and socio-economically disadvantaged region, to explore the experiences of English speaking women of Lebanese origin whose spouses had recently experienced an acute myocardial infarction (AMI). Semi-structured interviews were conducted with seven Lebanese-born women at 2- and 4-week intervals, following the discharge of their husbands from hospital. Qualitative analysis of narrative text revealed four distinct themes. These were: struggle to resolve distress; intensive monitoring of the AMI survivor; searching for avenues of support; and reflecting on the future. Study findings are discussed in relation to the literature. Implications for nursing practice and research are drawn from study findings.     

23例急性心肌梗死致心跳骤停急救分析

目的探讨如何提高急性心肌梗死致心跳骤停患者的抢救成功率。方法回顾性分析急诊科2006年11月至2008年10月23例急性心肌梗死致心跳骤停患者的抢救经过,总结其成功的经验。结果18例急性心肌梗死致心跳骤停患者经过及时、正确、持续有效的胸外心脏按压、呼吸机辅助通气、药物复苏及电击除颤等抢救成功,5例患者因院外心跳骤停而贻误了最佳抢救时机致心跳禾恢复。结论提高急性心肌梗死致心跳骤停的急救,关键是及时心肺复苏和电击除颤。     

急性心肌梗塞急诊冠状动脉介入治疗66例临床观察

目的评价急诊冠状动脉介入( PCI)治疗急性心肌梗塞( AMI)的疗效.方法 66例 AMI患者接受急诊 PCI术,其中 59例同时植入冠状动脉内支架.结果急诊 PCI成功 62例,成功率为 93.93%. 59例获 TIMI 3级血流.术后死亡 2例.术前梗塞相关血管狭窄程度为( 98.4± 1.5)%,术后残余狭窄为( 8.6± 6.1)%( P<0.001).术中心室颤动 1例、心室扑动 2例、房颤 1例、 2例出现无再流现象.随访 1～ 48个月,平均 25.5个月,有 6例( 9.09%)发生支架内再狭窄.结论急诊 PCI治疗 AMI安全,成功率高,梗塞相关血管残余狭窄轻.     

首次心肌梗死患者急性期压力感受的现象学研究

目的 探索首次心肌梗死患者急性期内的压力感受.方法 采用质性研究中的现象学研究方法,对1 8例首次发生急性心肌梗死患者在发病后3～4 d急性期进行深度访谈,并采用现象学分析法分析资料.结果 首次急性心肌梗死患者在急性期有很多压力体验,包括难以接受患病的事实,对疾病治疗过程焦虑,担心疾病对今后家庭及社会生活的影响,改变生活习惯的困难,难以排解负性情绪等.结论 首次急性心肌梗死患者在急性期会面临多方面的心理压力,护理人员应根据患者压力感受和压力来源,进行系统的压力管理.     

磁场对急性心肌梗死大鼠心肌的保护作用

目的探讨磁场对急性心肌梗死（AMI）大鼠心肌的保护作用。方法将65只Wistar大鼠分为空白对照组、磁场对照组、AMI组、药物治疗组和磁场治疗组，药物治疗组造模后每日肌肉注射心得安，剂量为5mg／kg体重，磁场治疗组造模后将0．09T的磁片埋于心前区皮下。于实验第6天测定大鼠血清Mg^2＋、血浆MDA、cAMP、cGMP、心肌ATP含量以及心肌梗死范围等。结果磁场治疗组和药物治疗组大鼠心肌梗死面积明显小于AMI组（P〈0．05）；AMI组ST段偏移幅度明显大于药物治疗组和磁场治疗组（P〈0．05）．T波倒置出现率也明显高于药物治疗组和磁场治疗组（P〈0．05）；磁场治疗组和药物治疗组血清Mg^2＋含量、心肌ATP水平均明显高于AMI组（P〈0．05或0．01）；AMI组血浆MDA、cAMP和cGMP含量均明显高于磁场治疗组和药物治疗组（P〈0．0I）。结论磁场作用可减小AMI大鼠心肌梗死面积、ST段偏移幅度，降低T波倒置出现率，使其血浆MDA、cAMP和cGMP的含量下降，血清Mg^2＋含量及心肌ATP水平上升，对心肌具有保护作用，可为磁场用于临床AMI的治疗提供实验依据。     

Electrocardiographic manifestations: acute inferior wall myocardial infarction

The 12-lead electrocardiogram (EKG) is an important tool in evaluating the patient with acute myocardial infarction (MI). Patients with acute inferior wall myocardial infarction (IWMI) represent a heterogeneous group in terms of morbidity, mortality, Emergency Department (ED) management, and site of occlusion in the culprit coronary artery. The standard 12-lead EKG, right-sided chest leads and posterior chest leads, in conjunction with clinical findings often provide the necessary information for the Emergency Physician (EP) to predict complications, morbidity and mortality. IWMI patients may have associated right ventricular infarction (RVI) or lateral and posterior wall extension. Each of these entities is associated with specific hemodynamic abnormalities and increased mortality. In addition, various atrioventricular (AV) blocks are commonly associated with IWMI. This article presents several cases of IWMI with EKGs and a discussion of EKG interpretation in the setting of IWMI.     

