Stress in women's daily life before and after a myocardial infarction: a qualitative analysis

BACKGROUND: Little is known about women's perceptions of their daily life before and after a myocardial infarction (MI), especially with regard to stress, which is a risk factor for coronary heart disease (CHD). AIM: To describe and explore women's perceptions of stress before and after an MI. METHOD: Two interviews with women who suffered an MI, the first at the hospital (n = 20) and the second 4-10 months after the MI (n = 14), were analysed using a phenomenographic approach. FINDINGS: The stress emanated either from within themselves (personal traits) or as an effect of their immediate surroundings. The period before the MI was stressful due to the different roles they had to maintain in their private and professional lives. They lost control over their daily life. After hospital discharge they both wanted and needed support, as they were terrified when they returned home. They did not know how much they could do and neither did their relatives, while little or no support was provided by the healthcare professionals. CONCLUSIONS: To prevent CHD in daily life and avoid reinforcing stress, it is important to place greater emphasis on stress as an important risk factor. An understanding of this phenomenon can assist primary healthcare, coronary care unit (CCU) and rehabilitation nurses in supporting these women as well as their partners to adapt their daily lives both before and after an MI. It is essential to formulate and implement individualised treatment plans and to provide support groups for women.     

老年人急性心肌梗死108例临床观察

目的 提高对老年人急性心肌梗死的诊断率,减少误诊率和心肌梗死危险事件的发生.方法 急性心肌梗死所有急性心肌梗死病人分为正确诊断组和误诊两组,对两组的症状、心电图特点进行率的比较.结果 误诊组中胸闷和心电图非ST段抬高的发生率分别高于正确诊断组(P＜0.01,P＜0.05).结论 老年人急性心肌梗死以胸闷为主要症状和心电图非ST段抬高,要结合病史、动态心电图和心肌酶学监测结果综合分析,及时诊断,进行危险分层评估.     

急性心肌梗塞后远离区心肌缺血患者出院后随访与分析

通过６２例急性心肌梗塞（ＡＭＩ）后有远离区心肌缺血患者和５５例无远离区心肌缺血患者的随访资料分析，显示前者再次梗塞（１３例）、左心衰竭（３１例）与猝死（１５例）等发生率均显著高于后者（分别为３例、６例和４例，Ｐ＜０．０５～０．００５）。提示远离区心肌缺血可显著影响ＡＭＩ患者的预后。作者指出，改善患者预后的关键是改善远离区心肌的缺血性改变及早期防治冠心病易患因素，并及时防治梗塞后心绞痛、室性早搏与左心衰竭等。如内科防治措施不奏效时，应考虑外科或介入性治疗。     

Plasma zinc after myocardial infarction

Plasma levels of zinc and albumin have been measured for eight consecutive days in patients suffering chest pain due to myocardial infarction or myocardial ischaemia. A substantial diurnal variation has been found in both controls and patients. Plasma zinc falls after myocardial infarction reaching the lowest level on day 2, thereafter returning to normal by day 8. The lowest plasma zinc levels occur within 48 h of a myocardial infarction and in some patients herald the development of a serious cardiac arrhythmia. Plasma albumin falls progressively after myocardial infarction, being lowest on day 8. The fall in plasma zinc is not totally explained by the fall in plasma albumin.     

Evolution of QRS duration after myocardial infarction: clinical consequences

The natural history of late potentials after acute myocardial infarction (AMI) has been studied in the first 2 years following myocardial infarction (MI). The purpose of the study was to assess the influence of some time delays since MI, including a time delay longer than 2 years on signal-averaged ECG (SAECG). SAECG was recorded at 40-Hz high pass filtering in 40 patients 10 days after acute MI (SAECG 1), then repeated 6-12 months later (mean 9 +/- 3 months) (SAECG 2), and then, 2-4 years later (mean 3 +/- 2 years) (SAECG 3). QRS duration, root mean square voltage of the last 40 ms of QRS (RMS 40), and low amplitude signal duration (LAS) were measured at the first (1), second (2), and third recording (3). Results: (***P < 0.001) [table: see text] The analysis of individual results showed a lengthening QRS duration at the third recording only in patients who had a decreased left ventricular ejection fraction (LVEF) at the third recording. In 12 patients with LVEF > 40%, QRS duration did not change at the first and third recording (104 +/- 15 vs 101 +/- 12 ms). In all 28 patients, but one with LVEF < 40%, QRS duration increased from 107 +/- 12 to 128 +/- 18 ms***. There was no correlation between QRS duration and LVEF at the second recording and no correlation between QRS duration increase at the third recording and the presence or not of late potentials at the first recording. QRS duration lengthening at the third recording was significantly correlated with a left ventricular (LV) dilatation occurrence at the two-dimensional echocardiogram. All arrhythmic events, but two, occurred in patients who developed a QRS duration prolongation and were significantly correlated (P < 0.01) to a mean longer QRS duration (132 +/- 20 ms) than in patients without arrhythmic events (113 +/- 17 ms). In conclusion, the patients with a LV impairment, and who developed a LV dilatation several months after AMI, presented a delayed lengthening of QRS duration noted only at least 2 years after infarction. These patients are at risk of arrhythmic events.     

