تصفح
دخول
تسجيل
نسيتها؟

احتشاء العضلة القلبية MI


احتشاء العضلة القلبية MI

المعلومة

Chest pain + ST elevation = myocardial infarction until proven otherwise (the diagnosis is rarely in doubt)

الألم الصدري مع ارتفاع الشدفة ST ؛ هو احتشاء العضلة القلبية حتى يثبت العكس .

المرجع

Cardiovascular Emergencies - Edited by Crispin Davies and Yaver Bashir
BMJ Books 2001
dr.msh's picture
by
بعد التخرج

myocardial infarction (MI)

infarction of an segment of the heart muscle, usually as a result of occlusion of a coronary artery. Syn: heart attack, cardiac infarction.

Myocardial infarction is the most common cause of death in the U.S. About 800,000 people annually sustain first heart attacks, with a mortality rate of 30%, and 450,000 people sustain recurrent heart attacks, with a mortality rate of 50%. The most common cause of MI is thrombosis of an atherosclerotic coronary artery. Less common causes are coronary artery anomalies, vasculitis, or spasm induced by cocaine, ergot derivatives, or other agents. Risk factors for MI include male gender, family history of MI, obesity, hypertension, cigarette smoking, and elevation of total cholesterol, LDL cholesterol, homocysteine, lipoprotein (a), or C-reactive protein. At least 80% of MIs occur in people without a prior history of angina pectoris, and 20% are not recognized, either because they cause no symptoms (silent infarction) or because symptoms are attributed to other causes. Some 20% of people sustaining MI die before reaching a hospital. The classical symptom of MI is crushing anterior chest pain radiating into the neck, shoulder, or arm, lasting more than 30 minutes, and not relieved by nitroglycerin; typically pain is accompanied by dyspnea, diaphoresis, weakness, and nausea. Significant physical findings, often absent, include an atrial gallop rhythm (4th heart sound) and a pericardial friction rub. The electrocardiogram shows ST segment elevation (later changing to depression) and T wave inversion in leads reflecting the area of infarction. Q waves indicate transmural damage and a poorer prognosis. Diagnosis is supported by acute elevation in serum levels of myoglobin, lactic dehydrogenase, the MB isoenzyme of creatine kinase, and troponins. Unequivocal evidence of MI may be lacking during the first 6 hours in as many as 50% of patients. Death from acute MI is usually due to arrhythmia (ventricular fibrillation or asystole), shock (forward failure), congestive heart failure, or papillary muscle rupture. Other grave complications, which may occur during convalescence, include cardiorrhexis, ventricular aneurysm, and mural thrombus. Acute MI is treated (ideally under continuous ECG monitoring in the intensive care or coronary care unit of a hospital) with narcotic analgesics, oxygen by inhalation, intravenous administration of a thrombolytic agent, antiarrhythmic agents when indicated, and usually anticoagulants (aspirin, heparin), beta-blockers, and ACE inhibitors. Patients with evidence of persistent ischemia require angiography and may be candidates for balloon angioplasty. Data from the Framingham Heart Study show that a higher percentage of acute MIs are silent or unrecognized in women and the elderly. Several studies have shown that women and the elderly tend to wait longer before seeking medical care after the onset of acute coronary symptoms than men and younger persons. In addition, women seeking emergency treatment for symptoms suggestive of acute coronary disease are less likely than men with similar symptoms to be admitted for evaluation, and women are less frequently referred than are men for diagnostic tests such as coronary angiography. Other studies have shown important gender differences in the presenting symptoms and medical recognition of MI. Chest pain is the most common symptom reported by both men and women, but men are more likely to complain of diaphoresis, while women are more likely to experience neck, jaw, or back pain, nausea, vomiting, dyspnea, or cardiac failure, in addition to chest pain. The incidence rates of acute pulmonary edema and cardiogenic shock in MI are higher in women, and mortality rates at 28 days and 6 months are also higher.

Stedman's Medical Dictionary 5.0

dr.msh's picture
dr.msh
بعد التخرج


بوركت جهودك

Dr.Syrian's picture
Dr.Syrian
طبيب مقيم


شي حلو ..

كتير بتفيدنا هالمعلومات على فكرة بالفيزيولوجيا العادية والمرضية ..

شكرً وجزاك الله خيراً

DR-MAK

Quote:
The classical symptom of MI is crushing anterior chest pain radiating into the neck, shoulder, or arm, lasting more than 30 minutes,;

if i brain-stormed you

which body language is most likely to present a MI chest pain manifestiation ?
and wat is the sign called ?
and explain anatomically the irradiation of impuleses ?

امرأة لا تتكرر's picture
امرأة لا تتكرر
السنة الخامسة

Quote:
الألم الصدري مع ارتفاع الشدفة ST ؛ هو احتشاء العضلة القلبية حتى يثبت العكس .

على ما أعتقد يثبت العكس - إن صح التعبير - بمعايرة الخمائر .. لأن ارتفاع الشدفة قد يظهر في خناق برينزميتال والاحتشاء .. والتمييز بينهما يتم بالخمائر ..
--

Quote:
which body language is most likely to present a MI chest pain manifestiation ?
and wat is the sign called ?

الصورة الأخيرة .. يضع المريض قبضة يده على منتصف الصدر .. وتسمى علامة ليفين Levine sign

Quote:
and explain anatomically the irradiation of impuleses ?

الألم بالخناق ألم رجيع .. يشترك فيه منعكس عصبي يتضمن الأعصاب من الرقبي السابع حتى الصدري الرابع C7 - T4 لذلك ينتشر الألم للكتف والذراعيين والمعصم والأصابع والرقبة والفك السفلي والشرسوف ..

Dr.TH's picture
Dr.TH


up

قطرة مطر's picture
قطرة مطر
السنة الثالثة
ابق على تواصل مع حكيم!
Google+