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1、Case analysis,病例分析,Chief Complaints,Paroxysmal precordium pain for 2 months，exacerbation for 16 hours.,病例分析,Medical history：ache location、 character、 degree？ radiation？ duration ？ Inducing and relief factor ？treatment process?,病例分析,Present illness,Paroxysmal precordium pain in the past 2 months. Bro
2、ke out after agitation or overwork ed,last for 2-3minutes， relieved after rest , didnt treatment.,病例分析,Present illness,Precordium pain aggravated without inducing factor 16 hours ago,accompanied with back and both upper limbs pain, left shoulder and upper limb obviously , accompanied with nausea. Ta
3、ken omeprazole capsule,the symptom couldnt relieve,precordium pain still existed persistently after local hospital treatment.,病例分析,Present illness,In emergency room of our hospital, taken“aspirin 300mg, ticagrelor 180mg”, “isosorbide mononitrate 20mg” intravenous drip.,病例分析,Past Medical History：2014
4、.09.19 gastroscope : esophagitis, gastric ulcer , erosive gastritis, duodenal bulb inflammation.Family History：His mother have history of hypertension, coronary heart disease and diabetes.Brother has history of diabetes and hypertension.,病例分析,Physical examination：Vital signs! Chest and heart examina
5、tionabdomen examination,病例分析,T 36.7 , P 72/min, R 20/min, BP117/75mmHg. Regular respirations. No edema in eye-lips. The lips are red. No sternum tenderness. Breathing sounds are rough, with both bottom of the lung moist rales. No abnormal pulsation an uplift in precordial region. The heart percussed
6、 normal in size. Heart beat 72. Abdomen is flat, No tenderness. No distension.,病例分析,Diagnosis,Differential diagnosis,病例分析,病例分析,Differential diagnosis？ Angina Acute pericarditis Acute pulmonary embolism Acute abdominal pain Aortic dissection ,病例分析,Auxiliary examinations ？,病例分析,ECG：The most important
7、the most quickly,Location,Inferior wall aVFAnterior wall V16Anteroseptal wall V1-3Apical or lateral wall V46Posterior wall-V7-9Right-sided -V4R-V5R,15,病例分析,cTnI 7.092ng/mL, CK-MB 156.43ng/mL，MYO 251.09 ng/ml。X-ray: heart shadow increased, bronchitis . UCG： Segmental ventricular wall motion abnormali
8、ties ,EF：45%.,病例分析,Diagnosis 1.coronary heart disease acute anterior wall myocardial infarction Killip class II.2.bronchial pneumonia. 3. esophagitis, gastric ulcer , erosive gastritis, duodenal bulb inflammation.,病例分析,Complications ？ Dysfunction or rupture of papillary muscle Rupture of the heart E
9、mbolism Cardiac aneurysm Postinfarction syndrome,病例分析,Treatment,General ：Stay in bed monitoring, oxygen Pain relief anti-ischemia Anti-platelet anti-coagulation Reperfusionthrombolytic treatment PCICABG,病例分析,How select thrombolytic treatment or PCI ? 3 6 12 24,病例分析,prevention A A B B C C D D E E,Thank You !,,