美托洛尔对急性心肌梗死后心律失常的疗效观察

目的 观察早期静脉注射后口服美托洛尔对急性心肌梗死(AMI) 后心律失常事件的影响,并评估其安全性.方法 设安慰剂对照的随机双盲临床试验,治疗组27例,首先静脉注射美托洛尔5 mg,共3次,然后给予口服美托洛尔200 mg/d;安慰剂组26例,除接受AMI的常规治疗,相应安慰剂静脉及口服方法 与治疗药相同,入组后24小时及出院前分别记录24小时动态心电图.结果 AMI后24小时内美托洛尔组室上性心动过速的例数明显低于对照组(11/27 vs 18/26,P<0.05),心房纤颤的发生美托洛尔组虽有减少趋势,但差异无统计学意义(0/27 vs 2/26,P0.05);美托洛尔组成对或二联律的室性期前收缩和室性心动过速的饲数明显低于安慰剂组(11/27 vs 19/26,5/27 vs 12/26,均P<0.05),心室纤颤两组各发生1例;出院前美托洛尔组的房性期前收缩和室上性心动过速的发生例教明显少于安慰剂组(15/25 vs 21/24,3/25 vs 9/24,P<0.05);成对或二联律的室性期前收缩以及室性心动过速的例数两组差异无统计学意义(2/25 vs 4/24,0/25 vs 2/24,均P0.05).结论 AMI后早期静脉及口服美托洛尔可有效的抑制心肌梗死后发生的房性和室性心律失常,但应在血流动力学稳定后开始使用,以避免增加心源性休克的风险.     

老年重症心肌梗死的预见性护理

目的探讨预见性护理在老年重症心肌梗死患者中的应用价值。方法将56例老年重症心肌梗死患者随机分为研究组和对照组各28例。对照组采用常规护理,即不良心理、并发症、便秘等均在发生后再对症进行护理;研究组采用预见性护理,在各类心理和生理不良反应出现前,于患者入院时起,即密切监视,预防不良心理和各类并发症的发生。结果研究组患者并发症发生率、便秘发生率和病死率均显著低于对照组,差异具有统计学意义(P0.05)。研究组患者抑郁评分和焦虑评分均极显著低于对照组,说明研究组患者的心理状态优于对照组,差异具有统计学意义(P0.01)。结论预见性护理对老年重症心肌梗死患者具有较好的应用价值,可降低并发症发生率、便秘发生率和病死率,并有利于患者保持良好的心态。     

急性心肌梗死后室间隔穿孔并室壁瘤形成1例

患者女,66岁。2004年无明显诱因反复出现胸闷、胸痛,每次发作2~3分钟缓解,未重视。2005年12月10日患者自觉胸痛频率、程度加重,每次持续20分钟,当地医院行心电图检查提示正常,给以消心痛及活血化淤药物治疗后,胸闷明显好转。12月16日患者在上厕所后突发胸痛剧烈,放射到背部,伴有四肢发冷,大汗、恶心、呕吐,胸痛持续不缓解,家人急送当地人民医院,行心电图检查提示“急性前间壁心肌梗塞”,予以住院治疗。治疗期间患者自觉胸痛稍缓解,但出现活动后呼吸困难,不能左侧卧入睡,心电图检测提示心肌梗死范围扩大,为广泛前壁心肌梗死。为进一步治疗,于…     

青年急性心肌梗死临床特点与冠状动脉造影分析

目的探讨青年(≤45岁)急性心肌梗死(AMI)患者的临床与冠状动脉造影特点。方法选择天津医科大学第二医院心脏科青年AMI(≤45岁)患者102例(青年组),老年AMI(60~75岁)患者100例(老年组),从危险因素、诱发因素、临床表现、生化指标、冠状动脉造影结果、并发症及预后方面进行比较。结果男性、吸烟史、饮酒史、早发冠心病家族史、高甘油三酯(TG)、低高密度脂蛋白胆固醇(HDL-C)以及高尿酸(UA)为青年组危险因素;老年组多存在高血压史和糖尿病史,空腹血糖水平高。青年组有明确诱因比例明显高于老年组52.0%(53/102)vs 28.0%(28/100)(P0.01);青年组发生典型心绞痛与老年组比较差异无统计学意义85.3%(87/102)vs 78.0%(78/100);青年组出现胸闷明显高于老年组31.4%(32/102)vs 16.0%(16/100)(P0.05);冠状动脉造影显示两组罪犯血管分布和血栓负荷差异无统计学意义,但青年组AMI多发生于前降支55.9%(57/102);青年组AMI单支病变、局限狭窄多见(P0.01);Gensini病变积分低(P0.05);与老年组比较,青年组并发症少,尤其是心律失常,心力衰竭发生率低,1周内病死率低(P0.01)。结论青年AMI的主要危险因素为男性、吸烟、饮酒、早发冠心病家族史、高TG、高UA及HDL-C降低,劳累和饮酒为主要诱发因素,单支、局限病变多见,Gensini评分低,并发症少,病死率低。     

