急性心肌梗死患者的护理

目的 探讨急性心肌梗死患者的护理措施,减少并发症,提高护理水平.方法 对41例急性心肌梗死患者做好心理护理,按护理程序进行整体护理以及健康教育等措施.结果 41例患者中,治愈9例,好转29例,死亡3例.结论 对急性心肌梗死患者提供积极有效的护理措施和健康教育可提高患者生活质量,使急性期病死率大大下降.     

Acute myocardial infarction: myocardial salvage assessment

Primary coronary revascularization by means of percutaneous coronary intervention(PCI)is a highly effective treatment of acute myocardial infarction re-establishing coronary perfusion and stopping the ongoing necrosis in the dependent myocardium.Single-photon emission computed tomography(SPECT)is the most widely used modality assessing myocardial salvage as the difference between the acute perfusion defect before intervention and the remaining scar size measured in a second scan several days after the event.SPECT allows quantification of area at risk(AAR)and final infarct size(FIS)by tracer injection prior to revascularization and after 1 month,respectively.SPECT provides the most validated measure of myocardial salvage and has been utilized in multiple randomizedclinical trials.However,SPECT is logistically challenging,expensive,and includes radiation exposure.More recently,a large number of studies have suggested that cardiac magnetic resonance(CMR)can determine salvage in a single examination by combining measures of myocardial oedema in the AAR exposed to ischaemia reperfusion with FIS quantification by late gadolinium enhancement.     

Acute myocardial infarction due to myocardial bridge

Myocardial bridge (MB) is regarded as a common anatomic variant rather than a congenital condition anomaly,defined as the intramyocardial course of a portion of the coronary artery.It was first mentioned by Rayman in 1737 and first described by Grainicianu in the early 1920s.The current gold standard for diagnosing     

急性心肌梗死216例诊断分析

【目的】探讨急性心肌梗死不典型症状及心电图变化，防止误诊误治的发生。【方法】分析我院2003年1月-2007年2月收入院的216例急性心肌梗死（acute myocardial infarction，AMI）患者的临床表现、心电图及心肌坏死标记物的动态变化。【结果】具有典型AMI症状及，或心电图演变的患者占全部患者的90．74％；表现为急性左心衰的占4．17％；以晕厥、低血压就诊的占0．93％；以快速房颤伴意识障碍就诊的占1．85％；以上腹痛、恶心、呕吐症状就诊的占1．85％；以发作性右胸痛为主要症状的占0．46％。这些不典型的AMI患者均为老年人伴有糖尿病、脑血管疾病或发病时出现低血糖者。【结论】重视AMI患者的不典型症状，监测心电图及心肌坏死标志物的动态变化可以避免误诊误治的发生。     

急性心肌梗死与高血糖

糖尿病是冠心病的独立危险因子。但非糖尿病急性心肌梗死患者亦常伴有血糖升高。有临床研究表明,非糖尿病急性心肌梗死患者早期血糖增高提示病情重、梗死面积大、并发症多、预后差及病死率高。血糖增高的程度与病情的严重程度密切相关。因此,提高对急性心肌梗死时血糖升高及其加重心肌损害和影响患者预后机制的认识,对伴有高血糖的急性心肌梗死患者进行积极的血糖控制,具有重要的意义。作者就血糖水平与无糖尿病急性心肌梗死患者预后的关系,以及加强对其进行血糖控制的研究进展作一综述。     

临床证据（九）：急性心肌梗死

背景知识定义　急性心肌梗死 (ＡＭＩ)是指引起心肌缺血坏死的冠状动脉的突然闭塞。发病率和患病率　无论在发达国家还是在发展中国家 ,ＡＭＩ都是最常见的死亡原因之一。 1990年全世界约 6 30万人死于缺血性心脏病 ,是导致死亡的首要原因。其年龄标准化发病率在不同国家之间和同一国家的不同地区之间是不同的1 。在美国 ,每年有大约 90万人发生一次ＡＭＩ,其中 2 2 5万人死亡。死亡者中约 1 2死于症状出现 1小时内和到达医院急诊室前2 。男性与女性的发病率均随年龄的增高而增高 ,男性高于女性 ,而且在任何年龄段 ,穷人高于富人。近2 0…     

Acute myocardial infarction and arterial embolectomy

Emboli of a main artery cause serious complications in patients suffering from acute myocardial infarction, in whom the surgical risk is high. In order to save the limb, embolectomy is indicated and should be considered. Early diagnosis and prompt surgical intervention with the use of the Fogarty catheter simplify the embolectomy procedure and enable restoration of circulation to the ischaemic limb. Thirty-two embolectomies were performed in twenty-eight patients suffering from acute myocardial infarction. Patients with cardiac compensation survived the surgery and recovered. However 50% of the patients in whom acute myocardial infarction was accompanied with congestive heart failure and arrhythmias died. The cause of death was the underlying disease. Considering the severity of the acute myocardial infarction this group of patients represents the expected mortality.     