前壁合并下壁心肌梗死的临床特点及罪犯血管

目的探讨前壁合并下壁心肌梗死的临床特点及其与冠状动脉造影结果的关系。方法对22例前壁合并下壁心肌梗死患者进行回顾性研究分析。结果本组患者22例,男21例,女1例。合并高血压病、高脂血症及糖尿病分别为72.7%、31.8%和18.2%。有吸烟史占22.7%。典型胸痛、不典型胸痛及无胸痛分别为54.5%、22.7%和22.7%。胸片、心脏超声、心电图及肾功能异常分别为72.7%、100%、100%和18.2%。冠状动脉造影显示:冠脉为右优势分布14例,占63.6%,左优势分布3例,占13.6%;均衡型分布5例,占22.7%。病变累及冠脉66支共76处,单支病变22.7%、二支病变27.3%、多支病变50.0%,受累的前降支(LAD)、右冠状动脉(RCA)、左回旋支(LCX)及左主干(LM)分别为100%、54.5%、72.7%和9.1%。A型病变累及冠脉17支22处(25.8%)、B型病变累及冠脉26支30处(39.4%)、C型病变累及冠脉23支24处(34.8%),重度以上狭窄占80.3%。16例(72.7%)有不同程度的侧支循环。3例AAMI+AIMI中,2例罪犯血管为单支病变,均为LAD,1例为多支病变,累及LAD、LCX及RCA。结论前壁合并下壁心肌梗死患者,多合并危险因素,临床表现复杂,临床检查多有异常,冠脉分布以右优势型居多,冠脉病变以二支及多支病变为主,B型及C型病变占大多数、冠脉狭窄程度较严重,多数患者有不同程度的侧支循环。AAMI+AIMI中,罪犯血管多为LAD,且预后良好。     

Coping with myocardial infarction: evaluation of a coping questionnaire

The negative effects of emotional distress on the recovery following myocardial infarction make it important to study coping strategies in this situation. The present study aimed to evaluate the psychometric properties and the validity of a 10 dimensions questionnaire labelled The General Coping Questionnaire (GCQ). The structure of the questionnaire was based on a previous interview study with 26 persons with different diseases. The 10 dimensions are called self-trust , problem-reducing actions , change of values , social trust , minimization , fatalism , resignation , protest , isolation and intrusion . The present study comprised 114 first-time myocardial infarction patients (37 women, 77 men). Five months after myocardial infarction, they answered questions about health-related quality of life, health complaints, sense of coherence and the GCQ. A multi-trait/multi-item analysis showed good item-scale convergent and discriminatory validity when the GCQ was reduced from 47 to 40 items. In conclusion, the results showed that the 40-item GCQ is a well-structured and reliable questionnaire for measuring coping strategies in myocardial infarction patients.     

急性心肌梗死并发脑梗死的临床特点

目的：探讨急性心肌梗死并发脑梗死的临床特点。方法：急性心肌梗死住院857例分成并发脑梗死组和无脑梗死组,对其资料进行回顾性分析比较。结果：并发脑梗死组平均肌酸激酶峰值、心尖部梗死、心源性休克、心律失常,均高于无脑梗死组（P＜0．05）,并发脑梗死组病死率高于无脑梗死组（P＜0．01）。结论：急性心肌梗死后并发脑梗死与上述因素有关,溶栓及综合防治可减少脑梗死发生率,从而降低急性心肌梗死后病死率。     

Acute myocardial infarction presenting as flank pain and tenderness: Report of a case

Studies have demonstrated that 4% to 10% of patients with chest pain and acute myocardial infarction (AMI) are discharged from the emergency department. The patient with an atypical presentation of AMI is difficult to diagnose and has been demonstrated to have an associated increased risk of morbidity and mortality. A case is reported of a patient with AMI presenting to the emergency department with flank pain and tenderness, mimicking acute renal colic.