以家庭为基础的自我管理在老年心肌梗死病人护理中的效果

目的:探讨以家庭为基础的自我管理在老年心肌梗死病人护理中的效果。方法:纳入郑州市第七人民医院2017年1月—2018年8月收治的160例老年心肌梗死病人。采用随机数字表法分为观察组和对照组各80例。对照组根据相关指南要求采用常规健康教育,观察组采用以家庭为基础的自我管理干预。两组均干预12周。收集并分析两组干预前后生活质量评分、焦虑评分、抑郁评分、血脂、血压、血糖情况。结果:两组干预前后躯体功能健康及精神心理健康评分比较差异均无统计学意义(P>0.05);干预后观察组躯体活动、药物不良反应、饮食及担心用药评分均低于对照组,差异具有统计学意义(P<0.05);观察组干预后SAS评分及SDS评分均低于对照组,差异具有统计学意义(P<0.05);观察组体质指数、收缩压、舒张压、总胆固醇(TC)、三酰甘油(TG)及空腹血糖水平均低于对照组,差异具有统计学意义(P<0.05)。结论:以家庭为基础的自我管理可改善老年心肌梗死病人的生活质量及相关生理指标水平,减少不良情绪的发生。     

心肌损伤标志物联合检测在急性心肌梗死诊断中的价值

目的评价心肌损伤标志物肌钙蛋白T/I(cTnT/I)、肌红蛋白(Myo)、肌酸激酶同工酶(CK-MB)在急性心肌梗死(AMI)中的诊断价值。方法对150例AMI患者进行心肌标志物和心肌酶谱比较。结果心肌标志物在AMI发病早期升高的幅度较心肌酶谱升高显著,差异有统计学意义(P0.01)。结论心肌损伤标志物cT-nT/I、Myo、CK-MB在AMI早期诊断中具有重要的临床价值。     

老年急性心肌梗塞合并心衰的康复

研究对象为老年急性心肌梗塞合并心衰的患者１３例。年龄６０～８０（６８±５９４）岁。左室射血分数３３％～５０％（４０６１％±６２３％）。１０例采用福建省老年医院的４周康复程序，３例采用泉州市第一医院的２周康复程序。程序结束时７例完成踏车试验（功率５０～１００Ｗ），２例活动平板运动试验达到Ｂｒｕｃｅ３级，４例能上、下三层楼或步行３００ｍ。结果提示基本控制的急性心肌梗塞合并心衰的老年患者在严密监护下进行康复医疗是安全、有益的。     

Sexual problems before and after myocardial infarction: patients' needs for information.

Changes occur in an individual's lifestyle after a myocardial infarction (MI), including his or her sexual activity. This study evaluated problems related to post-MI sexual functioning and the information needs of MI patients. The study included 110 MI patients who had home visits within 2-5 months after their discharge from the hospital. Data were gathered through a questionnaire that was completed through personal interviews. The study sample was predominantly male (95.5%). All patients were married, and 25% were between the ages of 24 and 40 years. We identified unnecessary limitations in sexual activities and mistakes in the reorganization of activities, such as resumption of sexual activity and frequency and positions of sexual intercourse. We found that all 110 patients had insufficient information about their future sexual functioning.     

老年人心肌梗死的发病特点及护理

目的 及早发现心肌梗死，防止发生并发症和猝死。方法 通过查阅病历、献、问卷调查及与患交谈，对47例60岁以上老年人心肌梗死进行分析，归纳总结其发病特点。结果 47例60岁以上尤其是65岁以上心肌梗死患，32例患典型表现不是胸痛，而是气急、胃肠道症状、休克、呼吸困难等。结论 老年人对自身疾病反应差，所以，不能以有无胸部疼痛作为鉴别老年人心肌梗死的主要临床依据，要加强心电监护，强调做好整体护理，防止心肌梗死并发症或猝死的发生。     

Physical activity six months after a myocardial infarction

In the present study, we wished to explore physical activity in middle-aged patients 6 months after a myocardial infarction and to compare the patients' self-reported activity level with pedometric measures of footsteps/day. The sample comprised 89 patients with myocardial infarction, aged ≤ 65 years. The self-report question showed that < 40% of the patients were engaged in at least 30 min of physical activity every day. The pedometric physical activity data showed a daily mean number of steps of 6719. The self-report question was correlated with the pedometric registration data. Among myocardial infarction patients, physical activity 6 months after the acute heart attack was insufficient in the majority of patients, both when evaluated with a self-report question and when evaluated with a pedometer. Efforts to increase physical activity after myocardial infarction are warranted.