急性心肌梗死合并心脏破裂2例

心脏破裂是急性心肌梗死的一种严重并发症,临床较少见,一旦出现,短期内迅速出现顽固性心衰、心源性休克及恶性心律失常而死亡.如能早期诊断并及时治疗,患者有望获救.     

急性心肌梗死并发心脏破裂42例临床分析

目的　探讨急性心肌梗死 (AMI)并发心脏破裂的临床特征 ,早期诊断及提出预防措施。方法　分析了院内死亡的 AMI并发心脏破裂病例 42例临床资料。结果　女性发病率多于男性 (P<0 .0 1)。所有心脏破裂均发生于第一周 ,首次发生 AMI者占 92 .9% ,全部为透壁性 AMI,6h后溶栓者心脏破裂发生率高于 6h内溶栓者 (P<0 .0 5 )。结论　 AMI并发心脏破裂应预防为主 ,早期发现早治疗。     

不同年龄段急性心肌梗死患者发生心脏破裂的临床特征

目的探讨老年与非老年急性心肌梗死(AMI)并发心脏破裂(CR)患者的临床特征。方法 AMI合并CR的患者53例,根据年龄分为老年组及非老年组,统计分析两组临床特征。结果老年组入院时收缩压、B型钠尿肽(BNP)水平明显高于非老年组(P<0.05),红细胞计数、血红蛋白、血细胞比容低于非老年组(P<0.05)。结论老年AMI患者并发CR风险高,对比非老年患者入院时收缩压、BNP水平较高,红细胞计数、血红蛋白、血细胞比容较低。     

急性心肌梗死并发心脏破裂的临床经验探讨

心脏破裂（cardiac rupture,CR）是急性心肌梗死（acute myocardial infarction,AMI）的一种并发症,病死率高。现将2008年10月～2011年2月在我院心脏监护病房住院期间发生心脏破裂的12例患者临床资料进行回顾性分析,为临床防治心脏破裂事件提供一定经验。     

急性心肌梗死患者心脏破裂的相关因素

目的 分析急性心肌梗死(AMI)患者发生心脏破裂的相关因素。方法 连续选取本院急诊科2007年1月~2014年12月确诊急性心肌梗死的1 129例患者,经超声心动图证实发生心脏破裂的28例患者,分析相关临床因素。结果 年龄、血清肌酸激酶（CK）、脑钠尿肽（BNP）、左室射血分数（LVEF）、ST抬高振幅、性别、心肌梗死部位均对AMI患者发生心脏破裂有显著意义（均P<0.05）。结论 年龄大、女性、BNP水平显著升高、LVEF值显著降低、ST抬高振幅显著升高是心脏破裂的独立相关因素。     

急性前壁心肌梗死合并心脏破裂1例

正随着生活水平的提高,心血管疾病逐渐成为中国人的主要死因。急性心肌梗死发病率逐年上升,心脏破裂是心肌梗死导致死亡的主要原因,约2%的急性ST段抬高型心肌梗死因发生心脏破裂导致死亡[1]。不同类型的心肌梗死出现心脏破裂的风险存在一定差异,有研究表明,急性ST段抬高型心肌梗死出现心脏破裂的风险明显高于非ST段抬高型心肌梗死[2]。本文报道一例急性前壁心肌梗死合并心脏破裂的典型病例。     

急性心肌梗死并发心脏破裂30例临床分析

目的:探讨急性心肌梗死(acute myocardial infarction,AMI)并发心脏破裂(cardiac rupture,CR)的临床特征、早期诊断及防治方法。方法:连续选取我院2002年3月至2010年3月住院确诊为急性心肌梗死的1 526例患者,经超声心动图或心包穿刺证实为心脏破裂的30例患者,结合冠状动脉造影结果进行分组分析。结果:1.发生CR患者年龄明显高于无破裂者(P<0.05);女性高于男性(P<0.05);2.合并高血压、糖尿病、血肌酐异常患者易发生CR;3.急性ST段抬高性前壁AMI并发CR的发生率明显增高(P<0.05);4.左心室舒张末径增大,射血分数(EF)<50%者易发生CR(P<0.05);LAD严重病变尤其是开口病变及LAD合并3支血管病变发生率明显增高(P<0.05);5.早期成功再灌注治疗者CR发生率明显少于无再灌注者(P<0.05)。结论:AMI合并CR预后明显欠佳。女性、高龄、前壁梗死、LAD严重病变及延迟再灌注患者易于发生。床旁超声心动图有助于早期诊断,积极预防及早期成功再灌注治疗可减少CR的发生。     

