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1、ACUTE MYOCARDIAL INFARCTION （AMI）,Definition Prevalence Cause Symptoms and signs Auxiliary examinations 。,Contents,Diagnosis The differential diagnosis complications Therapy 。,Definition,Death or necrosis of myocardial cells.,Definition,From an anatomic or morphologic standpoint - transmural -non tr
2、ansmural.,Definition,From ECG finding -ST elevation STEMI -non-ST elevation NSTEMI,Prevalence,The World Health Organization estimated in 2004, that 12.2% of worldwide deaths were from ischemic heart disease.,Leading cause of death in high- or middle-income countries. Second only to lower respiratory
3、 infections in lower-income countries.,Worldwide, more than 3 million people have STEMIs and 4 million have NSTEMIs a year. STEMIs occur about twice as often in men as women.,In general，MI can occur at any age，but its incident rises with age. Approximately 50% of all MIs in the US occur in people yo
4、unger than 65 years of age.,Mortality The mortality is 50% in 24 hours.,Cause,Coronary atherosclerosis Formation of thrombus Obstruction of blood flow Muscle death in cardiac muscle,Plaque rupture,adventitia,lipid core,Cholesterol nuclear,thrombosis,Ruptured plaques,Risk factors,Age Hyperlipidemia D
5、iabetes mellitus Hypertension Smoking Male gender Family history of atherosclerotic arterial disease (inheritance),Inducing factors,Early hours of the morning Overeating Heavy physical activity Agitation Rapid rise of blood pressure,Defecating hardly Shock Dehydration Surgery Severe arrhythmia,Sympt
6、oms,Prodromal symptoms: Pain of infarction Associated symptoms Painless infarction sudden death and Early arrhythmias,Prodromal symptoms,Occur at rest or with less activity than usual. Approximately one third have had symptoms from 1 to 4 weeks before.,Pain of infarction,At rest In the early morning
7、 Similar to angina in location and radiation but more severe. Nitroglycerin has little effect ,even opioid may not relieve the pain .,Associated symptoms,cold sweat weak Light-headedness apprehensive syncope,dyspnea orthopnea cough wheezing nausea and vomiting abdominal bloating,Painless infarction,
8、It is estimated that at least 20% of acute MIs are painless or atypical . Elderly patients and patients with diabetes are particularly prone painless or atypical MI.,sudden death and Early arrhythmias,About 50% occur before the patients arrive at the hospitals,with death presumably caused by ventric
9、ular fibrillation .,Signs,general Chest Heart Extremities,Signs,General Anxious Sweating profusely bradycardia or tachycardia Low cardiac output,Arrhythmia High or low blood pressure Respiratory distress Fever,Signs,Chest Rale(pulmonary edema ),Killip classification Class I =absence of Rales Class I
10、I=less 50% of the lung fields Class III=over 50% of the lung fields Class IV=cardiogenic shock(rales,hypotension , and signs of hypoperfusion ),Signs,Heart Abnormally located ventricular impulse dyskinetic infracted Jugular venous distension right atrial hypertension Soft heart sounds left ventricul
11、ar dysfunction,Heart S 4 atrial gallops S3 ventricular gallops cardiac insufficiency mitral regurgitation murmur papillary muscle dysfunction rarely rupture Pericardial friction rubs,Signs,Extremities Edema Cyanosis and cold temperature low output Peripheral pulses,Auxiliary examinations,Electrocadi
12、ography Laboratory findings Echocardiography,Electrocadiogram,ECG changes: ST segment elevation Q wave development T wave inversion,ST segment elevation,Q wave development,T wave inversion,Location,Inferior wall aVF Anterior wall V16 Anteroseptal wall V1-3 Apical or lateral wall V46 Posterior wall-V
13、7-9 Right-sided -V4R-V5R,Laboratory findings,Echocardiography,WHO Definition Of MI,Diagnosis,Chest pain,History 、examination and ECG,Acute coronary syndrome （ACS）,ST segment elevation,Non-ST segment elevation,NSTEMI,UA,No TnI(TnT),STEMI,TnI(TnT),TnI(TnT),The differential diagnosis,Angina Acute peric
14、arditis Acute pulmonary embolism Acute abdominal pain Aortic dissection,Complications,Dysfunction or rupture of papillary muscle Rupture of the heart Embolism Cardiac aneurysm Postinfarction syndrome,Therapy,General treament measures Control of cardiac pain Recanalization therapy Control of arrhythmias,Control of shock Control of heart failure Other therapies Therapies of complications,Prevention,A aspirin antianginal therapy B beta-blocker blood pressure control C cholesterol lowing cigarettes quiting D diet control diabetes treatment E education exercise,Thank You,
