英文病例分析-心肌梗死

病例分析ChiefComplaintsParoxysmalprecordiumpainfor2months，exacerbationfor16hours.

第一頁，共21頁。病例分析Medicalhistory：achelocation、character、

degree？radiation？duration？Inducingandrelieffactor？

treatmentprocess?第二頁，共21頁。病例分析PresentillnessParoxysmalprecordiumpaininthepast2months.Brokeoutafteragitationoroverworked,lastfor2-3minutes，relievedafterrest,didn’ttreatment.第三頁，共21頁。病例分析PresentillnessPrecordiumpainaggravatedwithoutinducingfactor16hoursago,accompaniedwithbackandbothupperlimbspain,leftshoulderandupperlimbobviously,accompaniedwithnausea.Takenomeprazolecapsule,thesymptomcouldn’trelieve,precordiumpainstillexistedpersistentlyafterlocalhospitaltreatment.第四頁，共21頁。病例分析PresentillnessInemergencyroomofourhospital,taken“aspirin300mg,ticagrelor180mg”,“isosorbidemononitrate20mg”

intravenousdrip.第五頁，共21頁。病例分析PastMedicalHistory：2014.09.19gastroscope:esophagitis,gastriculcer,erosivegastritis,duodenalbulbinflammation.

FamilyHistory：Hismotherhavehistoryofhypertension,coronaryheartdiseaseanddiabetes.Brotherhashistoryofdiabetesandhypertension.第六頁，共21頁。病例分析Physicalexamination：Vitalsigns!Chestandheartexamination

abdomenexamination第七頁，共21頁。病例分析T36.7℃,P72/min,R20/min,BP117/75mmHg.Regularrespirations.Noedemaineye-lips.Thelipsarered.Nosternumtenderness.Breathingsoundsarerough,withbothbottomofthelungmoistrales.Noabnormalpulsationanupliftinprecordialregion.Theheartpercussednormalinsize.Heartbeat72.Abdomenisflat,Notenderness.Nodistension.第八頁，共21頁。病例分析ChestpainDiagnosisDifferentialdiagnosis第九頁，共21頁。病例分析gastrointestinalCardiovascularMentalneuromuscularpleuralPulmonaryChestpain第十頁，共21頁。病例分析

Differentialdiagnosis？AnginaAcutepericarditisAcutepulmonaryembolism

AcuteabdominalpainAorticdissection…第十一頁，共21頁。病例分析Auxiliaryexaminations？第十二頁，共21頁。病例分析ECG：Themostimportantthemostquickly第十三頁，共21頁。Location

Inferiorwall——ⅡⅢaVFAnteriorwall——V1－6Anteroseptalwall——V1-3Apicalorlateralwall—V4－6Posteriorwall-----V7-9

Right-sided

----V4R-V5R14第十四頁，共21頁。病例分析cTnI7.092ng/mL,CK-MB156.43ng/mL，MYO

251.09ng/ml。X-ray:heartshadowincreased,bronchitis.UCG：Segmentalventricularwallmotionabnormalities,EF：45%.第十五頁，共21頁。病例分析

Diagnosis1.coronaryheartdiseaseacuteanteriorwallmyocardialinfarctionKillipclassII.

2.bronchialpneumonia.3.esophagitis,gastriculcer,erosivegastritis,duodenalbulbinflammation.第十六頁，共21頁。病例分析Complications？Dysfunctionorruptureofpapillary

muscleRuptureoftheheartEmbolism

Cardiacaneurysm

Postinfarctionsyndrome第十七頁，共21頁。病例分析Treatment

General：Stayinbed

monitoring,oxygenPainreliefanti-ischemiaAnti-plateletanti-coagulationReperfusion

thrombolytictreatment

PCICABG第十八頁，共21頁。病例分析