急性心肌梗死合并束支或分支阻滞的临床心电图分析

急性心肌梗死（AMI）是危害人类健康的全球范围的疾病,其发病率及死亡率均高,需要及早诊断及时处理,尤其是合并束支及分支阻滞的AMI患者,其梗死面积大、发病凶险,若不及时诊治将会因AMI并发症导致无法弥补的严重后果。     

Clinical efficacy and predictor of cardiac resynchronization therapy on left bundle branch block-associated heart dysfunction

Background Left bundle branch block （LBBB） results in an altered pattern of left ventricular （LV） activation and subsequent contraction. Cardiac synchrony and cardiac function are deteriorated by LBBB. However, the effect of LBBB history on progressive heart dysfunction and clinical efficacy of cardiac resynchronization therapy （CRT） in such patients are not clear. In this study we explore the clinical efficacy and predictor of cardiac resynchronization therapy in LBBB heart dysfunction. Methods Twenty-seven LBBB patients with severe heart failure were treated with CRT. Twenty-six LBBB patients without CRT served as control. During 6 months follow-up, ECG, plasma NT-proBNP and echocardiogram indexes were measured. Results Compared with baseline, NYHA functional class of 23 patients （85.2%） was improved in CRT group. Compared with baseline and control, QRS duration （QRSd） was significantly more narrow （P = 0.023, P = 0.019）, NT-proBNP was significantly lower （P = 0.011,P = 0.009）, ventricular septal to left ventricular posterior wall delay time and left ventricular dyssynchrony index （Ts-SD） were significantly worse （P 〈 0.05）; left ventricular ejection fraction, left ventricular end-systolic volume, mitral regurgitation area were significantly improved in CRT group （P 〈 0.05）. when the LBBB history was I〉 2 years and QRSd I〉 155 ms, the sensitivity and specificity of CRT super-response were 53.4% and 85.6% respectively. Conclusions CRT can improve the synchronization and hemodynamic of LBBB patients with heart dysfunction, the LBBB history I〉 2 years and QRSd I〉 155 ms are one of the CRT super-response predictors.     

心律失常合并急性心肌梗死的心电图诊断

众所周知,急性心肌梗死（AMI）病理性Q波是初始向量改变的结果,故凡改变初始向量的心律失常均可产生掩盖或酷似心肌梗死的心电图改变。另外,有些心律失常虽未影响初始向量改变,也可产生酷似心肌梗死的心电图改变。当出现酷似AMI时,易误诊,给患者造成精神上及经济上的负担;而掩盖时易漏诊,贻误抢救时机,造成严重的后果,     

血栓抽吸联合替罗非班成功抢救风心双瓣置换术后并发急性大面积心肌梗死一例

冠状动脉粥样硬化基础上斑块破裂继发血栓形成是导致急性心肌梗死（AMI）的主要原因,而冠状动脉栓塞引起的AMI临床上却罕见。现报道经导管血栓吸出术联合欣维宁治疗风湿性心脏病双瓣置换术后继发冠状动脉栓塞引起急性心肌梗死1例,取得良好效果,并对相关文献作一回顾。     

Role of Bradykinin on Left Ventricular Remodeling and Cardiac Function after Myocardial Infarction in Rats

