英文病例分析-心肌梗死_精品文档PPT格式课件下载.ppt

1、radiation？vduration？vInducingandrelieffactor？vtreatmentprocess?病例分析病例分析PresentillnessvParoxysmal precordium pain in the past 2months.vBrokeoutafteragitationoroverworked,lastfor 2-3minutes，relieved after rest,didnttreatment.病例分析病例分析PresentillnessvPrecordiumpainaggravatedwithoutinducing factor 16 hour

2、s ago,accompaniedwith back and both upper limbs pain,leftshoulderandupperlimbobviously,accompaniedwithnausea.vTakenomeprazolecapsule,thesymptomcouldntrelieve,precordiumpainstillexistedpersistentlyafterlocalhospitaltreatment.病例分析病例分析PresentillnessvInemergencyroomofourhospital,vtaken“aspirin300mg,tica

3、grelor180mg”,“isosorbidemononitrate20mg”intravenousdrip.病例分析病例分析vPastMedicalHistory：2014.09.19gastroscope:esophagitis,gastriculcer,erosivegastritis,duodenalbulbinflammation.vFamilyHistory：Hismotherhavehistoryofhypertension,coronaryheartdiseaseanddiabetes.Brotherhashistoryofdiabetesandhypertension.病例

4、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.Noabnormalpulsationanupliftinprecordialregio

5、n.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？pAnginapAcutepericarditispAcutepulmonaryembolismpAcuteabd

6、ominalpainpAorticdissection病例分析病例分析vAuxiliaryexaminations？病例分析病例分析vECG：The most important the most quicklyLocationInferiorwallaVFAnteriorwallV16AnteroseptalwallV1-3ApicalorlateralwallV46Posteriorwall-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:heart shadow

7、increased,bronchitis.vUCG：Segmental ventricular wall motion abnormalities,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？pDysfunction

8、orruptureofpapillarymusclepRuptureoftheheartpEmbolismpCardiacaneurysmpPostinfarctionsyndrome病例分析病例分析TreatmentvGeneral：Stay in bed monitoring,oxygen Pain relief vanti-ischemiavAnti-plateletvanti-coagulationvReperfusionthrombolytic treatment PCI CABG 病例分析病例分析vHowselect thrombolytic treatment or PCI?v3v6v12v24病例分析病例分析preventionvAAvBBvCCvDDvEE