急性心肌梗死发生心脏破裂心包填塞1例

1病例介绍患者,男,54岁,因“胸闷痛12d”于2013-03—14入院。患者入院前12d无明显诱因出现胸闷和胸骨后压榨性疼痛,伴气促、大汗淋漓,持续不能缓解,     

急性心肌梗死并发心脏破裂19例分析

目的 :探讨急性心肌梗死 (AMI)伴心脏破裂的临床特征、早期诊断及防治措施。方法 :对 AMI院内死亡的 112例患者中经心包穿刺或超声证实为心脏破裂者 19例 ,进行回顾性分析。结果 :年龄≥ 6 0岁者占 89.5 % ,女性发生率多于男性 (P <0 .0 5 ) ,首次发生梗死者 94.7% ,梗死累及广泛前壁者 89.5 % ,心脏破裂时 78.9%患者处于应激状态 ,所有患者均发生在 AMI第 1周内。心脏破裂 6 8.4%的患者表现为心跳骤停、电 -机械分离 ,其余表现为突然血压下降伴心包填塞或心力衰竭。结论 :AMI早期对老年、女性、首次发生的、特别是广泛前壁心肌梗死 ,应积极处理 ,避免增加心脏负担 ,防止心脏破裂。对疑有心脏破裂者 ,尽早行心包穿刺、超声检查 ,争取手术治疗     

急性心肌梗死并发心脏破裂的预防

心脏破裂(cardiac rupture,CR)是急性心肌梗死(acute myocardial infarction,AMI)最严重的并发症,注重CR的预防,了解CR发生的危险因素、手术治疗及介入治疗可有效降低CR的死亡率。本文通过查阅近年来有关AMI并发CR的相关文献,就目前AMI并发CR的病理机制、临床表现、预防的研究现状与进展进行阐述。     

心肌梗死心脏破裂患者血浆C反应蛋白和D-二聚体水平的变化

目的:探讨测定血浆C反应蛋白(CRP)和D-二聚体水平在冠心病急性心肌梗死(AMI)心脏破裂患者中的临床意义。方法:观察50例AMI心脏破裂(心室游离壁破裂)患者血浆CRP和D-二聚体水平,并与50例AMI但未发生心脏破裂的患者进行对照比较。结果:心脏破裂患者组(实验组)CRP和D-二聚体水平较未破裂组(对照组)明显升高,CRP和D-二聚体水平高低与心脏破裂的发生率呈正相关(P<0.05)。从风险比看,高CRP患者的破裂风险是低的4.125倍,高D-二聚体患者的破裂风险是低的2.471倍。结论:AMI患者的血浆CRP和D-二聚体水平,作为一种敏感性指标,对预测心肌梗死患者发生心脏破裂有一定的价值。     

急性心肌梗死合并室间隔穿孔患者的临床特点及预后因素分析

目的总结分析急性心肌梗死(AMI)合并室间隔穿孔(VSR)患者的临床特点。方法纳入首都医科大学附属北京朝阳医院1999年1月至2018年10月共收治AMI 16038例,其中合并VSR患者44例,对这44例AMI合并VSR患者的临床资料进行回顾性分析。结果44例AMI合并VSR患者中男性24例(54.5%),女性20例(45.5%),平均年龄(71.0±6.5)岁;前壁心肌梗死患者(包括累及前壁的心肌梗死)35例(79.5%),非前壁心肌梗死9例(20.5%)。手术治疗9例,其中7例为室间隔缺损介入封堵术,2例外科手术(1例为室间隔修补术+冠状动脉旁路移植术+室壁瘤切除术,1例为室间隔修补术+冠状动脉旁路移植术+瓣膜修补术)。术后心功能改善情况均较显著,除2例封堵术患者院内死亡外,其余手术患者生存期均大于1年。结论VSR是AMI少见但严重的并发症,手术治疗的近期预后明显优于非手术治疗,介入封堵治疗在改善症状及预后等方面发挥出日益重要的作用。     

Prediction of rupture in acute myocardial infarction

In two patient series including 809 and 327 patients, respectively, with acute myocardial infarction we have compared those who died in myocardial rupture (verified at autopsy, Group A) with those who died without rupture (autopsied, Group B), and those who survived hospitalization (Group C) with regard to previous history and clinical course in hospital. Rupture among autopsied patients was observed in 45% and 40% of the cases in the respective studies. Previous infarction was observed in each study as 0% and 0% in Group A compared with 25% and 31% in Group B, and 20% and 34% in Group C. Previous angina pectoris was observed in 26% and 22% in Group A compared with 50% and 54% in Group B and 52% and 54% in Group C. Maximum serum enzyme activity in Group A did not differ from Group B, but was higher than in Group C (p less than 0.001). Group A patients tended to have a higher initial pain score and a higher requirement of analgesics compared with other groups, whereas initial heart rate or systolic blood pressure did not differ in these patients compared to others. We thus conclude that patients with myocardial rupture have a very low occurrence of previous myocardial infarction and angina pectoris, and that their pain course appears to be particularly severe in the acute phase.     