Objectives To investigate the influences of bradykinin （BK） on hemodynamics, left ventricular hypertrophy and interstitial collagen metabolism after myocardial infarction （MI） in rats and the contribution of BK in angiotensin-converting enzyme （ACE） inhibition therapy. Methods By means of hemodynamic measurements, morphometric study of myocyte hypertrophy and SDS-PAGE technique, the effects of enalapril （500 μg.kg^-1.day^-1 ）, enalapril （500 μg.kg^-1.day^-1） with BK B2 receptor antagonist Hoe-140 （500 μg . kg^-1.day^-1）, angiotensin Ⅱ （AgⅡ） type 1 （AT1） receptor antagonist losartan （3 mg.kg^-1.day^-1 ） on mean arterial pressure （MAP）, left ventricular end-diastolic pressure （LVEDP）, as well as maximum positive left ventricular pressure change （ ＋ dp/dtmax）, V（m） n, collagen content and the ratio of type Ⅰ to type Ⅲ collagen （ Ⅰ / Ⅲ ） of noninfarcted area were observed in rats after MI. Treatments were started on the 3rd day after MI and continued for another 28 days. Results Enalapril reduced LV- EDP, V （m） n and collagen content as well as collagen Ⅰ /Ⅲ compared with the untreated MI group （ P 〈 0. 05 ）, and all of these effects of enalapril were partly blunted by concomitant treatment with hoe-140 （ P 〈 0. 05 ）. Losartan was less effective than enalapril （P 〈 0. 05 ）. However, three treatment groups had no significant differences in ＋ dp/dtmax and had similar reductions in MAP compared with untreated MI group. Conclusions BK can improve cardiac function and prevent left ventricular hypertrophy with myocardial fibrosis independent of blood pressure. The mechanisms of ACEI are both blockade of Ang Ⅱ formation and inhibition of BK degradation.     

影响急性心肌梗死后早期心室重构的细胞外基质研究进展

急性心肌梗死（acute mvocardial infaretion,AMI）发生后的心室重构（ventfieular remodeling,VR）是指AMI后所产生的心室大小、形态、组织结构及功能状态的改变,是AMI后发展为心衰的基本病理过程,是影响AMI预后的主要原因。据统计,AMI后VR的发生率为30％～50％。再灌注治疗的开展及普及,使AMI急性期的死亡率明显下降,     

Effects of Late Reperfusion on Left Ventricular Function and Its Relationship With Viable Myocardium After Acute Myocardial Infarction in Patients With or Without Diabetes

Objectives To compare the different effects of late successful reperfusion with PCI on left ventricular function and its relationship with viable myocardium after acute anterior wall myocardial infarction in patients with or without diabetes. Methods A total of 125 consecutive subjects with acute anterior wall myocardial infarction were selected, and divided into diabetes mellitus （DM） group （ n = 43） and Non-DM group （ n = 82） according to WHO diabetes diagnosis criteria. All patients received successful PCI at 12 ± 8 days from onset. Ischemic viable myocardium was detected with low-dose dobutamine echocardiography, and left ventricular function and wall motion abnormality were also assessed with echocardiography before PCI. The data of clinical manifestations and angiograms before and after PCI were analyzed. Levels of creatinine kinase-MB （CK-MB）, and troponin T （TnT） before PCI, 6 hours and 24 hours after PCI were assessed. All patients received clinic and echocardiography follow-up for 6 months. Results Higher rate of TIMI 2 flow, and lower rate of TIMI 3 flow in DM group were demonstrated immediately after PCI, and the rate of serum CK-MB and/or TnT levels were higher in DM group, compared with Non-DM group（P 〈 0.05）. 63% of DM patients and 56% of non-DM patients had viable myocardium before PCI（ P 〉 0. 05）. There were no significant differences of left ventricular ejection fraction （LVEF）, left ventricular end diastolic volume index （LVEDVI）, left ventricular end systolic volume index （LVESVI）, and wall motion score （WMS） between two groups at baseline before PCI（P 〉 0.05）. After six months, WMS was decreased and LVEF was increased in Non-DM group, but the WMS and the LVEF did not changed, and the LVEDVI was increased in DM group compared with baseline; the LVEDVI, LVESVI, LVEF, and WMS were significantly different between two groups （P 〈 0.05 or P 〈 0. 01 ）. Conclusions Compared with non-diabetics, delayed successful revascularization with PCI in diabetics patient with acute myocardial infarction has less benefitial effect on the improvement of late phase left ventricular function, and it may be because the insufficient reperfusion or reperfusion injury to myocardium but not the viable myocardium contributing to the poor result. （S Chin J Cardiol 2009; 10（4） ： 196 -203）     