Acute myocardial infarction and Friedreich's ataxia

While cardiac disease is noted in 90% of patients with Friedreich's ataxia (FRDA), the finding of coronary artery disease is unusual. To the best of our knowledge only two cases of acute myocardial infarction (AMI) has been reported in patients with FRDA. Large vessel CAD has not been reported previously in patients with FRDA. We report a young patient with AMI and obstruction of large epicardial arteries.     

Acute myocardial infarction following transfusion reaction

Indications for blood transfusion in critically-ill patients in general have become very restrictive. Still, the role for blood transfusion in the setting of acute coronary syndrome is unclear, as evidence regarding outcomes with different blood transfusion strategies has been conflicting. We report a 53-year-old Hispanic woman with acute ST-elevation myocardial infarction (STEMI) following a febrile nonhaemolytic transfusion reaction. Coronary angiogram showed complete occlusion of intracoronary stent in the left anterior descending (LAD) artery. Angiogram done earlier in the day had shown complete patency of the LAD stent with good distal flow. This suggests a possible role for the febrile nonhaemolytic transfusion reaction in triggering the stent occlusion and development of the STEMI.     

Acute myocardial infarction in an adolescent

Myocardial infarction (MI) is known to be common in adults. Interestingly, we report a case of a 15-year-old boy who presented with typical chest pain secondary to myocardial infarct attributable to a combination of familial hyperlipidemia and possible episode of Kawasaki disease in the past. The patient failed treatment and follow-up care, and died 2 years later. Although rare, this case demonstrates that MI should be considered as a diagnosis in adolescents presenting with typical chest pain as early detection, and management is vital for survival.     

Acute myocardial infarction in the young

In space of 2 years our CCU admitted 38 patients under 40 years and the trend seems to be on the increase. The high prevalence of risk factors, the low frequency of arrhythmias and the low mortality rate were notable features. The role of psychological and physical stress in the pathogenesis of cor H. D. deserve more attention. The fact remains that the only road to a substantial reduction in premature death from CHD must be in its prevention.     

Acute myopericarditis masquerading as acute myocardial infarction

Patients with abrupt onset of chest pain,ischemic ECG abnormalities and elevated levels of cardiac markers could be given a diagnosis of acute myocardial infarction.However,some other diseases should be taken into consideration in this clinical setting when coronary arteries are proven to be normal.Here we report a case of acute myopericarditis with clinical presentation of myocardial infarction and normal coronary anatomy.The Herpes Simplex Virus II was considered as the organism causing myopericarditis and the patient was recovered by the treatment with valacicloavir.A precise diagnosis is a prerequisite of successful treatment and favorable prognosis.     

冠状动脉造影正常的急性心肌梗塞

目的 :分析 11例冠脉造影 (CAG)正常的急性心肌梗塞 (AMI)患者的临床特征 ,并探讨其发病机理。方法 :132例临床确诊的AMI于MI后 3— 4周行CAG ,据CAG结果分为冠状动脉正常组 (A组 )和冠状动脉病变组 (B组 )。结果 :132例AMI中 11例CAG正常 ,占 8.3% ;A组与B组相比 :A组明显年轻 ,男性比率明显高于B组 ,除吸烟外 ,其他冠心病主要危险因子相对较少 ,梗塞前心绞痛史显著少于B组 ;A组 11例患者其AMI临床表现、心电图演变与心肌酶变化典型 ,7例尿激酶溶栓再通 ,2例无效 ,2例未溶栓 ;左室造影示A组中室壁瘤发生率高 ,但LVEF高于B组 ;A组 11例患者随访 1年均存活。结论 :AMI可发生于CAG正常的患者 ,其临床症状典型 ,发病趋向于年轻男性 ,除吸烟外 ,其他危险因子相对较少 ,发病机制主要与冠状动脉痉挛 (CAS)和 /或血栓形成有关 ;室壁瘤发生率高 ,可能与侧枝循环不能及时有效建立有关。CAG正常的AMI患者预后好于冠状动脉狭窄的AMI患者     

Acute myocardial infarction related to smoke inhalation and myocardial bridging.

A previously healthy 26 year old woman who was exposed to smoke during a house fire developed acute anterior myocardial infarction complicated by ventricular fibrillation. Subsequent left ventriculography confirmed anterior infarction, but coronary arteriography was normal apart from myocardial bridging over a segment of the left anterior descending artery. The development of acute myocardial infarction in this patient suggests that, in the presence of bridging, carbon monoxide inhalation may cause regional infarction.