急性ST段抬高心肌梗死中心脏破裂的认识

目的：研究对急性ST段抬高心肌梗死中心脏破裂的认识。方法选择2010年10月-2011年12月,我院收治的急性ST段抬高心肌梗死患者150例,对患者的心脏破裂进行诊断,并根据诊断结果将150例患者分成12例心脏破裂组,138例无心脏破裂组。观察两组患者的性别,年龄,治疗使用的方法。结果在心脏破裂中,年龄、性别,治疗方法的不同对其均有影响（P〈0.05）。结论心脏破裂是急性ST段抬高心肌梗死中最严重的并发症,了解急性ST段抬高心肌梗死中出现心脏破裂的因素,为临床医生在治疗时提供有利依据,延长患者的生命。     

急性心肌梗死合并室间隔穿孔临床分析

目的 探讨急性心肌梗死（acute myocardial infarction,AMI）后发生室间隔穿孔（ventricular septal rupture, VSR）患者的临床特点、治疗方法及其预后情况.方法 对2000年11月至2013年4月就诊于大连医科大学附属第一医院的23例确诊为AMI合并VSR患者的临床资料进行回顾性分析.结果 此期间共收治AMI患者5 300例,其中合并VSR 23例,发生率为0.43％.其中男性15例（65.2％）,年龄（71±10）岁.合并原发性高血压14例,前壁心肌梗死15例,左心室射血分数34.2％±20.1％.诊断VSR的平均时间为3.6 d.5例患者择期手术治疗.COX回归模型发现女性（P=0.009）、心率（P=0.002）是影响患者生存期的主要因素.结论 AMI合并VSR在临床中并不多见,内科保守治疗效果较差,内科保守治疗维持血流动力学稳定后行手术治疗可提高生存率.     

Potential prevention of myocardial rupture resulting from acute myocardial infarction

The clinical characteristics of 30 cases of myocardial rupture resulting from acute myocardial infarction were analyzed. Predisposing factors of myocardial rupture appeared to be the following (1) age 60 years or older, (2) female, (3) no previous history of angina or myocardial infarction, (4) hypertension on admission, (5) persistent or recurrent chest pain, (6) physical activity and/or emotional unrest, (7) less than 10 days since the onset of myocardial infarction. From 1979 to 1982, we tried to eliminate these risk factors in the acute stage of myocardial infarction, of which hypertension appeared to be the most important and main correlating factor. The incidence of myocardial rupture before elimination of risk factors was 31.2% (26 of 84 patients) which was reduced to 8.8% after elimination. In the years 1981 and 1982, only two cases of myocardial rupture were found in each year, 4.3% and 5.6% of MI patients, respectively.     

Cardiac free wall rupture in acute myocardial infarction: ameliorative effect of coronary reperfusion.

To investigate the pathophysiology of cardiac free wall rupture (cardiac rupture) following acute myocardial infarction (AMI), and to clarify whether reperfusion therapy prevents cardiac rupture, 1,329 cases of AMI (conventional therapy group: 807 cases and reperfusion therapy group: 533 cases) were studied retrospectively. The overall incidence of cardiac rupture was 2.3% (2.7% in the conventional therapy group vs. 1.7% in the reperfusion therapy group). Patients with cardiac rupture were divided into two subgroups according to the time interval from the onset of AMI to cardiac rupture (early rupture less than or equal to 72 h and late rupture greater than or equal to 4 days). The indices of initial evolution of AMI was a significant risk of early cardiac rupture. The reperfusion therapy group showed significantly lower incidence of late rupture (0.4 vs. 1.5% in conventional therapy group; p less than 0.05). The incidence of cardiac rupture in the unsuccessful reperfusion therapy group was higher than that of the successful group (5.9% of 118 cases vs. 0.5% of 404 cases; p less than 0.05). It is concluded that the etiology of cardiac rupture following AMI cannot be explained by any single factor. Early rupture depends on the initial evolution of AMI, and early reperfusion and collateral flow prevent the late onset cardiac rupture.