Upregulation of miR-29b contributes to the anti-fibrotic effect of macrophage migration inhibitory factor in diabetic myocardial fibrosis

Background Macrophage migration inhibitory factor(MIF) possesses proinflammatory function when secreted from the cells, and it also exhibits antioxidant properties based on its intrinsic oxidoreductase activity.However, the role of MIF in cardiac fibrosis is not well known. In the present study, the effect of MIF on fibrosis-associated gene expression and the underlying mechanism were examined. Methods The collagen content in mouse myocardium was detected by Masson staining. Expressions of MIF and fibrosis-associated Col1a1, Col3a1 and α-SMA in mouse myocardium or mouse cardiac fibroblasts were detected by quantitative real-time PCR and Western blot assay, respectively. Mature miR-29b expressions in mouse myocardium and cardiac fibroblasts were determined by real-time PCR. Smad3 activation in MIF-treated cardiac fibroblasts was also detected by Western blot assay. Results Compared with the db / m control mice, the collagen content was significantly increased in the myocardium of diabetic db / db mice. MIF was up-regulated, but miR-29b was down-regulated in the diabetic myocardium. Quantitative real-time PCR and Western blot assay showed that MIF could inhibit fibrosis-associated Col1a1, Col3a1 and α-SMA expressions in mouse cardiac fibroblasts.Smad3 activation was inhibited, but miR-29b was up-regulated in MIF-treated cardiac fibroblasts. Enforced expression of miR-29b significantly suppressed Col1a1, Col3a1, and α-SMA mRNA and 1protein expressions in cardiac fibroblasts. Conclusions MIF possesses the anti-fibrosis activity through inhibiting Smad3activation and through up-regulating miR-29b expression, and miR-29b can inhibit fibrosis-associated Col1a1,Col3a1 and α-SMA expressions in cardiac fibroblasts.     

Increasing Uric Acid Concentration in Elderly With Ischemic Cardiomyopathy

Objectives Plasma uric acid （UA） concentration was suspected to elevate in elderly with ischemic cardiomyopathy （ICM）. Methods We analyzed the data of 235 elderly aged 60 years and older with coronary heart disease： silent myocardial ischemia or angina pectoris confirmed by angiography. Among these patients, 154 had ICM defined as left ventricular end-diastolic diameter （LVDd） male 〉 55 mm, female 〉 50 mm （mean. 63.51 ± 7.70 mm） measured by echocardiography. Difference in UA was analyzed between patients with and without ICM. Results There was significant increase of UA in ICM compared with non-ICM （432.82 ± 143.05 umol/L vs 361. 06 ± 137.35 umol/L, P 〈 0. 05 ） ; and UA was positively related to LVDd （ r = 0. 25, P 〈 0. 05 ）. Conclusions There was significant increase of UA in elderly with ICM due to longterm silent myocardial ischemia and angina pectoris. Moreover, UA was positively related to LVDd. （ S Chin J Cardiol 2009; 10（4） ： 212 -215）     

心血管疾病戒烟干预中国专家共识

吸烟是心血管疾病的独立危险因素,并且也是患者唯一能够自我控制的致病因素。许多心血管医生已经认识到吸烟的危害和戒烟干预的重要性,但尚缺乏相应的戒烟知识和戒烟技巧。本共识通过全面总结吸烟的危害和戒烟的益处,     

109例症状不典型老年急性心肌梗死患者特点

本研究回顾性分析本院2005年1月至2009年4月109例症状不典型老年急性心肌梗死患者的临床表现、心电图表现、梗死部位及治疗情况,以提高不典型急性心肌梗死的早期确诊率,实行有效的治疗,从而提高治愈率,改善预后。     

