英文病例分析-心肌梗死_精品文档.ppt

英文病例分析-心肌梗死_精品文档.ppt

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Caseanalysis病例分析病例分析ChiefComplaintsvParoxysmalprecordiumpainfor2months，exacerbationfor16hours.病例分析病例分析vMedicalhistory：

achevlocation、character、degree？

radiation？

vduration？

vInducingandrelieffactor？

vtreatmentprocess?

病例分析病例分析PresentillnessvParoxysmalprecordiumpaininthepast2months.vBrokeoutafteragitationoroverworked,lastfor2-3minutes，relievedafterrest,didnttreatment.病例分析病例分析PresentillnessvPrecordiumpainaggravatedwithoutinducingfactor16hoursago,accompaniedwithbackandbothupperlimbspain,leftshoulderandupperlimbobviously,accompaniedwithnausea.vTakenomeprazolecapsule,thesymptomcouldntrelieve,precordiumpainstillexistedpersistentlyafterlocalhospitaltreatment.病例分析病例分析PresentillnessvInemergencyroomofourhospital,vtaken“aspirin300mg,ticagrelor180mg”,“isosorbidemononitrate20mg”intravenousdrip.病例分析病例分析vPastMedicalHistory：

2014.09.19gastroscope:

esophagitis,gastriculcer,erosivegastritis,duodenalbulbinflammation.vFamilyHistory：

Hismotherhavehistoryofhypertension,coronaryheartdiseaseanddiabetes.Brotherhashistoryofdiabetesandhypertension.病例分析病例分析Physicalexamination：

vVitalsigns!

vChestandheartexaminationvabdomenexamination病例分析病例分析vT36.7,P72/min,R20/min,BP117/75mmHg.Regularrespirations.Noedemaineye-lips.Thelipsarered.Nosternumtenderness.Breathingsoundsarerough,withbothbottomofthelungmoistrales.Noabnormalpulsationanupliftinprecordialregion.Theheartpercussednormalinsize.Heartbeat72.Abdomenisflat,Notenderness.Nodistension.病例分析病例分析ChestpainDiagnosisDifferentialdiagnosis病例分析病例分析gastrointestinalCardiovascularMentalneuromuscularpleuralPulmonaryChestpain病例分析病例分析Differentialdiagnosis？

pAnginapAcutepericarditispAcutepulmonaryembolismpAcuteabdominalpainpAorticdissection病例分析病例分析vAuxiliaryexaminations？

病例分析病例分析vECG：

ThemostimportantthemostquicklyLocationInferiorwallaVFAnteriorwallV16AnteroseptalwallV1-3ApicalorlateralwallV46Posteriorwall-V7-9Right-sided-V4R-V5R15病例分析病例分析cTnI7.092ng/mL,CK-MB156.43ng/mL，MYO251.09ng/ml。

vX-ray:

heartshadowincreased,bronchitis.vUCG：

Segmentalventricularwallmotionabnormalities,EF：

45%.病例分析病例分析Diagnosisv1.coronaryheartdiseaseacuteanteriorwallmyocardialinfarctionKillipclassII.v2.bronchialpneumonia.v3.esophagitis,gastriculcer,erosivegastritis,duodenalbulbinflammation.病例分析病例分析vComplications？

pDysfunctionorruptureofpapillarymusclepRuptureoftheheartpEmbolismpCardiacaneurysmpPostinfarctionsyndrome病例分析病例分析TreatmentvGeneral：

Stayinbedmonitoring,oxygenPainreliefvanti-ischemiavAnti-plateletvanti-coagulationvReperfusionthrombolytictreatmentPCICABG病例分析病例分析vHowselectthrombolytictreatmentorPCI?

v3v6v12v24病例分析病例分析preventionvAAvBBvCCvDDvEE