,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,病例分析,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,病例分析,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,病例分析,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,病例分析,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,病例分析,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,病例分析,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,病例分析,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,病例分析,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,病例分析,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,病例分析,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,病例分析,Case analysis,Case analysis,病例分析,Chief Complaints,Paroxysmal precordium pain for 2 months,，,exacerbation for 16 hours.,病例分析Chief ComplaintsParoxysmal,病例分析,Medical history,：,ache,location,、,character,、,degree,？,radiation,？,duration,？,Inducing and relief factor,？,treatment process?,病例分析Medical history：ache,病例分析,Present illness,Paroxysmal precordium pain in the past 2 months.,Broke out after agitation or overwork ed,last for 2-3minutes,，,relieved after rest,didnt treatment.,病例分析Present illnessParoxysmal,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.,Taken omeprazole capsule,the symptom couldnt relieve,precordium,pain still existed persistently after local hospital treatment.,病例分析Present illness,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Present illness,病例分析,Past Medical History,：,2014.09.19 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Past Medical History：2014.,病例分析,Physical examination,：,Vital signs!,Chest and heart,examination,abdomen,examination,病例分析Physical 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 normal in size.Heart beat 72.Abdomen is flat,No tenderness.No distension.,病例分析T 36.7,P 72/min,R 20/m,病例分析,Chest pain,Diagnosis,Differential,diagnosis,病例分析Chest pain DiagnosisDiffe,病例分析,gastrointestinal,Cardiovascular,Mental,neuromuscular,pleural,Pulmonary,Chest pain,病例分析gastrointestinalCardiovasc,病例分析,Differential diagnosis,？,Angina,Acute pericarditis,Acute pulmonary embolism,Acute abdominal pain,Aortic dissection,病例分析 Differential diagnosis？,病例分析,Auxiliary examinations,？,病例分析Auxiliary examinations？,病例分析,ECG,：,The most important the most quickly,病例分析ECG：The most important the,Location,Inferior wall aVF,Anterior wall V,1,6,Anteroseptal wall V,1-3,Apical or lateral wall V,4,6,Posterior wall-V,7-9,Right-sided,-V,4R,-V,5R,15,Location Inferior wall ,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 abnormalities,EF,：,45%.,病例分析cTnI 7.092ng/mL,CK-MB 156,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 Diagnosis,病例分析,Complications,？,Dysfunction or rupture of papillary,muscle,Rupture of the heart,Embolism,Cardiac aneurysm,Postinfarction syndrome,病例分析Complications？,病例分析,Treatment,General,：,Stay in bed,monitoring,oxygen Pain relief,anti-ischemia,Anti-platelet,anti-coagulation,R,eperfusion,t,hrombolytic treatment,PCI,CABG,病例分析Treatment General：Stay in,病例分析,How,select,t,hrombolytic treatment,or PCI?,3,6,12,24,病例分析How select thrombolytic t,病例分析,prevention,A A,B B,C C,D D,E E,病例分析 prevention,Thank You!,Thank You!www.themegallery.co,