The Regulation Effects of β2-AR on INCX in Myocytes from Infarcted Rat Heart

Objectives This study is designed to investigate the regulation effects of β2-adrenergic receptors （AR） on expression of the Na^± - Ca^2 ± exchanger （ INCX） in myocytes from the infarcted rat heart. Methods Twenty-eight adult Wistar rats were randomly divided into four groups ： the control group, the two weeks, four weeks and eight weeks post-myocardial infarction （post-MI） groups, respectively. The chest of rat was opened and a ligature was placed around the left anterior descending coronary artery. Rats in control group were sham-operated without the coronary artery ligation. After the operation, rats were fed for two, four or eight weeks respectively. Myocytes were enzymatically disassociated by Langendorff perfusion. The whole cell-patch clamp recording technique was used to record INCX in specific pipette solution and superfusion according to the specific holding potential and command potential program. Results The INCX in ventricular myocytes from the border zone of infarcted myocardium increased significantly at eight weeks after MI （0. 51 ± 0. 12 pA/pF vs 1.07± 0. 21 pA/pF, P 〈0.05）. β2-AR agonist increased INcx more strongly in myocytes from post- MI heart than in controls. β2-AR antagonist attenuated the rise of INCX, strongly in myocytes from post-MI heart than in controls, whereas β1-AR onist. Conclusion The regulation effects of β2-AR on INCX in myocytes AR had closer relationship with the genesis of malignant arrhythmia afte     

心室壁瘤的诊断标准及预后影响因素

室壁瘤是在发生急性心肌梗死（AMI）时,由于梗死面积较大且呈透壁性,局部收缩力下降或丧失所致局部向外膨出,呈带状、囊状或不规则状,是AMI的常见并发症之一,是左室重构的主要形式。它可引起血流动力学障碍,     

心房纤维化及重构与房颤发展的新视点

房颤的发生源于心脏电生理改变和心房结构重塑的共同作用。心房纤维化是一个有害的过程,会引起细胞外基质沉积与降解失衡及成纤维细胞的过度增值等。早期研究显示,心室纤维化会引起心室壁进行性硬化,进而引起心室功能不全和充血性心力衰竭。但随后的研究突出显示了心房纤维化与房颤的关系,与瓣膜病、高血压和老龄化的关系。     

Evaluation of Glucose Metabolism in Acute Myocardial Infarction by Glycated Albumin and Glycated Haemoglobin

Objectives To detect whether persisting or transient glucose metabolism disorder is responsible for admission hyperglycemia in patients with acute myocardic infarction （AMI）. Methods Two groups of patients were enrolled： AMI group and control group. Fasting plasma glucose, 2 hours plasma glucose, glycated albumin（GA） and glycated haemoglobin （ HbA1 c） were measured at baseline in both groups and 30 days after AMI attack in AMI group. Results （ 1 ） There were no significant differences in baseline characteristics between both groups; （2） Compared with the control group, the levels of GA and HbA1 c in AMI group at baseline were significantly higher. （ 3 ） At 30 day follow-up in AMI group, both FBG and 2hPG decreased to normal values, HbA1 c did not change, but only GA kept on increasing. Conclusions Hyperglycemia on admission in patients with AMI resulted from both preexisting metabolic disorder and stress reaction as well. GA is the only indicator that could recall the exaggeration of glucose metabolic disorder during AMI attack at 30 day follow-up. （ S Chin J Cardiol 2009; 10（4） ： 186 -189）     

Clinical significance of serum miR-21 in old and young patients with acute myocardial infarction

Background There may be dysregulation of circulating microRNAs in acute myocardial infarction （AMI）, which is an aging-related process. However, the difference between young and elderly people in expression level of circulating miR-21 in AMI patients has not been investigated. Methods The study included 72 consecutive patients with AMI. The group I consisted of 43 patients aged equal to or above 65 years and the group II consisted of 29 patients aged equal to or below 45 years. Real-time RT-PCR was applied to detect serum miR-21 expression levels at the time of mechanical reperfusion and 12 h, D1, D3 and D7 after PCI, respectively. Results The expression level of miR-21 in AMI patients increased markedly 12 h after PCI and reached the peak at D1 after PCI in both groups. There was no difference of miR-21 expression between Group I and U at the time of mechanical reperfusion （5.12 _＋ 0.73 vs. 4.98 ＋ 0.87） and D7 after PCI （1.28 __ 0.75 vs. 1.94 ＋ 0.89）, However, group I patients exhibited higher miR-21 expression level than group I1 at 12 h （7.96 ＋ 0.78 vs. 4.23 0.77, P 〈 0.05）, D1（9.32 __ 0.89 vs. 6.12 __ 0.92, P 〈 0.05） and D3 （4.78 __ 0.91 vs. 2.97 _＋ 0.77, P 〈 0.05） after PCI, respectively. Conclusion Our data reveal an increase of miR-21 in patients with AMI may be a mechanism of myocardial ischemia reperfusion injury. The expression of miR-21 was related to the development and progression of AMI, and there is an age-related change in the expression of miR-21 in acute myocardial infarction patients.     

以肠梗阻为首要表现的胆囊十二指肠瘘1例

病例：患者女,86岁,因＂间断腹痛、呕吐5 d＂于2010年12月23日就诊于我院消化内科。患者入院前5 d无明显诱因下出现上腹部疼痛,呈间断性发作,伴恶心、呕吐胃内容物,1~2次/d,约50 ml/次。患者发病期间无排便、排气,无发热、呕血,小便正常。门诊行腹部立位平片示,肠梗阻（见图1）。患者既往有胆囊结石病史20余年,曾于2010年9月28日行上腹部CT检查示,胆囊结石,胆囊壁增厚（见图2）。遂以肠梗阻、慢性胆囊炎收治入院。     

Pilot study of gated-PET/CT for evaluating myocardial blood-supply and myocardial metabolism in pigs

Background As for the patients with coronary arteriosclerosis, the presence of ischemic myocardial survival is significant for the treatment and prognosis. Gated 13N-NH3 and 18SF-FDG PET/CT imaging provides myocardial perfusion, metabolism and cardiac function which can valuate myocardial viability accurately and noninvasively. Methods Four pigs were subjected to bilateral internal mammary artery Y-bypass operation in operating room. The pigs under the anesthetized state were sent to PET center when the operation finished. Then 13N-NH3 gated-PET/CT and 18F-FDG gated-PET/CT were performed. Results The myocardial perfusion and myocardial metabolism is well-distributed of left ventricular wall. The motion of the wall was normal. The ejection function was greater than 50%. Conclusion Gated-PET/CT can be used for noninvasive evaluation of myocardial perfusion, myocardial metabolism and left ventricle function.     

Glycemic Control for Patients With Acute Myocardial Infarction

The risk of myocardial infarction increases in patients with diabetes mellitus. The incidence of myocardial infarction is similar in patients with type 2 diabetes without history of myocardial infarction and in non-diabetic patients with history of myocardial infarction. Diabetes mellitus was considered as a coronary disease equivalent by the National Cholesterol Education Program. Strict glycemic control can improve the long-term outcome of both type 1 and type 2 diabetes mellitus. Whatever with diabetic or non-diabetic, strict glycemic control with intensive insulin therapy can reduce the mortality of critically ill patients in hospital. After myocardial infarction,     

医师提供人文医学服务探究——不同医学模式的医疗服务差异性分析

近些年来,社会上呼唤人文医学或人文医生的声音很响,似乎而今的医疗服务使社会大众难于接受。对此,我们复习研究了许多相关文献,从远古时代的神灵主义医学模式发展到今天的生物一心理一社会医学模式各时段的医疗服务。这一文献复习始于朱宗涵教授于2001年在北京地区会议上讲话时提出的“人文医学”这一概念。